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The Rising Role of Dollar
Stores as Food Access Points Among Rural Households |
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Author:
Madeline M. Roberts
MPH, PhD A recent article in the American Journal of Public Health analyzed this shift with a particular emphasis on what’s happening in rural areas. The authors found that between 2008 to 2020, dollar stores were the fastest-growing food retailers, an overall increase of 89.7%. Rural areas, however, experienced the highest increase at 102.9%. In context, dollar stores remain a small proportion of total national food purchases (2.1% in 2020), but for certain demographics, particularly within underserved and rural communities, these stores are increasingly becoming food access points. The study results also showed that rural non-Hispanic Black households spent the greatest proportion (11.6%) of their food budget in dollar stores. Additionally, an inverse relationship was observed between income and proportion of food expenditures in dollar stores. The lowest income households (less than $25,000 annually) spent the highest proportion of their food budgets in dollar stores, and of these low-income households, those located in rural areas spent the most on food in dollar stores. By geographic region, rural households in the South spent the highest proportion of their food budgets at dollar stores. The sticking point is that, in general, dollar store food offerings are predominately packaged goods with lower nutritional value, though some dollar stores now carry more nutritious items such as dairy products and eggs. With high-calorie, low-nutrient density food comes the increasing potential for both short- and long-term deleterious health outcomes. This dangerously dovetails with the fact that rural communities also often have reduced access to health care compared to more densely populated areas. According to the United States Census Bureau, 97% of our nation’s land mass is classified as rural, while only approximately 20% of the U.S. population lives in a rural area. The remaining 80% of us live on just 3% of the U.S. land area in more densely populated urban areas. Those living in rural areas have several social determinants associated with poorer health—they are generally older, earn less, and are less educated compared to their urban counterparts. Rural areas also report significantly more preventable hospitalizations and significantly fewer primary care physicians and mental health providers per 100,000 residents compared to urban areas. Over the past five years, food insecurity within the United States has remained stable, though not optimal, at around 10% (EpiMonitor has written previously about food insecurity here). The US Department of Agriculture Economic Research Service reports that in 2021, 90% of U.S. households were food secure, while the remaining 10% experienced food insecurity at least some time during the year. Single-mother households and those living below the poverty line experience the highest rates of food insecurity, and approximately 12% of households with children experience some type of food insecurity. Rural households comprise 18% of all food-insecure households in the U.S. For those at-risk for food insecurity and/or for those living in areas lacking proximity to grocery stores, dollar stores may fill a critical gap in meeting household food needs.
If dollar stores are
indeed a potential intervention point for food insecurity, particularly in
rural areas as these study results may indicate, then perhaps gains can
also be made in increasing the nutritional value of the product selection.
If dollar stores have been able to achieve and thus far sustain such rapid
growth, perhaps the next iteration of incremental change involves
improvements (even if only modest ones) in food quality for these
underserved areas. The need still exists for research that explores
economic incentives for such stores to improve nutrition quality, as well
as innovation in food distribution. It is not completely impossible to
think that in identifying an opportunity for gaining market share in the
food retail space, dollar stores or a similar concept could one day be
leveraged for improving access to nutritious foods.
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