The study, published in SSM – Population Health by a research team led by John Pastor Ansah of Case Western Reserve University and University Hospitals Medical Center, is among the first to model urban food access as a dynamic system rather than a static snapshot. Using a technique known as system dynamics modeling, the researchers built a mathematical representation of how household income, food prices, grocery store viability, emergency food networks, and demographic change interact and reinforce one another over time. The model was calibrated with data from the U.S. Census Bureau, County Health Rankings and Roadmaps, the U.S. Department of Agriculture, and Ohio state sources, then run forward across a thirty-year horizon from 2015 to 2045.

Cleveland offers a stark testing ground for such an analysis. With a poverty rate exceeding 30 percent, more than double the national average, it ranks among the poorest large cities in the United States. Roughly 10.2 percent of U.S. households experienced food insecurity in 2021, but rates are substantially higher among Black and Hispanic households, and post-industrial cities like Cleveland concentrate the structural conditions—segregation, disinvestment, retail decline—that make nutritious food scarce where it is needed most. In many neighborhoods, residents depend on convenience stores, dollar stores, and fast-food outlets offering calorie-dense but nutrient-poor products, a pattern linked to elevated rates of obesity, diabetes, and cardiovascular disease.

The model’s architecture reflects this reality. It tracks the city’s population as two shifting stocks: people with adequate access to healthy food and people with limited access. Flows between these states are governed by birth and death rates, net migration, and transition rates modulated by the quality of the food environment, nutrition education, and support from food banks and pantries. Beneath this demographic layer sits an economic engine: food affordability is modeled as the proportion of households spending no more than 12 percent of income on food, a threshold reflecting typical expenditure shares in high-income countries. Healthy food costs, calibrated from USDA data for an average family of 2.4 people, rise with inflation, while household income grows through wages and Supplemental Nutrition Assistance Program benefits distributed across twelve income groups.

The most provocative insight lies in a feedback loop connecting charity to decline. As food becomes less affordable, demand for food banks and pantries rises. But the model proposes that expanding free food distribution can erode the customer base of grocery stores selling healthy food, straining their finances and pushing them toward closure. Each closure lengthens the average distance residents must travel to reach fresh produce, deepening food insecurity and driving yet more reliance on emergency food. The model’s authors are careful to stress that food banks play a vital, even life-sustaining role in the short term; the danger emerges when charity operates as a substitute for structural income and market interventions rather than a complement to them.

Under the business-as-usual scenario, the projections are grim. The share of households spending 12 percent or less of income on food falls from 27.4 percent in 2025 to just 15.6 percent by 2045, while the city’s food environment index collapses by roughly 53 percent. Limited access to healthy food climbs from 7.3 percent of residents to 17.7 percent. Meanwhile, the availability of unhealthy food outlets rises from 48.5 percent to 61.7 percent, full-service grocery stores dwindle from 21 to 8, and food banks and pantries multiply from 151 to 273 as the emergency system strains to absorb escalating need.

The intervention scenarios reveal a clear hierarchy of effectiveness. Simply doubling food bank funding cuts limited access modestly, to 14.6 percent, but leaves affordability untouched and even accelerates the underlying deterioration: in that scenario, grocery stores fall to just 5 and unhealthy outlets reach 64.1 percent. SNAP Double Up programs, which match benefits when spent on fresh produce, barely move the needle at all. Retail-focused incentives—grants and low-interest loans to keep grocery stores open—perform better, nearly tripling the number of stores by 2045 and trimming limited access to 13.4 percent. But the transformative results come from income. A substantial income increase, modeled as a shift toward higher earnings through federal and state economic and educational policies, lifts affordability to 46.1 percent—a 195 percent improvement over the baseline—cuts limited access to 6.1 percent, and reverses the retail exodus.

Most striking of all is the comprehensive scenario combining income growth, SNAP Double Up, grocery store incentives, and food bank funding. Together these policies cut limited access to healthy food by 82 percent relative to the status quo, raise the food environment index by 242 percent, and push affordability to 44.7 percent. Grocery stores recover to 20, unhealthy outlets recede to 37.5 percent, and even the emergency food network contracts back toward 170 pantries, a sign that fewer residents need the safety net at all. No single intervention achieves anything close to this; the model suggests the reinforcing feedback loops that drive food insecurity can only be broken by attacking income, retail viability, and assistance simultaneously.

The findings carry weight well beyond Ohio. Roughly half of Cleveland households earn $40,000 or less annually, and two-thirds earn under $60,000, meaning food consumes a disproportionate share of family budgets even before shocks like inflation. The researchers argue that policies strengthening household purchasing power—wage growth, workforce development, and income supports, including evidence from programs like the Alaska Permanent Fund dividend and municipal guaranteed-income pilots—may be as important to food security as anything that happens within the food sector itself. Unconditional transfers may be particularly effective, they note, because they reduce the financial uncertainty that leads households facing what psychologists call extrinsic mortality risk to prioritize immediate survival over long-term health investments.

The authors caution that their results are scenario-based insights rather than forecasts, and that the intervention scenarios are stylized policy experiments, not predictions of specific programs’ real-world feasibility. The model treats food access at an aggregate level and does not yet disaggregate by race, neighborhood, or household type, though community stakeholders—including residents of affected neighborhoods—helped shape its structure through group model-building workshops held in November 2023 and February 2024. Future work, the team suggests, could combine system dynamics with microsimulation to capture how policies affect different socioeconomic groups. For now, the message is unambiguous: food banks feed Cleveland today, but only incomes, supported by a stable retail landscape, can feed it tomorrow.

Subject of Research: System dynamics modeling of urban access to healthy food in Cleveland, Ohio

Article Title: Modeling the Dynamics of Access to Healthy Food. The Case of Cleveland, Ohio

Article References: Ansah, J. P., Rua, R. S., Patki, A., Yamoah, O., & Rajagopalan, S. (2026). Modeling the Dynamics of Access to Healthy Food. The Case of Cleveland, Ohio. SSM – Population Health, Article 101964. https://doi.org/10.1016/j.ssmph.2026.101964

Image Credits: AI Generated

DOI: 10.1016/j.ssmph.2026.101964

Keywords: food insecurity, food deserts, system dynamics, Cleveland, food affordability, grocery stores, food banks, SNAP, health equity, simulation modeling, income policy, food environment