Relevance of social and structural determinants of health to the food safety facet of the human right to food in the U.S.: a narrative review

Having reliable and dignified access to safe, wholesome, and nutritious food is recognized by the United Nations as a basic human right. However, for millions of U.S. households, this right is undermined by social and structural factors that shape how the resources necessary for realizing the right to food are distributed across communities. Inequities in access to health-promoting resources and opportunities, such as earning living wages, receiving a high-quality education, being afforded gainful employment opportunities, having reliable means of transportation, and residing in proximity to healthful neighborhood food environments, underlie disparities in the right to food. Consequently, these inequities also underlie disparities in the burden of food-related diseases, that is, diet-related chronic diseases and, as we illustrate in this review, potentially also foodborne illnesses. We also note that it is plausible that inequities in access to healthcare and paid sick leave may contribute to reporting bias in foodborne illness surveillance data, potentially obscuring the true distribution and magnitude of disparities that may exist in foodborne illness burden. This narrative review aims to synthesize the contemporary literature exploring the relationships between social and structural determinants of health and both the burden of domestically-acquired foodborne illness and exposure to foodborne illness risk factors through the built food environment. Overall, the emerging literature suggests that several of the social and structural determinants of health found to drive disparities in diet-related chronic disease exposures and disease burden—such as socioeconomic status, rurality, features of the residential built environment, and the marginalization of specific communities on the basis of race and/or ethnicity—may also contribute to disparities in foodborne illness burden and exposure to foodborne illness risk factors. However, we caution that, at present, these relationships appear tenuous, vary somewhat by etiological agent, may be influenced by reporting bias, and, where evidence exists, are supported by limited literature. Nonetheless, there is some indication that, at minimum, additional research on this topic is warranted to investigate what may be underappreciated public health targets for foodborne illness prevention efforts.