IF YOUR nearest grocery store were 10 miles away, and you lived across the street from a McDonald's and a Quickie Mart, how often do you think you'd pile the kids into the car to go buy fresh fish and sweet potatoes for dinner?

The California Center for Public Health Advocacy (CCPHA) refers to the collective food venues in a given neighborhood as its "food landscape," and it includes everything from fast-food restaurants and convenience stores to supermarkets and farmer's markets. Mounting evidence suggests that this landscape plays a significant role in influencing our food choices and corresponding rates of obesity and Type II diabetes. According to the Center's January 2007 policy brief, "To act on a decision to eat a nutritious diet, the consumer must have information about the nutritive value of a food choice and be able to find and afford it."

In 2005, California had more than four times as many fast-food restaurants and convenience stores as supermarkets and produce vendors, and the types of food businesses varied dramatically from region to region. If one region has 10 drive-throughs for every grocery store, where do you think most residents will get their food? By the same token, neighborhoods with few supermarkets are often teeming with convenience stores, but it's hard to make a balanced meal from a Twinkie and a Red Bull.

Of course, food landscape is inextricably intertwined with race and class, with immigrant-heavy and poor communities disproportionately lacking access to healthy food choices. In fact, according to California State Assemblyman Kevin de León and Martin Martinez, policy director of the Oakland-based California Pan Ethnic Health Network, many immigrants who were poor in their home countries see their health decline once settled here. In some neighborhoods "it's easier to buy a burger than an apple," Martinez said at a public hearing last week.

If you think Santa Clara County is immune to these problems, think again. State Senator Elaine Alquist (D–Santa Clara) says that 24.7 percent of children in the county are overweight. These are the same children at highest risk for later developing what she terms "diabesity."

Fortunately, there is hope, and progress churns forward on multiple fronts. The California Pan Ethnic Health Network, for one, is working to expand access for communities of color by ensuring that nutrition messages are delivered in linguistically and culturally appropriate ways. And Kaiser Permanente, the managed care giant, has opened 17 farmers markets on hospital grounds in diverse communities all over Northern California (as well as in four other states), including two in Silicon Valley (in Santa Clara and San Jose). Much more work is needed, of course. In the mean time, keep in mind that not everyone eats a Big Mac because they like the way it tastes—sometimes it's the only game in town. And that's one landscape that really needs to change.

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