One of the hands-on lessons I asked the medical students in my nutrition elective to do was to engage with the geography of food accessibility and with the well-meaning advice that it is possible to eat healthfully on a shoestring budget from convenience stores.
You've probably heard the term "food desert," a term coined in the the 1990s to describe a neighborhood in which any kind of food, but especially fresh foods, are scarce. This is sometimes measured by at least 1/3 of the population living >1 mile from a store. "Food deserts" can be urban, as when a neighborhood is considered too dangerous for a company to want to put a standard grocery store. But they can also be rural, as when a family might have to drive 30-45 minutes to get to the closest big-box store. Some people have talked about "food swamps," where products are available but not of good quality (e.g. convenience stores with mostly processed items), but other food justice advocates argue that they don't want where they live to be described as "a swamp," and besides both of those terms suggest natural phenomena, whereas lack of accessibility to healthy food is a human-made problem. So the latest concept is "food apartheid" to recognize that human policies set some communities apart. (I asked students to listen Food Apartheid: (And Why We Don’t Call it a Food Desert),” a Point of Origin podcast from November 2020 with Karen Washington, Bryant Terry, and Hanna Garth.)
The assignment was for students to shop for and prepare a recipe from a convenience-store food guide published by the local children's hospital, or from Dollar General's own website of "easy meals." Because I didn't want to make anyone have to spend money on this class or necessarily change their eating habits, the other option was to compare one of these recipes to a standard recipe (e.g. mac and cheese from two different sources) to see what similarities and differences would emerge. I am usually wary of experiential learning like poverty or disability simulations, because I think it fosters the idea that the best way to understand another point of view is to try to replicate it, when that lived experience is just an identity put on for a few minutes or hours and then taken off again, like a costume. As someone who studies historical ideas and practices, I will never KNOW what it was like to live 100 years ago, but I have to believe that it is possible to gather a good enough impression from texts and objects. How much easier to ask someone who lives with food scarcity what that's like, rather than trying to recreate it?
However, I also believe that healthcare workers should be part of their communities, and that includes knowing where people shop, or send their kids to school, or place their elderly relatives in nursing homes. It would be pretty condescending of me to advise a single mother to "just use these recipe suggestions" to feed herself and her kids without ever having tried it myself, as if I were too good to eat food from a convenience store. So I designed this meal challenge with limited expectations. A purist, I decided to stick with the Dollar General a 15-minute walk from our house, although there is an organic grocery store 2 blocks from us, and I passed 3 pharmacies with "food marts" (Walgreens, Rite Aid, CVS) on the way. I can't say that the shopping experience was enjoyable, given the pallets of items blocking the aisles due to insufficient employees to stock them, and the fact that I was the only person properly wearing the mask that I had retraced my steps to grab. A sign on the door says this location is closing due to lack of staff, so I almost didn't go in, thinking it might already be closed.
It was lucky timing that Nicole Spector's article asking "Should You Buy Groceries at the Dollar Store?" came across my news feed the week before. Writing for a personal finance website, Spector notes, "It really depends on what you’re buying and how well you’ve done the math. Perhaps surprisingly, there are instances in which you’ll pay more for essentials at the dollar store than you would at a grocery mart." This is because the convenience store doesn't buy in bulk or move items at the same rate as a grocery store, which is why she also recommended checking both the expiration dates and the unit prices. Non-perishable goods and spices may be sweet deals, while baking supplies and perishable items may cost more. My experience was varied, with off-brand powdered ginger costing $0.50 and McCormick's red pepper flakes $2.95.
For our salmon patty dinner, I nabbed the remaining 4 packets of salmon packed in vegetable broth ($5.40) and easily found the quick oats ($1.65). The recipe has no serving suggestions--it doesn't even opine on whether to serve the salmon burgers on buns--so I freelanced the rest of the meal. I contemplated making cornbread with canned corn in it, but there wasn't a ready mix, so I would have had to buy the corn meal, flour, sugar, oil, and baking powder, in addition to the corn and other things I already needed. The packages of fancy pasta had too much sodium, so I opted for a packet of sour cream and chive instant mashed potatoes (4 servings for $1.00). I later found that an 8-pack of white hamburger buns go 2 for $1.00, and the extras could have been used for other meals.
