Dr. Jill Foster was a practicing family physician in Cincinnati when she became increasingly dismayed treating preventable illnesses. “A young female patient of mine who weighed 200 pounds asked me, ‘Doctor, am I obese?’ Foster recalls. “When I told her she was, the poor child was devastated.” As both a vegetarian and doctor, Foster knew that unhealthy diets were the root cause of many of her patients’ problems. So rather than slog upstream through the quickening torrent of diet-related disease, she took leave from her practice to study nutritional science in Birmingham, Alabama.
Had she been looking for the fastest route to the belly of the beast, Foster couldn’t have chosen a better place. According to the Trust for America’s Health, Alabama has the second-highest level of adult obesity (28.9 percent) in the nation. For African-Americans the numbers are worse: 38 percent are obese. And 286,000 Alabamians, or about 6 percent of the state’s population, have been diagnosed with diabetes, a number that has climbed by more than 50 percent since 1994.
As a new resident of Birmingham, Dr. Foster, a petite black woman, soon noticed that most of the people around her were at least fifty pounds heavier than she was. “Poverty has a lot to do with obesity,” she noted, “and so does race. When you’re poor, you eat what’s cheap and what’s available.” She also found that the only vegetables available in the city’s poorer neighborhoods were fried okra and fried green tomatoes.
Foster’s experience comes as no surprise to researchers and community food advocates, who commonly use the term “food desert” to describe the lack of affordable, healthy food outlets across the country. In general, the data show that people living in lower-income, nonwhite communities must travel greater distances to reach well-stocked and reasonably priced food stores than people living in higher-income areas. Healthy food is also more expensive on a calorie-for-calorie basis than junk food. According to the Institute for Agriculture and Trade Policy, the real cost of fresh fruits and vegetables has risen nearly 40 percent in the past twenty years, while the real cost of soda, sweets, fats and oils has gone down.
While Alabama’s obesity rate tops the national charts, the state is beginning to distinguish itself for its efforts to improve its food environment. Tapping into Alabama’s agrarian roots, community leaders, clergy and government officials are hoping that the agricultural sector can play a vigorous role in promoting healthy eating. But is this just wishful thinking in a state where cotton, peanuts and poultry are the dominant farm industries?
Skepticism is warranted. The homepage of Alabama’s Department of Agriculture and Industry’s website reads: “Our department has the responsibility to help the few family farmers that remain in business in any way that we can.” This doesn’t sound like a bureaucracy that can save itself, let alone the hundreds of thousands who are suffering from obesity.
But walk across the street in Montgomery’s capital district and you’ll find a more upbeat view from Don Wambles, executive director of the Alabama Farmers Market Authority. With the intention of helping farmers as well as nutritionally vulnerable consumers, Wambles has increased the number of Alabama farmers’ markets from seventeen in 1999 to ninety today. With his leadership and the commitment of hundreds of community leaders, Alabama now has at least one market in nearly every one of its sixty-seven counties.
Wambles, a cotton and peanut farmer turned state bureaucrat, knows all the potholes on the road to agricultural survival. “Over the course of my farming career I’d have one good year in four,” Wambles says. Like most other commodity producers, he found that his crop prices stayed flat while his input costs–fertilizer, equipment, fuel–went up. Though he had one of the biggest farms in Pike County, the bank told him he had to get bigger or get out. “I was tired of fighting a losing battle, so I got out.” From the hard lessons he learned as a “price-taker” in the cotton and peanut markets, he decided to push his fellow farmers toward something they could control, namely fruit and vegetable production for direct sale to consumers.
But the push wasn’t enough. Wambles also needed a “pull”–which he discovered in the form of a federally funded program with the ungainly title of The Women, Infants, and Children Farmers Market Nutrition Program (WIC/FMNP). The program, which Wambles brought to Alabama in 1999, provides coupons to lower-income mothers and children in annual amounts of only $20 per person to purchase fresh produce at farmers’ markets. In 2001 he brought the newly established federal Senior Farmers Market Nutrition Program to the state. That program does the same as the WIC/FMNP but targets lower-income senior citizens. Together the two programs now serve 86,000 low-income Alabama mothers, children and seniors.
