Food environment on the rural Great Plains

Rural Health
Small Towns

Jon M Bailey looks at food access and security in rural and non-rural counties of the Great Plains. 

Food is a major component of health and healthy living. Consumption of healthy foods and a balanced diet will limit obesity, accompanying health issues, and premature death. But not all people have equal access to healthy foods or live in a healthy food environment.

Previous research has shown strong evidence that residing in a food desert – where you lack access to grocery stores or other food outlets that provide healthy foods – is correlated with a high prevalence of obesity and premature death. Supermarkets traditionally provide healthier options than convenience stores and some smaller grocery stores.

Food insecurity, the lack of access to a constant source of healthy food due to low income and/or location, can be another barrier to healthy food access. Food insecurity is related to negative health outcomes such as weight-gain (and all health conditions that go with that) and premature mortality.

The ability of individuals and families to provide consistent balanced meals is also an important component of healthy eating. Research has shown that while the consumption of fruits and vegetables is important, it may be equally important to have adequate access to a constant food supply.

Based on the importance of access to healthy food, the 2015 County Health Rankings added a Food Environment Index as a variable in determining the relative health of all US counties. The Food Environment Index, with a range of 0 (worst) to 10 (best), is composed of two indicators of the local food environment:

  • Access to healthy foods, measured as the percentage of the population who are low-income and do not live close to a grocery store. In rural areas, it is defined as living less than 10 miles from a grocery store. In urban areas, it means less than 1 mile. Low income is defined as an annual family income of less than or equal to 200% of the federal poverty level ($48,500 for a family of four in 2015).
  • Food insecurity, as measured by the percentage of the population without access to a reliable source of food during the past year.

The data in the table below shows the Food Environment Index scores for the top 10 counties and the bottom 10 counties (and ties) in nine Great Plains states: Colorado, Iowa, Kansas, Minnesota, Montana, Nebraska, North Dakota, South Dakota, and Wyoming.. The closer a county is to 10, the better its access to healthy food and less food insecurity for its residents.

Food Environment Index Scores for the Great Plains (10 Best, 0 Worst)

State State overall Index score Bottom 10 county avg Bottom 10 county rural avg Top 10 county avg Top 10 county rural avg
CO 7.4 4.86 4.71 8.21 8.10
IA 7.8 6.71 6.47 8.75 8.69
KS 7.2 4.46 4.41 8.53 8.64
MN 8.3 6.98 7.00 9.21 9.20
MT 7.2 4.13 4.12 7.90 7.90
NE 7.8 4.04 4.04 8.59 8.57
ND 8.5 6.12 6.12 9.37 9.37
SD 7.4 2.97 2.97 8.32 7.20
WY 7.7 7.28 7.23 8.26 8.26

Source: 2015 County Health Rankings

Rural areas of the region generally have much worse scores in the Food Environment Index. This can be seen in the rural dominated bottom 10 county averages compared to the more urban top 10 county averages for each Great Plains state.

In most cases these differences are significant. The food challenges rural areas of the region experience are not surprising – a major number of low-income residents, few if any comprehensive healthy food purchasing options, and vast distances to healthy food purchasing options. 

However, rural county averages in the bottom 10 counties in Minnesota, Iowa, and North Dakota are most interesting. While still lagging the top 10 averages, and even the rural county averages in the top 10, the rural bottom 10 averages in those states are still healthy Index scores. They were over 6 in Iowa and North Dakota, and 7 in Minnesota. It's worth exploring what those states and rural communities are doing to meet the usual rural food challenges.

Other Observations:

Overall scores for North Dakota and Minnesota both stand out at over 8. Otherwise, the overall state Index scores are comparable for each state – a few tenths of a point on either side of 7.5.

90% of the bottom 10 counties (and ties) are rural or small city counties. The remainder are big city counties. The top 10 counties (and ties) are also dominated by rural counties with 69% of that category being rural or small city counties. That is to be expected given the rural nature of the Great Plains. The vast majority of counties in the Great Plains are rural or small city (also called micropolitan).

The top 10 county category also contains numerous high-income counties that are suburbs of the major cities of the region – Denver, Minneapolis-St. Paul, Kansas City, and Omaha. These counties have few low-income residents and numerous food sources.

Major cities of the region are inconsistent. Counties with major cities are generally not included in either category. They contain numerous higher-income residents and food sources, especially compared to rural counties. But big cities also have a large number of low-income residents and areas devoid of comprehensive healthy food sources (the urban “food desert’).

The significant difference in rural county scores in South Dakota is attributable to inclusion of five Native American reservation counties, among the lowest-income counties in the nation, in the bottom 10 South Dakota counties. For example, Corson County, South Dakota, home of the Standing Rock Reservation has a 0 Index score, the worst county Index score in the nation. North Dakota (2), Montana (2), and Minnesota (1) also have reservation counties included in their bottom 10 counties, but none with Index scores as low as the reservation counties in South Dakota.

The average of rural counties in the top 10 counties is healthy in every state, comparable to the overall top 10 average in each state. The rural counties in the top 10 of each state have the advantage of being small city counties and/or proximity to big city counties in each state. Thus they likely score better on the measure of access to healthy foods (living closer to comprehensive grocery stores) than other rural counties. Some rural counties in the top 10 lists tend to have higher incomes than other rural counties. The risk of food insecurity (both from income and distance) are less for these counties.

Jon M. Bailey is a rural policy and research expert and former Center for Rural Affairs Policy and Research Director. Contact him at