CHAPTER II
LITERATURE REVIEW

There is a wide and varied literature pertinent to this study drawn from the fields of economics, nutrition, international development, retailing, social science, and geography. These previous studies are reviewed under the following categories: (1) food security, access, and rights, (2) hunger and health, (3) grocery stores, and (4) studies on grocery store access.

Food Security, Access, and Rights
The US Department of Agriculture (USDA) defines food security as the ability for people to have "assured access, at all times, to enough food for an active, healthy life" (Andrews, 1999, 1). The World Bank (n.d., para. 1) adds to this definition the need for "quality, quantity, and diversity" of food. The Food and Agriculture Organization (FAO) broadens these definitions: food security is "a situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life" (FAO, 2001, Glossary). Finally, Leidenfrost (1993, 2nd definition) notes that a minimum definition of food security also includes "an assured ability to acquire acceptable foods in socially acceptable ways (e.g.; without resorting to emergency food supplies, scavenging, stealing, or other coping strategies)".

The term "food security" was originally coined as a way of addressing food-related problems in industrializing countries (World Bank, 1986). Household food security is often assessed in terms of a multi-tiered rating system: food secure, food insecure without hunger, and food insecure with hunger. Food insecure with hunger can be sub-divided into moderate or severe hunger. With moderate hunger, adults reduce their own food intake, often for the sake of children. Severe hunger is where the children of a household also have their food intake reduced (Ohio Hunger Task Force, 2001).

Anderson and Cook (1999) have tried to bring together varying threads of the idea of "community food security" (CFS) into a cohesive set of ideas rooted in a common theory. They assert that three main groups contribute to food security: 1) community nutritionists and educators, 2) progressive agricultural researchers and grass roots activists, and 3) anti-hunger and community development researchers and activists. All three have different objectives and interests, but together they form the collective interpretation of community food security.

Conceptually, food security can be divided into food availability, food access, and food utilization (World Bank, n.d.). Thus, in order to utilize (i.e. eat) food it must be accessible, and in order for it to be accessed it must be available.

Frongillo (1999) describes food insecurity for individuals along the following spectrum: the least severe form is people who are uncertain of being able to obtain food in socially acceptable ways, to the most severe form where people simply do not eat enough due to insufficient resources and thus "experience the physical and psychological consequences of hunger" (Frongillo, 1999, 506s). In this view, food insecurity has four components: quantity and quality of food (related directly to food), and certainty and acceptability (psychological and social).

Food security is most commonly evaluated through direct questioning (interviews or questionnaires). The Food Security Supplement is a measure of food security based upon two previous developed measures from Radimer/Cornell and the Community Childhood Hunger Identification Project (CCHIP). These questionnaire-style measures have proved to be accurate and precise measures of food security (Frongillo, 1999; Carlson, et al., 1999). A household is food insecure when: 1) there is worry that food will run out before more money is available to buy more, 2) the food purchased does not last and money to buy more food does not exist, and 3) financial resources are inadequate to purchase food for balanced meals (Economic Research Service, 2000).

Food insecurity is widespread. About 7.8 million persons in the US were food insecure with hunger in 1999 (Economic Research Service, 2000). Ten percent of all US households are food insecure, while nearly 17 percent of all children live in food insecure households (Ohio Hunger Task Force, 2001). In Ohio, 8.5 percent of households are food insecure, 3.4 percent overall that are food insecure with hunger (Nord, et al., 1999).

Food access is the means by which food security is satisfied. Leidenfrost (1993) states that food security in developed countries consists of three aspects pertinent to food access: 1) the quantity and quality of food available, 2) its geographical accessibility, and 3) the affordability of food. Common factors in food access are: available shopping facilities, available transportation networks, price and availability of healthy foods, individual knowledge regarding healthy eating, and a suitable household budget (New Policy Institute, 2000; Koralek, 1996; Staatz, 1996).

Food access is a short-term (1-3 years) dimension of household food security and is generally viewed as part of the more long-term goal of reducing poverty and improving food markets (World Bank, n.d.).

The FAO Director-General Jacques Diouf says that the "right to food" is "the most fundamental of human rights" (Diouf, n.d.). In this light, it would seem that since the US is faced with rare levels of hunger for an industrialized country it would be in its citizens' best interest to have the US sign, ratify, and enforce the International Covenant on Economic, Social and Cultural Rights. Since the US has not ratified the Covenant and because the US Constitution says nothing of human rights, the US does not have any formal international obligation to "take appropriate steps to ensure the realization" of the right to adequate food and "to be free from hunger" as the Covenant requires (UN, 1966, Article 11).¹ Additionally, even as a signatory to such a document, the US needs to create programs for achieving the goals, mechanisms for enforcement, and subject itself to international oversight. This would require massive time and effort, funding, popular support, and political will, which at present, are lacking in the US.

