One grocery store in a community of roughly 25,000 people. This town has a poverty rate of 32%. The majority of the population is either Black or Latino. The median household income is roughly $33,000 a year, just $7,000 above Florida’s federal poverty line.
About 50 miles away in the same county, an affluent city bursts with life and luxury. The City of Naples has an average household income of $118,141 with a poverty rate of 8%.
Social determinants of health are a major reason why people born in one part of Collier County are expected to live 15 years longer than those in other parts of the county, according to life expectancy estimates from the U.S. Census Tract and the National Center for Health Statistics.
Examples of social determinants of health include safe housing, transportation, education, income, access to nutritious foods, physical activity opportunities, and language and literacy skills. These social determinants affect a wide range of health, functioning, and quality of life outcomes and risks. In a community like Immokalee, all these factors contribute to health inequity, specifically when it comes to food security.
Food security is dependent on availability, stability, and accessibility of food supplies, many of which are scarce or nonexistent in a rural, low-income area like Immokalee.
“People that have food insecurities and don't have the right funds to get the right nutrition, which is produce and fresh fruits because they're highly priced, unfortunately, tend to rely a lot on foods that are processed,” Carolina Pavon, a family nurse practitioner at Best Care Community and Family Health Center, said.
Immokalee resident Tracy McGhee understands this all too well. She's lived in Immokalee for more than 30 years and does all her grocery shopping at Winn-Dixie on Lake Trafford Road. This Winn-Dixie is the only major grocery store in Immokalee. McGhee said when she does have the option of eating out with her family, the main choices are some fast-food places. Those are located just a few miles from the grocery store. They include a Wendy’s, a Papa John’s, and a Popeye’s.
McGhee and Pavon said a wide variety of healthy foods are not as accessible to the Immokalee community as other places. The healthy items that are available are not affordable for some families. Accessibility and affordability also need to work in conjunction with stability, meaning a person has money and time to shop for healthy foods. This proves to be difficult for many residents like McGhee, who often work physically demanding jobs just to come home and worry about feeding their family on a time crunch and with limited resources.
“Prices are going so sky high,” McGhee said. “It's easier to go to a drive through to get your kid something to eat after school or when a family is working all the time. You don't get off until late, so they run through there.”
Immokalee resident Luis Escapita also shops at Winn-Dixie for his groceries. He said they have major deals on certain things. He added that sometimes they have deals on necessities, but most of the deals are on processed foods.
“Either you pay good money for what you really want or you pay for something cheap and pay the consequences later on,” Escapita said.
While some residents of Immokalee have limited options for healthy food, many people in the neighboring community of Naples have different experiences. Naples resident Alea Keith takes advantage of her options when it comes to grocery shopping.
“I actually do it a little bit of everywhere,” Keith said. “I go here (Walmart). I go to Whole Foods. I go to Trader Joe's. I go to Sam's Club. I go to Costco. So, I kind of run the gamut.”
Not only do Naples residents have more produce options, but they also have healthy restaurant options in the community. Keith and her family dine out in mainstream restaurants like Outback or some places on Fifth Avenue in Naples. She said her family enjoys going to Lake Park Diner, a casual eatery that focuses on quality and sustainable products, putting both health and the environment first.
Eating unhealthy, processed food affects the health of people, according Carolina Pavon, ARNP.
“It just promotes bad habits, bad habits that over time get passed on to our children and to the people we live around,” Pavon said. “Overall, it just creates bad repercussions when it comes to our health.”
In general, lower food security is associated with higher probability of chronic diseases such as hypertension, coronary heart disease, hepatitis, stroke, cancer, asthma, diabetes, arthritis, chronic obstructive pulmonary disease, and kidney disease, according to U.S. Department of Agriculture.
“Diabetes is something that as Latins, as Blacks, we are predisposed to it,” Pavon said. “The moment you start taking away the healthy foods and the healthy habits, then automatically you're already putting yourself at a higher risk of becoming a diabetic.” Pavon said food insecurity can come down to lack of money as well as lack of choices. "A lot of these communities have people who do not have documents and they work for small amounts of money,” Pavon said. “And so, I believe that's one of the factors.”
Pavon added that another factor is education; not knowing what certain foods are going to do to your body and your health over time.
“I think a combination of lack of education, the right education, lack of funds, and the lack of exercise contributes to poor eating and therefore the high incidence of obesity, diabetes, high blood pressure, and hypertension,” Pavon said.
Immokalee resident Escapita said that fast food is the most readily available to him and his community. Yet he said that even having healthier options on the menu does not make a difference.
“Even in a fast food joint a salad costs $8 versus a $1 burger,” Escapita said. “(Healthy options) They're available; scarcely. Affordable...No, they're definitely not affordable.”
Other people like McGhee agree. McGhee said when shopping for her family, she looks for the most affordable options, not the healthiest.
“Everything's going up so high,” McGhee said. “So you want the cheapest stuff. Unfortunately, when you go to a grocery store or a farmers' market, the most expensive things are the fresh meats, the produce, the fruits, the fresh fish, that's all very expensive,” Pavon said. “For a normal family with a medium income that could be a little taxing, especially in communities that are already underprivileged.”
Even some residents in Naples like Hannah Sherrill say that the healthier option isn’t always affordable.
“I would say that they're easily accessible,” Sherrill said. “But as far as cost, not always.”
While Sherrill said healthier foods are not always affordable, she did acknowledge that it is a privilege to have so many options available.
“Because maybe we can't afford it every week, or every time we go grocery shopping, but maybe sometimes we can or maybe in smaller amounts,” Sherrill said. “Maybe we have to supplement with less healthy food, but the fact that it's available just in general, obviously, it's going to help.”
While existing on the opposite side of the spectrum, some Naples residents, like Alea Keith, understand the issue of health inequity and how communities in their county need help. Keith said she has been to Immokalee once. “I think that they do need more grocery options, but they need more appropriate grocery options,” Keith said. “I think that they would be better suited to have more farm to table options in their community only at a more affordable price or to have community gardens that are open and free to the public.”
However she thinks the best course of action is to ask community members what they need. “The best thing is to ask the people,” Keith said. “Ask the people on the ground what are they seeing and how can they be helped and just try to find the best way to meet their needs.”
McGhee said Immokalee also needs recreation for healthier lifestyles.
“We used to have an skating rink here when I was younger,” McGhee said. “We don't have that now. Get something that the whole family can go out and participate in to get out moving.”
Some people, like Immokalee resident Luis Escapita, said change will only happen if it is a collaborative effort amongst outsiders and residents. “Everybody needs to come in and do their part,” Escapita said. “It can be a well-oiled machine but if the parts aren’t moving, you're not going to get anywhere.”
As far as organizations and healthcare experts wanting to make a difference regarding health inequities in Collier County, Immokalee residents say they want their voices heard.
“Come here and get feedback from everybody about what they could use here,” McGhee said. “They have to do something better out here.”