Fast food accessibility contributes to health disparities in Bethlehem

With 45 fast-food restaurants — about 2 per square mile — there’s no shortage of greasy french fries, crispy chicken sandwiches and other affordable yet unhealthy dining options for Bethlehem residents. 

This accessibility contributes to health disparities, as low-income individuals and families in Bethlehem are more likely to purchase fast food items, and fast food consumption which is inextricably linked to numerous health complications.

Eric Ruth, co-chair of the Lehigh Valley Food Policy Council — a team working to improve food access in Bethlehem — said the lack of nutritious options compared to processed foods is a systematic problem for everyone, but more so for low-income communities. 

“If you add in the social determinants of health — where you can’t get (nutritious foods) in your neighborhood (or) where you can’t afford it — it magnifies that for people who are less resourced,” Ruth said.

According to 2022 U.S. Census Bureau data, there were an estimated 18.3% of people in poverty in Bethlehem, compared to 12.6% of people nationwide. 

Lehigh Health professor Carly Camplain said fast food restaurants tend to populate in low-income areas more than in wealthier areas. She said these dining options are convenient and negatively impact health and well-being.

Lehigh University’s registered dietitian Keri Lasky said consuming fast food consistently over a long period of time can result in chronic conditions, and according to the CDC, “eating a diet high in saturated fats, trans fat and cholesterol has been linked to heart disease and related conditions, such as atherosclerosis” — a buildup of plaque in and on the artery walls.

Though it’s possible to make “healthier” choices at fast food restaurants,  Lasky said individuals usually eat at these places without regard to nutritional balance. She said fast food often lacks micronutrients and is high in calories, as well as ingredients — including salt, sugar and unhealthy fats — that are harmful to one’s health if consumed in excess.

Heart disease is the leading cause of death in Bethlehem, according to the city’s 2022 Community Health Needs Assessment. 

Heart disease is also the leading cause of death in the country, and “​​high-income is the only category of income group in which there have been decreasing numbers of deaths from (this) disease,” according to the World Health Organization.

The city’s assessment suggests diet choices are influenced by both personal decisions and socioeconomic constraints, including access to healthy grocery stores, supply chain issues and income.

To combat the health disparities Bethlehem residents face and to address the dangers of over-consumption of processed foods, the city works with several partners to create culturally relevant nutrition and lifestyle education programs. The city also provides funds for purchasing nutritionally dense foods. 

From the assessment, Bethlehem officials chose food insecurity and chronic disease as two main focus areas for its Community Health Improvement Plan.

In the plan, the Bethlehem Health Bureau defines food insecurity as “a household-level economic and social condition of limited or uncertain access to adequate food” and chronic disease as “conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both.”

The city created a Food Security Action Plan, which plans to decrease food insecurity and is equipped with options for exploring healthy and nutritious food locally.

The city also developed a Chronic Disease Action Plan with objectives to “decrease the prevalence of obesity, diabetes, stress levels and heart disease by 10% by 2025,” and “to improve fruit, vegetable, whole grain, fiber intake, sleep and physical activity levels by 10% by 2025.”

Sherri Penchishen, the director of chronic disease programs for the Bethlehem Health Bureau, said the department tries to teach the community the importance of nutrition and physical activity. The bureau provides individual and group counseling on weight loss, diabetes, hypertension and high cholesterol. 

Ruth is co-founder and CEO of the Kellyn Foundation, which the city has partnered with for additional educational programs as part of the two action plans.

The foundation is one of many local organizations working to improve nutrition education in schools, access to healthy food and medically-based lifestyle change programs.

Ruth said over the last 30 years, scientific research has proven that primarily whole-food diets can alleviate eight of the 10 things that kill most people. 

“We’re literally killing ourselves by the food we eat, along with a few other lifestyle habits,” Ruth said.

Working per this research, Ruth and his team boast their Healthy Neighborhood Immersion Initiative to provide short- and long-term health benefits as well as cost savings to individuals and families. 

Ruth said the city funds the foundation’s intervention programs and gives out coupons to Bethlehem residents for the foundation’s market, which holds over 70 different items from produce and fruits to nuts and seeds. 

The foundation meets with groups to educate them on the health benefits of limiting processed foods and replacing them with whole foods. 

To be as beneficial as possible, Camplain said, nutrition education needs to be culturally relevant. 

“Nutrition tends to be an upper-middle-class white American’s game historically,” Camplain said. “Making sure that education is culturally and significantly relevant to the people we’re giving it to will make a lot of difference.”

 According to the U.S. Census Bureau, 30.1% of Bethlehem residents are Hispanic or Latino.

Recognizing this, Penchishen said the Bethlehem Health Bureau hopes to implement culturally appropriate nutrition education and work with local Spanish supermarkets and Ideal Food Basket to ensure individuals in the community have access to healthy recipes and nutritious foods from their culture.

Ruth said gearing nutrition education toward the specific group is important, and the Kellyn Foundation teaches individuals how to take their favorite cultural recipes and cook healthy versions of them. 

They have served over 700 families in South Bethlehem alone, Ruth said, and they teach in all 16 of the Bethlehem School District’s elementary schools.

He said in addition to nutrition courses, the Kellyn Foundation plants gardens and helps groups learn to cook. 

Penchishen said in the past, the bureau has also done cooking demonstrations and provided kits to make healthier food options.

She said this aims to implement the idea that preparing foods from farm to kitchen is not only nutritionally healthier but “you feel better about yourself,” and eating nutritious foods in the long-term assists in “improving quality of life.” 

Taking people back to the roots of home cooking and trying to eliminate processed foods, she said, will benefit health greatly. 

“It’s cheaper to buy the seed and grow the vegetables plus it’s much more self-satisfying to eat the food that you planted,” Penchishen said. “We’re hoping that we’ll have people take more advantage of growing their own foods, which is a healthier option.” 

Bethlehem is home to the Community Garden Program, in which, according to the program’s website, “Monocacy Farms makes community garden plots available to area residents wishing to plant and maintain their own vegetable gardens.”

Though these gardens exist in Bethlehem, Camplain said there are often limited alternatives in low-income communities that are as affordable as fast food.

She said part of the reason for the abundance of fast food options and lack of alternatives is the structural barriers to health — including zoning laws and financial insecurity. She said these are things that nutrition and lifestyle education can’t solve. 

“Nutrition education is so important, but with all of these structural barriers in place, all the education in the world isn’t going to help everyone,” Camplain said. “It’s not going to help everyone if you don’t have readily available alternatives that are about the same price and as easy.”