The FMNP’s economic benefit to farmers was readily apparent to Wambles, but he also recognized the social benefit to low-income households. “I grew up real poor,” he says. “My mother raised two boys on $3,672 per year plus $50 per month in child support from the State of Alabama. But I also study the Bible and it tells us to take care of one another.”
Sally Allocca is a minister who reads the Bible, too. She’s co-pastor of the East Lake Methodist Church in Birmingham’s lower-income East Lake neighborhood, the site of one of Alabama’s newest farmers’ markets. She told me one Saturday over the market’s hustle and bustle, “God put our church here to serve the people in this community, and East Lake is what is known in planner’s jargon as a ‘declining neighborhood.'” Noting the area’s high proportions of single head-of-household families and elderly, she added, “Our church decided to concentrate its resources on health issues because the neighborhood is so prone to heart disease and diabetes from obesity.”
Hence the farmers’ market, the inspiration for which Allocca got from Don Wambles, who planted the idea and then watered it with several thousand dollars of FMNP coupons. The reason for the coupons was simple: A new farmers’ market in a so-called declining neighborhood is not going to attract farmers unless there is an incentive. No farmers, no fresh produce. Surveying the busy church parking lot, Allocca is happy with the results. “People are proud that this farmers’ market is here. It’s helping to turn this neighborhood around.”
In an incremental way, the FMNP is beginning to modify farmer practices in the way Wambles is trying to encourage. Art Sessions grows 1,500 acres of pecans, cotton, and some fruits and vegetables just west of Mobile. Until recently he sold exclusively to the wholesale and commodity markets. But at Wambles’s request, Sessions gave the new Mobile farmers’ market a try, and as a result of his success there has been reducing his commodity-crop acreage and increasing his retail fruit and vegetable production. “Cotton subsidies might take a big hit in the next farm bill,” he notes. But, he says, “over 25 percent of my vegetable sales now come from senior citizens and WIC moms, and many of them come back after they’ve used up their coupons. I must say that the FMNP is one of the few federal programs that really work.”
State agency evaluations conclude that the coupons stimulate increased consumption of fresh fruits and vegetables. In Dr. Foster’s opinion this is one way to attack the nation’s obesity problem. “We have to look at the economics of food choices,” she asserts, “and we have to make it easy and affordable to buy fresh fruits and vegetables.”
But until Congress appropriates more money for the FMNP, Alabama and other participating states can’t do more. Currently, Congress provides the WIC version with $20 million annually, divided among forty-five state agencies and federally recognized Indian tribal governments. The senior program receives $15 million, which is distributed to thirty-eight states. Thanks to Wambles’s aggressiveness, Alabama has captured 1.8 million of those dollars. But that has been enough to reach only 20 percent of the state’s WIC participants and 27 percent of the eligible seniors. If, for instance, Alabama received $8 million, 200,000 of the state’s most nutritionally vulnerable residents would have a strong incentive to eat more fresh fruits and vegetables.
In the world of big agricultural subsidies, $8 million doesn’t even show up as a rounding error. In fact, it would be 12 percent of the $66 million in cotton subsidies that went to 8,500 Alabama growers in 2004 ($1.65 billion in cotton subsidies were paid out nationally the same year). Given that the state spends $1.3 billion annually on obesity-related medical expenses, Alabama’s citizens might expect a better rate of return from a higher investment in the FMNP, since greater fruit and vegetable consumption should reduce medical bills.
A well-funded FMNP could be part of a more rational US farm and food policy that puts the health needs of the consumer ahead of the needs of a relatively small number of large commodity-crop producers. As it stands now, a farmer can plant 1,000 acres of cotton and be guaranteed a price. But a farmer who plants collards, melons or carrots receives no price guarantee at all. A robust Farmers Market Nutrition Program wouldn’t provide a guaranteed price, but it would encourage more farmers to grow fresh produce, fuel the growth of farmers’ markets, especially in lower-income areas, and significantly improve the ability of consumers to purchase healthy food.