“The way the health system chooses to address those problems is not moving the needle or supporting efforts that would get at the heart of these problems,” she said.
Andress focuses on what she calls “upstream levers,” such as infrastructure investments, economic development and employment opportunities, that affect efforts “downstream” when it comes to how seniors in rural regions acquire nutritious food.
“In my research, I assume we have enough people working downstream—trying to teach people how to eat, looking at their bodies, their health or disease state. But what we don’t have is enough people making the connection between context and policies, and how that contributes to what we as health practitioners do downstream,” Andress said.
Her findings bear out that seniors in rural areas have a hard time getting healthy food for reasons related to the “upstream levers.” Based on rural regions’ historically poor economy, their incomes are relatively low. And the food available in their area costs more—and is less varied—than what urban and suburban areas offer.
Andress’ latest study, published in the journal Cogent Medicine, was carried out in rural Preston County. Most of her research subjects—who ranged in age from 59 to 85—had chronic conditions, such as diabetes and high blood pressure, and lived at or below the poverty line. All had physical impairments that limited their mobility.
As part of the study, research participants took photographs to illustrate their interactions with food.
Andress analyzed the photo narratives and found that distance from a grocery store was not the greatest threat to food security, according to participants’ perceptions. Instead, participants more frequently cited produce that was sold in impractically large packages, cost more than they could afford, wasn’t as fresh as what they could grow in a garden or was hard to reach while using a cane or motorized scooter.
“I’ve heard stories of people who had to take one bag of groceries into the house at a time and rest between bags. Then they had to go lie down after it was all done,” she said.
The difficulties seniors face aren’t just a matter of health. According to Andress, they’re a matter of how society treats its older or most vulnerable members. Good nutrition helps seniors live longer, healthier lives, and it is especially relevant in West Virginia, which has the third-highest concentration of residents aged 65 and older.
Andress’ findings suggest that advantageous upstream levers might include hospital investments in infrastructure that support community health; tax incentives for businesses that will build stores in rural, underserved areas or provide high-quality, discounted fruits and vegetables to seniors; and public-private partnerships to give the elderly more options for traveling to and from sources of food.
“When I think of what it takes to make people healthy, I tend to look away from what we have always done in the U.S. healthcare and public health systems. It hasn’t been successful,” Andress said. “Instead I am wondering how our health systems and institutions can embrace equity through a broader social and economic policy agenda. My intent is to study, teach and live in a way that can define the barriers and opportunities to move in that direction.”
Becker, WVU School of Public Health