The addendum to the food security definition requires people acquire food in "socially-acceptable ways" (Leidenfrost, 1994). This appears to argue against community-based food support. It excludes many methods by which many impoverished people get their food: food banks, shelters, public assistance programs, and the like. This definition (repeatedly stated in the literature) suggests that someone is only food secure when the ability to eat is individually obtainable, not publicly assured. Boles (1986) applies a counter-veiling thought by arguing that "equality of opportunity" is insufficient to achieve "equality of outcome", and includes distributive equality and equality of access, both applicable towards the question of food security.

This structural viewpoint sees three separate, and perhaps hierarchical, "food rights": 1) the right to be fed, 2) the right to food, and 3) the right to feed. The first, emergency food feeding, is viewed as passive and patronizing; the second, the ability to acquire food, is product-oriented; and the third, to have control over food supply and decision making, suggests active agency and is preferred (Van Esterik, 1999).

Hunger and Health
Hunger is a situation in which someone unwillingly goes without food for an extended or intermittent period of time (Ohio Hunger Task Force, 2001; Economic Research Service, 2000). As a social issue, it has been on the public agenda in the US for the greater part of 60 years (Poppendieck, 1997). Poppendieck says the social problem of hunger in the US is really poverty-related malnutrition. Hunger (and food insecurity) increases with poverty (Klein, 1998). Therefore, it is instructive to also look at conditions of poverty when studying hunger and hunger-related issues.

At every geographic scale, people experience hunger and poverty. In Ohio, 1.3 million people are still living in poverty (Ohio Hunger Task Force, 2001). In the city of Akron, 20 percent of residents fell below the poverty level in 1989 (US Census Bureau, 1990a).

In addition to adults, hunger and poverty directly affects children. Approximately 12 million children under 18 years old experienced hunger during 1991 in the US. Compared with other industrialized countries, poor children in the US are worse off than poor children in all but two of the 18 industrialized countries (Cook and Brown, 1996). One in six children in Ohio go to bed hungry or are at risk of hunger each night (Ohio Hunger Task Force, 2001). Twenty-five percent of children ages 5 to 17 that live within the Akron city school district during 1997 were estimated to be poor (US Census Bureau, 1997), which suggests that a significant number of Akron's children may be hungry.

Women, Infants, and Children (WIC) is a program that subsidizes the purchases of certain nutritional items to supplement a healthy diet for pre- and post-natal mothers, and children. The total number of women, infants, and children served by the WIC program in Summit County decreased from 1998 to 1999 by 2.9 percent of those eligible (Ohio Hunger Task Force, 2000). Even more alarming, are the extreme changes in the food stamp program. From 1996 to 1999, there was a sharp decrease in participating individuals and households, average monthly benefits, and total benefits administered in Summit County. The change in benefits decreased nearly 40 percent during this three-year period (OHTF, 2000).

Another health concern is of dietary imbalances and excesses that are related to certain diseases - such as heart disease, some cancers, stroke, and diabetes. These now rank among the top causes of illness and death in the US. Health differences between the poor and affluent are "almost universal for all dimensions of health whether it be undernutrition or diet-related chronic disease" (Nitzke and Phillips, 1998, Problem section, para. 8).

The increasing trend of obesity in the US has been shown to be related to unhealthiness stemming from poor nutrition (Townsend, et al., 2001). Townsend found a positive correlation between food insecurity and overweight women nationwide. Although it seems paradoxical that someone with less food would actually gain more weight, the phenomenon is clearly witnessed in Townsend's study. One possible explanation rests in overeating by food insecure households when food is plentiful (for example when food stamps or money for food is available), followed by involuntary restriction. Such an eating pattern could result in gradual weight gain. A New York Times article on the same subject suggests additional explanations: lack of nutritional knowledge, daily habits, and limited access to stores with healthier foods (Barboza, 2000).

Grocery Stores
Any store whose primary sale item is food may be classified as a grocery store. This ranges from small corner "ma-and-pa" stores to large supermarkets. This range can be viewed hierarchically: larger stores will usually have more items for sale, lower prices, more floor space and more aisles, more specialty sections, and are more likely to be part of a larger corporate grocery chain (Census Bureau, 1992). For most, getting a wide variety of food at low prices means shopping at supermarkets.

