States’ Food, Housing, and Transportation Initiatives Aim to Reduce Health Disparities

October 10, 2019 | ASTHO Staff

The environments in which people live, learn, work, play, and worship directly impact health. Considerable evidence supports the connection between housing, food security, and transportation and health outcomes. Further, systemic and structural barriers have created disparities among groups in terms of their ability to be healthy and to live in healthy environments, which has subsequently stymied the opportunity for all communities to achieve optimal health. States are advancing place-based initiatives and implementing policies to build healthy environments that improve health and ensure equitable opportunity for wellness.

Healthy Food Access

Easy access to affordable, healthy foods directly correlates with improved health. High consumption of unhealthy, processed foods contributes to chronic conditions such as cancer, heart disease, diabetes, obesity, and high blood pressure. Food deserts, areas of the country with limited access to foods that make up a salubrious diet, compound barriers to accessing nourishing foods. Moreover, they disproportionately affect racial and ethnic minority communities, residents of low-income communities, and rural communities. Food deserts make it extremely difficult for individuals in under-resourced communities to easily access nutritious and varied food options.

Economically disadvantaged neighborhoods, which are more likely to be predominantly black and Hispanic, have a higher number of convenience stores and limited grocery stores selling foods of lower nutritional quality. Several studies have also found a higher prevalence of fast food restaurants in lower-to-middle-income neighborhoods than in high-income neighborhoods, increasing exposure to unhealthy food sources for those in lower-income neighborhoods. Supermarkets with comprehensive selections of food are more likely to be located in wealthier and predominantly white communities; as such they may be inaccessible to people who live outside of these communities due to distance or limited public transportation routes.

In January, New Jersey enacted a law implementing the Healthy Corner Store Program, which aims to increase the availability and sales of fresh produce and nutritious foods by small food retailers (e.g., convenience stores, bodegas, and small grocery stores) in rural and urban low-income and moderate-income areas. The program will be supported through the state’s Healthy Small Food Retailer Fund, which the commissioner of health will use to distribute funds to approved grantees.

In April, Washington state developed the Fruit and Vegetables Incentives Program. The initiative seeks to alleviate food insecurity among Washingtonians by providing fruit and vegetable incentives and food vouchers for low-income shoppers that can be used in grocery stores and farmers markets.

In June, Nevada enacted a law that will establish a program to provide loans to certain operators of grocery stores located in underserved communities.

In September, New York amended a law to encourage increased fresh fruit and vegetable production through community gardens. This law intends to foster the growth, size, and scope of community gardens in the state with help from a task force that includes community garden organizations and the New York State Department of Health, Department of State, Office of Children and Family Services, and Division of Housing and Family Renewal. The task force will study, evaluate, and develop recommendations to support community garden activities and encourage state agencies, local governments, and private parties to establish community gardens.


Communities face challenges establishing affordable, accessible transportation options that incorporate environmental design. People of color and low-income individuals are more likely to live close to highways and inhale traffic-generated air-pollution. Neighborhoods without sidewalks, bicycling infrastructure, or other opportunities for physical activity are also more prone to vehicle-related pedestrian accidents and obesity.

Illinois enacted a law in June to establish a transportation equity workgroup at the Illinois Department of Transportation to increase and improve transportation conditions for communities of color and low-income neighborhoods. This legislation will also prioritize a complete streets policy plan to implement more bicycling and walking facilities and revise state roadway designs to encourage safer driving.

California is also prioritizing improvements to its state infrastructure and roadway safety to provide increased access to transportation for under-resourced communities. In September, the state legislature enacted a law to establish project development teams—which will include representatives from transportation sectors, low-income communities, and community-based organizations—to convene and prepare an asset management plan. The teams will report on performance measures related to projects that prioritize and implement safe and connected facilities for pedestrians, bicyclists, and transit users.

In May, Montana enacted a law to increase the safety and utilization of bicycling in Montana by designating an interim committee to study bicycle and pedestrian paths. The committee will study the purpose, safety implications, economic impacts, and funding of bicycle and pedestrian paths and will conclude the study in September 2020.


An individual’s housing impacts his or her wealth, health, and job opportunities. Inadequate housing can cause many adverse health outcomes that disproportionately affect impoverished communities and racial and ethnic minority groups. Residential crowding, homelessness, and substandard housing conditions such as poor water quality, pest infestations, and poor ventilation are associated with several physical and mental health conditions.

In April, Washington State enacted a law to invest in facilities and projects that “keep people in homes” by providing services that will prevent homelessness and ensure affordable housing. This project will allow a city or county to use revenue from a real estate excise tax to plan, acquire, construct, reconstruct repair, replace, rehabilitate, or improve facilities for affordable housing projects and individuals experiencing homelessness.

Years of racial discrimination in housing sales, rentals, and financing has marginalized minority homeowners, and unfair practices still exist today through biased credit scoring systems and lending practices that worsen the homeownership gap. To combat housing discrimination, in July New Jersey enacted a law requiring real estate license applicants to take at least 30 hours of courses in housing ethics and ethical conduct and at least one hour on fair housing and housing discrimination.

Nationwide, states are pursuing legislation to build strong communities and increase equitable access to nutritious food, adequate transportation, and safe housing. By addressing these important factors, states can reduce social and economic barriers to health and ensure that people live in communities that allow them to adopt salutary lifestyles.