I did decide to get the milk and eggs from the Dollar General. The cooking booklet recommends skim or 1% milk, but skim was not available, and 1% only in a gallon. I therefore chose a 1/2 gallon of 2% (even though I only needed 2 tablespoons of it and contemplated just using water for moisture, $3.20). The eggs were easy, although they came in an environmentally unfriendly Styrofoam container ($2.15). I didn't notice any fruits or veggies for sale, although there were a variety of dairy products such as yogurt, cheese, and sour cream.
It is too bad there are no serving suggestions beyond drinking water or milk, as these could have carried over the MyPlate.gov ideals of portion sizes and "a balanced diet" that includes fruits, veggies, and a reasonable number of carbs or starches in addition to the protein entrée. Nevertheless, because the booklet suggests these salmon burgers are suitable for a "fancy" meal, I decided to upgrade our usual beverage of choice (filtered tap water) by splurging on a zero-calorie lemon-lime flavored water ($0.80) and dessert. We rarely have "dessert" in our household but almost always snack in the evenings, typically on pretzels, popcorn, hot chocolate or cider, grapes, cherries, clementines, or occasionally ice cream. The freezer cabinet was surprisingly well stocked; because chocolate gives DH migraines, I chose a box of 6 strawberry popsicles $3.75, for a total of $21.40 for 4-5 servings, plus milk, oats, and eggs that would be left over.
Salmon Burgers Estimated Preparation Time: 10 minutes Serving: 1 [meal? makes 5 patties]
Ingredients 14 oz Canned salmon (bones removed, if needed) 1 cup Quick oats 1 tsp Dried dill 1 Egg, lightly beaten 2 tbsp Low-fat milk ¼ tsp Salt 2-4 tbsp Canola oil Black pepper to taste
Instructions 1. Drain salmon. Remove bones, if required. 2. Combine salmon, oats, dill, egg, milk, salt, and pepper in a medium bowl. Mix thoroughly. 3. Shape into 5 patties. 4. Cook in a small amount of oil in a hot pan. 5. Flip when the first side has cooked to golden brown. Serve immediately when second side is done cooking (approximately 7 minutes per side).
Helpful Hints Allow your kids to make a “fancy” dinner tonight. ~ Have them take your order, set the table and pour the water or milk you ordered. ~ Set out all of the ingredients for the burgers in bowls on the counter and allow them to pour them all into one big bowl. Let them use their hands to mix up and form the patties (after washing their hands, of course). ~ Assist them in cooking the salmon burgers while encouraging them to arrange the plate and serve it to you.
Dinner took a little longer than 10 minutes to prepare, of course, but less than half an hour. Although I only had 10oz of salmon instead of 14, I still ended up with 5 patties. Unfortunately, these didn't hold together well during cooking, and I found them under-seasoned (may be due to operator error). The mashed potatoes were fast and delicious, and the flavored water tasted sweet thanks to the sucralose (aka Splenda). The asparagus were the big disappointment of the night, coming out of the can a dingy gray-green color and only made more damp by my trying to steam them. I suppose some hot sauce could have livened up the taste, but there was nothing to do for the texture. The can advertised itself as a single serving, but we got three out of it, and I threw the rest away in favor of the canned carrots with the leftover patties.
Nutritionally, I estimated 340 kcal per serving, including a tablespoon of ketchup for the patties, but >50% recommended daily value of sodium. For $5 per serving, that's not bad, although I can understand why this was pitched as a "fancy" meal, given the trouble it takes to make the salmon burgers. While I do not think I have much of a sense of what it would be like to rely on a convenience store for the majority of my diet--when a fast-food burger with lettuce and tomato might provide a rare opportunity for fresh produce--I do feel that I could better navigate a conversation with a patient about what is and isn't possible given the constraints of food apartheid.
Read more about this medical school elective here.
