A confluence of food hardship, poverty and housing shortens lifespans in Winston-Salem

This story is part of a series on food insecurity and possible solutions in Forsyth County, reported, written and photographed by Wake Forest University journalism students. The series was part of a semester-long class was taught by Newsline Environmental Investigative Reporter and Assistant Editor Lisa Sorg. The series will run throughout the week.

Tawanna Archia has witnessed the hard choices that low-income Forsyth County residents face when trying to get enough to eat.

“A lot of times, these residents have to make a choice between paying for medication or buying groceries — or do I pay my rent today and not get medication…?” Archia, the Healthy Forsyth program manager said. “And then, even if there are available food pantries, a lot of times they don’t have the transportation to go get there.”

A Healthy Communities report showed that the census tract with the greatest Food Hardship index also had the highest poverty rate — 85.7% — and the highest percentage of people with severe housing problems — more than 63%.

Healthy Forsyth, was established in 2023 with the goal of addressing hypertension, diabetes and mental health in three underserved areas of the city. The group held community conversations last fall and is meeting with local residents to discuss ways to combat these problems.

Many local residents don’t have access to nutritious food. Malnutrition or a poor diet could shorten lifespan and contribute to the development of many chronic conditions, including obesity, cardiovascular disease, hypertension, stroke, Type 2 diabetes, metabolic syndrome, some cancers, and mental health issues.

According to 2021 Forsyth County Community Health Assessment, overall death rates due to chronic diseases were higher than the state average, and life expectancy was lower. (The next Community Health Assessment is scheduled for 2025.) Disparities in access to affordable health care, safe housing and nutritious food also contributed to higher death rates for Blacks than whites. This was especially acute in in zip codes 27101, 27105 and 27107, where “he African-American and Spanish-speaking community has the highest rates in these chronic health conditions,” Archia said. And the Healthy Communities report showed a stark disparity in life expectancy between one of the poorest census tracts and the more affluent: 67.9 years for east-central Winston-Salem compared with 84.6 in the western part of the city.

Many of these same areas also lack fully stocked groceries with fresh produce. Instead, these neighborhoods are dominated by convenience marts and dollar stores that sell highly processed food.

Archia emphasized the importance of community members’ experiences in barriers to healthy food that could otherwise be overlooked. “I spoke to a doctor last week who said he suggested somebody go for a walk and they said, ‘Well, we don’t have sidewalks. It’s not safe.’ Or, ‘There’s gun violence,’” she said. “You can’t tell somebody who has those barriers to go outside and walk. But what are some things you could do inside?” Archia said.

Healthy Forsyth also added mental health to its list of chronic conditions that could be worsened by malnutrition, and “to address some of those other overlapping disparities and the intersection that happens with all diseases also because of social determinants of health,” Archia said.

Data from the 2019 Winston-Salem/ Forsyth County School Youth Risk Behavior Survey shows that 22.5% of middle school students have seriously considered attempting suicide, 14.1% have made a suicide plan, and 11.5% have attempted suicide at some point in their lives. Although several factors contribute to depression and suicidal thoughts, such as bullying and other forms of violence, nutritional deficiencies, such as vitamin B12, B9 and zinc can also contribute to low mood, fatigue, cognitive decline and irritability. Diets high in processed foods are correlated with an increased risk of depression, while diets high in whole foods have been found to be correlated with protecting against developing it.

The survey responses of the middle school students were believed to largely mirror student behavior. Because students took the survey anonymously, they are very open about their thoughts, feelings and behavior,” Lovette Miller, Epidemiology & Surveillance Director at the Forsyth County Department of Public Health, said in an email.

Though Healthy Forsyth is a new organization, Archia hope its solutions will be revolutionary.

“We’re looking at behavior change, and behavior change takes a lifetime,” said Archia. “You can’t undo in a day. So it’s not about quick fixes or quick numbers… Being able to educate people on lifestyle changes that are sustainable and livable — and affordable — is what, for me, is a little bit more unique.”