Data show that the food desert environment is correlated with high risk of diet-related illness in low-income urban communities. Using an empirical model of grocery purchasing decision processes, we explained how specific components of the economic and structural environment influenced purchasing decisions that conflicted with shoppers understanding of healthy eating. In this paper we describe how the policy environment and suppliers influence purchasing; why interventions to increase healthy purchases must be designed using an understanding of food desert system dynamics; and why several intervention approaches are incomplete. We recommend a complex of evidence-based strategies to facilitate healthy purchasing in urban American food deserts.


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