The supermarket is "a retail format with long-established ties to suburban, middle class life" (Lavin, 2000, 49). It functions on the strategies of "impulse buying, promotion of national brands, and customer self-service" (Michman and Mazze, 1998, 6). Shopping at supermarkets has "taken on ritualistic meaning within urban life, linked to wider social themes of family, gender and identity" (Pritchard, 2000, 206).

In the US, many major chain grocery stores left inner city areas following race riots in the 1960s (Weinstein, 2000). To this day, some still claim insurance costs for fire and theft are so high in such neighborhoods that grocery stores will not locate there (Michman and Mazze, 1998). Thus, food retail outlets follow a "hole in the donut" model with wealthy suburbs surrounding an under-served inner-city core, which is attributed to a failure in the US to promote multi-class, mixed-use downtown areas (Toronto Food Policy Council, 1996).

A study of retail market share and saturation states that only in the case of small towns will all stores compete with each other. Analysis becomes more complex when the city is large enough to have multiple stores where distinguishable sub-markets exist. In such cases, stores are not all in direct competition with each other (O'Kelly, 2001). Unlike in the suburbs, there is no saturation of supermarkets in the inner city, and therefore retailers are looking to these areas for expansion. What attracts them is the more than $331 billion of "retailing purchasing power" that inner city residents wield (Janoff, 1999).

The grocery industry in the US was one of the last to be released from the wage and price controls of the early 1970s. Grocery retailing has become a much more concentrated industry, with fewer but larger grocery chains controlling more market share -the top five companies control one-third of the market. As a result of this concentration, an estimated 100,000 jobs have been lost in the food industry since mid-1995 (Keh and Park, 1997; American Antitrust Institute, 1999).

US supermarkets controlled between and estimated 40 percent and 65 percent of the retail food market in the 1990s (Toronto Food Policy Council, 1996). Supermarkets have consolidated to the point where the top five supermarket chains controlled 37 percent of the market in 1999. According to Gambino this consolidation weakens the power of both manufacturers and consumers. Family-run and regional chains are viewed as the next targets of acquisitions (Turcsik, 2001). There also has been a concerted effort by large department stores to enter into the food retail business. As a result, powerful chains can exert enormous influence onto an industry that already has very small profit margins.

Sexton and Zhang (2001) observe that the present trend of increasing food industry market power and consolidation can lead to an even larger share of market surplus. They observe that concentration in food manufacturing has grown rapidly through mergers and consolidations, and that "exercise of market power anywhere in the market chain will reduce consumers' welfare" (their emphasis) (Sexton and Zhang, 2001, 60). Sexton and Zhang were primarily concerned with food manufacturing (not food retailing) and although these are at different stages in the food distribution network, their work is important because of its direct implication for food insecurity, in this instance being provoked from behind the scenes.

The top four firms in the US own 43 percent of national supermarkets. The largest grocery chain in the US, Kroger, is now being rivaled by Wal-Mart, the world's largest department store. Wal-Mart sold $15 billion in supermarket sales in 1999, putting it as the 5th largest supermarket chain in the US, even though it is not technically a supermarket. An increasing percentage of Wal-Mart's sales are from supermarket items - now at 30 percent of all sales (Franklin, 2001). Wal-Mart plans to open "neighborhood stores", to primarily sell food items, effectively putting it into direct competition with large supermarket chains (Seiders and Tigert, 2000).

Seiders and Tigert (2000) did a case study on the effect of supercenters by looking at four American metropolitan areas, including Columbus, Ohio. They found that Wal-Mart and K-Mart supercenters captured 16 percent of primary shoppers and 27 percent of secondary shoppers in the study (primary stores are most often shopped, while secondary stores are second most frequented). In the case of Columbus, 41 percent of shopped considered a convenient location to be at least twice as important as any other reason for choosing stores (Seiders and Tigert, 2000). This may indicate that Wal-Mart and other supercenters and department stores may be using their market share to move into other industries.

Although difficult to gauge in the case of Akron, if national trends are occurring locally, then it is likely that the horizontal integration of department stores such as Wal-Mart is having an impact upon supermarkets and grocery stores in Akron, Ohio.

