Food environment index
Index of factors that contribute to a healthy food environment, from 0 (worst) to 10 (best).
The 2021 County Health Rankings used data from 2015 & 2018 for this measure.
Reason for Ranking
The County Health Rankings measure of the food environment accounts for both proximity to healthy foods and income. This measure includes access to healthy foods by considering the distance an individual lives from a grocery store or supermarket, locations for health food purchases in most communities, and the inability to access healthy food because of cost barriers.
There is strong evidence that food deserts are correlated with high prevalence of overweight, obesity, and premature death as supermarkets traditionally provide healthier options than convenience stores or smaller grocery stores.[1-4] Additionally, those with low income may face barriers to accessing a consistent source of healthy food. Lacking consistent access to food is related to negative health outcomes such as weight gain, premature mortality, asthma, and activity limitations, as well as increased health care costs.[5-8]
Key Measure Methods
The Food Environment Index is a Scaled Index
The Food Environment Index ranges from a scale of 0 (worst) to 10 (best) and equally weights two indicators of the food environment:
1) Limited access to healthy foods estimates the percentage of the population that is low income and does not live close to a grocery store. Low income is defined as having an annual family income of less than or equal to 200 percent of the federal poverty threshold for the family size. Living close to a grocery store is defined differently in rural and nonrural areas; in rural areas, it means living less than 10 miles from a grocery store whereas in nonrural areas, it means less than 1 mile.
2) Food insecurity estimates the percentage of the population that did not have access to a reliable source of food during the past year. A two-stage fixed effects model was created using information from the Community Population Survey, Bureau of Labor Statistics, and American Community Survey to estimate food insecurity.
In 2020, the average value (median) for counties was 7.6 and most counties fell between about 6.9 and 8.2. More information on the two metrics the food environment consists of can be found in their measure descriptions.
Can This Measure Be Used to Track Progress
This measure is not appropriate for tracking progress. Individual county improvement is impossible to track due to the scaled nature of the measure. However, the two individual composite measures that make up the index could be used individually to track progress with some caveats.
Years of Data Used
2015 & 2018
USDA Food Environment Atlas, Map the Meal Gap from Feeding America
From the United States Department of Agriculture (USDA):
The Atlas assembles statistics on three broad categories of food environment factors:
Food Choices--Indicators of the community's access to and acquisition of healthy, affordable food, such as: access and proximity to a grocery store; number of foodstores and restaurants; expenditures on fast foods; food and nutrition assistance program participation; food prices; food taxes; and availability of local foods.
Health and Well-Being--Indicators of the community's success in maintaining healthy diet
Community Characteristics--Indicators of community characteristics that might influence the food environment, such as: demographic composition; income and poverty; population loss; metro-nonmetro status; natural amenities; and recreation and fitness centers.
Using the annual USDA Food Security Survey, Feeding America (Map the Meal Gap) models the relationship between food insecurity and other variables at the state level and, using information for these variables at the county level, we establish food insecurity by county.
Gundersen, C., E. Waxman, E. Engelhard, A. Satoh, & N. Chawla. Map the Meal Gap 2013: Food Insecurity Estimates at the County Level. Feeding America, 2013.
The USDA produces two excellent resources for communities looking to explore their food environment: the Food Access Research Atlas and the Food Environment Atlas. Both resources are regularly updated and can provide you with information on where there are healthy food options, and where people live with few easy options for finding healthy foods. In addition, Feeding America’s Map the Meal Gap program creates the annual estimates of food insecurity used in the Food Environment Index. They also provide a measure of child food insecurity. The Disrupting Food Insecurity Database also provides county-level data on numerous food security metrics.
 Ahern M, Brown C, Dukas S. A national study of the association between food environments and county-level health outcomes. The Journal of Rural Health. 2011;27:367-379.
 Taggart K. Fast food joints bad for the neighbourhood. Medical Post. 2005;41.21:23.
 Schafft KA, Jensen EB, Hinrichs CC. Food deserts and overweight schoolchildren: Evidence from Pennsylvania. Rural Sociology. 2009;74:153-277.
 Wrigley N, Warm D, Margetts B, Whelan A. Assessing the impact of improved retail access on diet in a ‘food desert’: A preliminary report. Urban Studies. 2002;39.11:2061-2082.
 Brownson RC, Haire-Joshu D, Luke DA. Shaping the context of health: A review of environmental and policy approaches in the prevention of chronic diseases. Annu Rev Public Health 2006;27:341-70.
 Adams EJ, Grummer-Strawn L, Chavez G. Food insecurity is associated with increased risk of obesity in California women. The Journal of Nutrition 133(4). 2003:1070-1074.
 Gunderson C, Ziliak JP. Food Insecurity and Health Outcomes. Health Affairs (2015); 34; 11.
 Berkowitz SA, Basu S, Meigs JB, Seligman HK. Food Insecurity and Health Care Expenditures in the United States, 2011-2013. Health Services Research (2018), Jun; 53(3):1600-1620.
See how this component fits into our model
When it comes to developing and implementing solutions to problems that affect communities, evidence matters. The strategies below give some ideas of ways communities can harness evidence to make a difference locally. You can learn more about these and other strategies in What Works for Health, which summarizes and rates evidence for policies, programs, and systems changes.