Social determinants of health are increasingly becoming part of the health care dialogue. Food insecurity is a critical one. Here’s how it has inched its way into popular culture.

I think about food a lot. I like to eat, try new things. I care about nutrition and sustainability. And, yes, I’ll admit: I enjoy reality TV shows, like BRAVO’s Top Chef. And that last one is the reason Roy Choi — Los Angeles street-food trailblazer – caught my eye in a recent article (he was a guest on a memorable Top Chef season 10 episode). As I read, I quickly realized that while this story was about food, it was about much more than that. It was a story about the social determinants of health.

Choi and Michelin-star chef Daniel Patterson are undertaking an impressive new endeavor – “to create a new fast-food chain that was good for you, good for the planet, and just as guilty-pleasure delicious as, say, Taco Bell’s Crunchwrap Supreme?” They plan to open this chain – called LocoL – in America’s food deserts.

Food Access – a Social Determinant of Health

The USDA defines food deserts as “parts of the country vapid of fresh fruit, vegetables, and other healthful whole foods, usually found in impoverished areas. This is largely due to a lack of grocery stores, farmers’ markets, and healthy food providers.”

What happens in food deserts is people tend to rely on unhealthful options, such as fast food, because it’s cheap and it’s there. This is part of what’s known as food insecurity, which can include the inability to access nutritional food (e.g., food desert), disrupted eating patterns, or reduced food intake.

Food insecurity is a critical social determinant of health. It worsens health outcomes and can have a number of repercussions on disease management, prevention, and treatment strategies. So the fact that Choi and Patterson are attempting to address this issue is noble – and important. But they aren’t the only ones.

Chefs and Hospitals – Unlikely Companions

Many essential hospitals have been working for years to tackle food insecurity among their patients. Because they are often the only health care providers for people living in impoverished areas, essential hospitals see this issue firsthand.

For example, at Boston Medical Center, families can visit the food pantry twice a month and receive three to four days’ worth of food – fresh fruits and vegetables in winter, meats year round. The pantry specializes in costly items low-income families can’t afford.


Eskenazi Health in Indianapolis has helped develop a 6,000-square-foot urban garden used to produce fresh, healthy food items for sale through local farmers’ markets and eateries and to engage community members in learning about gardening and healthy food. When Eskenazi built a new hospital building in 2013, it added a green roof complete with an organic sky farm, which will provide additional healthy food options for patients, visitors, and staff.

These are just two of many essential hospital initiatives to end food insecurity in impoverished areas.


There is a clear link between access to healthful food and health. And that is why hospitals, of all places, are tackling the food deserts in their communities. They are helping people gain access to nutritious foods and teaching them how to prepare healthful, tasty meals.

But, for better or worse, fast food is a part of our culture. And even with an affordable grocery store on every street, sometimes, fast food is just easier. That’s where LocoL comes in.

But What About the Taste??

It’s true. People love McDonald’s because it tastes good. And it’s cheap. How can you compete with that combination when you’re dedicated to making healthful, fresh food, which is bound to cost more?

The answer seems to lie within the communities themselves. Traditionally, people with lower incomes use less expensive ingredients, such as less-tender cuts of meat, when making meals. This food also incorporates a lot of seasoning to add flavor.

In the same vein, LocoL will operate on a zero-waste philosophy – meaning they will use all parts of whatever they buy, including those tough cuts, and they will combine traditional techniques with modern culinary science to bring out the best in the ingredients.

As Choi said, “Everything we buy, we use, and the things we use are going to be things we can shred, chop, braise, cook down, pickle, peel and turn into something else. We’ll transform bruised, misshapen vegetables into purées and sauces. We’ll buy off-cuts of meat and make them work.”

But, you may ask, if they’re using all cuts of meat, that means they’re using the less-healthful, fattier ones too. Yes, but as Choi explains, they cut those pieces with other ingredients. “Cutting the burger with cooked grains so that it’s not all meat. Processing the grains to the same size and mouthfeel as ground beef, then finding a way to bind it and emulsify it so it eats just like a regular patty. That obviously reduces cost and creates a healthier burger — but it also tastes just like a burger.”

“We wanted it to be addictive,” Patterson said. “You have to want to take another bite, and then another. We wanted it to be so good that someone who eats meat would willingly choose this instead. You wouldn’t even think of it. You’d just think of it as food.”

The Way Forward

LocoL is still a long way from being a reality. But in the meantime, essential hospitals are doing their best to fill some of the food gaps in our country. Chefs and hospitals – they’re surprising companions. But indeed their goals align, and perhaps together they can change our culture of food.