Local Food System Approaches to Address Food and Nutrition Security among Low-Income Populations: A Systematic Review

Abstract

Local Food System Approaches to Address Food and Nutrition Security among Low-Income Populations: A Systematic Review Katharine Garrity 1 , Kathleen Krzyzanowski Guerra 2 , Hannah Hart 3 , Khawlah Al-Muhanna 1 , Emily C Kunkler 1 , Ashlea Braun 4 , Kathryn I Poppe 3 , Kara Johnson 1 , Emma Lazor 1 , Yang Liu 1 , Jennifer A Garner 1,2,* 1 Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University; 2 John Glenn College of Public Affairs, The Ohio State University; 3 College of Public Health, The Ohio State University; 4 Department of Nutritional Sciences, College of Education and Human Sciences, Oklahoma State University ABSTRACT Food and nutrition insecurity disproportionately impact low-income households in the United States, contributing to higher rates of chronic diseases among this population. Addressing this challenge is complex because of various factors affecting the availability and accessibility of nutritious food. Short value chain (SVC) models, informally known as local food systems, offer a systemic approach that aims to optimize resources and align values throughout and beyond the food supply chain. Although specific SVC interventions, such as farmers markets, have been studied individually, a comprehensive review of SVC models was pursued to evaluate their relative impact on food security, fruit and vegetable intake, diet quality, health-related markers, and barriers and facilitators to participation among low-income households. Our systematic literature search identified 37 articles representing 34 studies from 2000–2020. Quantitative, qualitative, and mixed-method studies revealed that farmers market interventions had been evaluated more extensively than other SVC models (i.e., produce prescrip tion programs, community-supported agriculture, mobile markets, food hubs, farm stands, and farm-to-school). Fruit and vegetable intake was the most measured outcome; other outcomes were less explored or not measured at all. Qualitative insights highlighted common barriers to SVC use, such as lack of program awareness, limited accessibility, and cultural incongruence, whereas facilitators included health-promoting environments, community cohesion, financial incentives, and high-quality produce. Social marketing and dynamic nutrition education appeared to yield positive program outcomes. Financial incentives were used in many studies, warranting further investigation into optimal amounts across varying environmental contexts. SVC models are increasingly germane to national goals across the agriculture, social, and health care sectors. This review advances the understanding of key knowledge gaps related to their implementation and impact; it emphasizes the need for research to analyze SVC potential comprehensively across the rural-urban continuum and among diverse communities through long-term studies of measurable health impact and mixed-method studies investigating implementation best practices. This trial was registered at PROSPERO as CRD42020206532. Keywords: fruits and vegetables, nutrition education, nutrition incentive programs, farmers markets, produce prescription programs, community-supported agriculture, mobile markets, farm stands, farm-to-school, food hubs