Urban poverty and nutrition challenges associated with accessibility to a healthy diet: a global systematic literature review

Abstract

Background There is an increasing global trend towards urbanization. In general, there are less food access issues in urban than rural areas, but this “urban advantage” does not benefit the poorest who face disproportionate barriers to accessing healthy food and have an increased risk of malnutrition. Objectives This systematic literature review aimed to assess urban poverty as a determinant of access to a healthy diet, and to examine the contribution of urban poverty to the nutritional status of individuals. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology, our review included quantitative and qualitative studies published in English or in Spanish between 2000 and 2019. The articles were eligible if they focused on nutrition access (i.e. access to a healthy diet) or nutrition outcomes (i.e., anemia, overweight and obesity, micronutrient deficiency, micronutrient malnutrition) among urban poor populations. Articles were excluded if they did not meet pre-established criteria. The quality of the quantitative studies was assessed by applying Khan et al.’s methodology. Similarly, we assessed the quality of qualitative articles through an adapted version of the National Institute for Health and Care Excellence (NICE) methodology checklist. Finally, we systematically analyzed all papers that met the inclusion criteria based on a qualitative content and thematic analysis. Results Of the 68 papers included in the systematic review, 55 used quantitative and 13 used qualitative methods. Through the analysis of the literature we found four key themes: (i) elements that affect access to healthy eating in individuals in urban poverty, (ii) food insecurity and urban poverty, (iii) risk factors for the nutritional status of urban poor and (iv) coping strategies to limited access to food. Based on the systematization of the literature on these themes, we then proposed a conceptual framework of urban poverty and nutrition. Conclusions This systematic review identified distinct barriers posed by urban poverty in accessing healthy diets and its association with poorer nutrition outcomes, hence, questioning the “urban advantage”. A conceptual framework emerging from the existing literature is proposed to guide future studies and policies. Systematic review registration PROSPERO Registration number: CRD42018089788.

Assessing Predictive Factors of COVID-19 Outcomes: A Retrospective Cohort Study in the Metropolitan Region of São Paulo (Brazil)

“…Additionally, it is known, albeit not absolutely, that the social and economic environment, including factors as diverse as family income and social status, employment, levels of education and culture and health literacy, among others, can determine access to a balanced diet based on safe and nutritionally adequate foods. The least advantaged groups living in urban areas may have a diet based on high-energy foods, especially those that are ultra-processed and rich in sugar, and poor consumption of vegetables and fruit when compared to their counterparts [25]. These conditions can enhance the development of certain diseases such as obesity, diabetes, hypertension, cancer and malnutrition.…”

The influence of the urban food environment on diet, nutrition and health outcomes in low-income and middle-income countries: a systematic review

“…In urban LMIC, individuals are more likely to buy than grow food for their own consumption and a number of distinct barriers exist which may reduce access to healthy food, such as more expensive fresh food. 18 There is evidence that diets, dietary behaviour and related health outcomes may be poorer in urban LMIC settings than in rural LMIC settings. The global burden of disease study noted a marked difference between obesity prevalence in rural and urban populations 19 and a more recent review highlights higher prevalence of central obesity in urban residents.…”

Residents’ Insights on Their Local Food Environment and Dietary Behaviors: A Cross-City Comparison Using Photovoice in Spain

“…Poverty was mentioned as one of the main barriers for having a healthy diet [ 52 ]. As shown in the literature, food choice conditions are enabled when enough money, transportation, and retail food outlets are easily available [ 53 ].…”