Skip to main content
Skip Navigation

Cross-cities comparisons are useful when designing and promoting healthier local food environments

Researchers at the Johns Hopkins Center for a Livable Future (CLF) and the University of Alcalá examine the differences between food purchasing options in Baltimore, MD and Madrid, Spain

Jun 29, 2016


According to a new study published in the journal Preventive Medicine, supporting and improving small-sized food stores and public markets as a healthy food source may improve food environments in U.S. cities and abroad. Researchers examined food access in median neighborhoods in Madrid, Spain, and Baltimore, Md., to understand what factors promote healthier food environments.

The team of researchers found that, compared to those in Baltimore, residents in the Madrid study area had a denser and more evenly distributed local food environment, with greater pedestrian access to healthy foods and to a larger variety of food store types. The presence of public markets and small food stores in Madrid (selling mostly fruits, vegetables, and fresh foods) contrasted with the high density of corner stores in the Baltimore, which are often a source of cheap, highly processed, and nutrient-poor foods.

The results of geocoding and in-store (or market) audits also show that 77% of residents in Madrid could reach a healthy food store by walking less than 200 meters. In contrast, only 1% of the residents in Baltimore could access a healthy food store within 200 meters. In the Baltimore study area, 82% of residents lived at a distance of 800 meters from a store carrying fruits and vegetables. These results highlight that the ability to purchase healthy foods in Baltimore is highly dependent on car use. 

Co-author and CLF-Lerner Fellow Usama Bilal notes, “As a native Spaniard, former Madrid resident, and someone who now lives in Baltimore without a vehicle of my own, I have been personally able to see the difference in access to healthy foods between these two very different cities. Having healthy, easily available options, even at small corner stores, is imperative for personal and community health.”

Researchers expect that the results will promote interventions from local city agencies to allocate resources to existing small-sized food stores, and to create walkable urban environments. These actions may influence food choices, especially for those residents lacking access to private vehicles or convenient and affordable public transportation.

“We are looking at large-scale problems to find large-scale solutions,” says co-author of the study and CLF’s founding director, Robert Lawrence, MD. “While individual access to healthy, fresh foods is important, it compounds neighborhood problems when an entire sector of a city lacks access. Food deserts are one of those large-scale problems, particularly for Baltimore. By placing one healthy store in a central location in a neighborhood, you can improve the health and lives of an entire community.”

Understanding differences in the local food environment across countries: A case study in Madrid (Spain) and Baltimore (USA)” was written by Julia Díez, Usama Bilal, Alba Cebrecos, Amanda Buczynski, Robert S. Lawrence, Thomas Glass, Francisco Escobar, Joel Gittelsohn, and Manuel Franco.

An accompanying audioslides presentation to the article is available at: