Beyond Availability: Effective Access, Provisioning Systems, and Dietary Inequality

Food policy often assumes that increasing retail availability of nutritious foods will translate into healthier consumption. Nevertheless, physical presence does not necessarily lead to their incorporation into everyday diets, particularly among economically vulnerable populations. This article develops a provisioning-systems framework to explain this gap. Drawing on macromarketing perspectives on market-mediated inequality, it proposes effective access as an interpretive concept examining healthy food consumption as a socially structured capacity arising from the relationship between provisioning conditions and household capacities. The framework considers four dimensions: material availability, economic affordability, retail usability, and cultural desirability. It is examined through a convergent mixed-methods study across six districts of Paraguay, combining retail audits of 26 establishments, surveys of 432 consumers, price analyses of 338 products, and contextual field observations. Findings indicate that widespread availability can coexist with affordability constraints, heterogeneous retail pricing, uneven retail organization, and food practices that limit routine fruit and vegetable consumption.