Studies on Grocery Store Access
Studies of food access in urban centers have shown the tendency for food to be less accessible (physically and financially) in lower-income neighborhoods and core urban areas (Cotterill and Franklin, 1995; Sustainable Food Center, 1999; Toronto Food Policy Center, 1996; Koralek, 1996). Financial impediments can also exist for the elderly and disabled (Klesges, 2001). However, Cotterill and Franklin (1995) have observed that the city of Cleveland was an exception to this rule because a specific chain made a dedicated effort to re-enter urban areas.²

Limited access to grocery stores is not only an urban problem; a study of a large rural area has indicated that certain people, mainly the poor, have limited access to grocery stores. These rural stores are similar to those in the inner city - both places have high prices, lack a variety of food items, and are geographically removed from inexpensive supermarkets in the suburbs (Kaufman, 1999).

These grocery store access studies have been conducted at different geographical scales using different criteria. For example, Cotterill and Franklin (1995) studied 21 of the US's largest metropolitan statistical areas (MSA's) and evaluated the floor space per capita aggregated at the zip code level, comparing the percentage of people on public assistance and the percentage of private vehicle ownership with what they discovered in each metro area. The study found that zip codes with a higher percentage of public assistance tend to have "significantly less square feet per capita of grocery space" (Cotterill and Franklin, 1995, 7). Also, zip code areas with the highest public assistance levels also had the fewest stores per capita. Vehicle ownership also drops drastically with higher levels of public assistance.

The Sustainable Food Center (SFC) studied the impoverished community of East Austin, Texas and considered the cost per "food basket" of each grocery store, availability of staple items, and the supermarkets per capita ratio. The study found that two supermarkets serve 24,000 residents living within a six-square-mile area, while in the rest of the Travis County there is one supermarket for every 8,876 people. They also found that many shoppers lack transportation and needed to rely on carpooling, buses, taxicabs, and walking to get to food stores. As a result, most did not shop at their preferred store, but stores that are more easily accessible. Convenience stores are often chosen because they are quicker and closer than supermarkets. Yet among the 38 convenience stores in East Austin, "only five offer a selection of food choices from which it would be possible to cook a nutritious balanced meal" (SFC, 1999, "Limited access to food" section).

Klesges, et al. (2001) studied food access for women 65 years and older with disabilities living in retirement communities in Baltimore. The study found that minority women (49.5 percent) were more likely than White women (13.4 percent) to report financial difficulty acquiring food. Among those reporting financial difficulty, only 20 percent received food stamps and fewer than 7 percent participated in food assistance programs. Also, nutritional services were rare in these communities, compounding nutritional deficiencies.

Dowler (1999) study mapped grocery store locations and surveyed available food items in London. Although its findings are not as comparable due to it being in the United Kingdom, its methodology is useful. It identified roads within 500 meters of well-stocked and "reasonably" priced shops and created local maps of food access. Dowler also developed food access indices "in relation to low income and ethnic minority groups", a food availabilities index, and a food price index (Dowler, 1999, 2). However, no association between inadequate food access and poor income areas could be made.

Kaufman's (1999) survey of rural households in the Lower Mississippi Delta area measured net accessibility by a ratio of available large grocery stores and potential food spending of a household, aggregated on a multi-state zip-code level. Thirty-eight percent of the zip codes studied had food supplies that matched or exceeded the demand. The rest were areas where food expenditures were not fully satisfied by accessible large retailers. The study also determined that rural households face supermarket prices that are roughly four percent higher than suburban markets.

Akron's citizens have noticed the disparity of available food in their communities and have sought solutions to this problem in recent years. For example, the lack of a supermarket in Akron's predominantly Black Westside, prompted community leaders to campaign for a supermarket. Acme, a locally-owned supermarket chain, created its very first franchised store for this community, Henry's Acme, which is run by a man who rose up the ranks of Acme starting as a bag-boy (Ethridge, 1999).³

The site of a former Acme supermarket on East Exchange Street has been vacant for a number of years, thus depriving the city's center from any supermarket. Yet, it was announced in mid-2001 that a Cleveland supermarket chain called "Dave's" would be building on the former Acme supermarket grounds. This development will likely greatly aid those in this community by increasing their food access and security (Mackinnon, 2001).

[1] Up to date listings of signatories and ratifying countries can be found here: http://www.un.org/Depts/Treaty/final/ts2/newfiles/part_boo/iv_boo/iv_3.html

[2] Dave’s Supermarket. Later it will be noted that Dave’s is planning to do the same in Akron.

[3] Henry’s Acme fell just outside of this paper’s study area, but its inclusion would likely have played a role in shifting some of the results.