Dealing with Disparities in Food Acquisition Among Refugees (DDFAR)

Window-Buffalo NY, Rik-shaw, 2012, Modified.

Window-Buffalo NY, Rik-shaw, 2012, Modified

Recent Publication

Alexandra Judelsohn, Heather Orom, Daniela Leon & Samina Raja (2020) Refuge in new food environments? The role of urban planning in facilitating food equity for new Americans, Journal of Urban Affairs, DOI: 10.1080/07352166.2019.1705845

At the end of 2014, 19.5 million people were reported to be refugees in the world, and the number has continued to rise.  In 2014, 4,085 refugees were resettled in New York State, with Erie County receiving the highest number. Resettlement is meant to be a durable, long-term habitation solution so refugees can lead full, healthy lives. However, refugees are often resettled in neighborhoods that expose populations to a variety of health risks. 

In Erie County, refugees are resettled on the East Side and West Side of Buffalo, where the housing stock is older with greater likelihood of lead and asbestos use compared to the rest of the county. Soil and water bodies in such neighborhoods tend to be contaminated with heavy metals and other toxins, and fewer amenities, such as supermarkets, are available. It is plausible that the “durable long-term habitation solution” that resettlement is intended to offer may, in fact, be placing refugees at place-based chronic health risks.

Of concern to this project is the way in which the post-resettlement experience shapes food-related experiences of refugees. Existing literature suggests that exposure to new low-cost low-nutrient dense food, low socioeconomic status, limited employment opportunities,viii and delayed acculturation leads to chronic diseases among resettled refugees. The formation of diet-related chronic disease among resettled refugees is well documented in the public health literature. However, existing scholarship on refugee health explores diet-related outcomes and dietary behaviors largely through the lens of a single discipline - a shortcoming we intend to address.

Our proposal seeks to gain a broad understanding of how Burmese-American residents acquire healthy, affordable, and culturally acceptable foods in their new country. A pilot project will characterize the food acquisition practices of Burmese-Americans at least six months post resettlement. We will explore how these food acquisition practices, and perceptions of health risks tied to food acquisition practices are influenced by their environment, their membership in co-ethnic networks, cultural preferences, and personal history of trauma. Ultimately, we intend to use the pilot data to develop more comprehensive projects that explore how food-related disparities among refugee populations may be alleviated through local government policy reform.

The public health literature tends to emphasize the role of individual decision making in diet decisions although a growing body of literature has begun to examine the role of broader social and environmental determinants on health. On the other hand, existing urban planning and policy literature has an overly deterministic view of the link between built environment and human health, and fails to acknowledge the complex factors that drive health behaviors. Existing literature also creates a disempowering narrative that largely views low-resource individuals, including immigrants and refugees, as having no agency/ability to improve their new habitat. Our proposal will address these disconnects by bringing together a transdisciplinary group of scholars to concurrently gain a broader understanding of the social and environmental drivers that influence access to affordable, nutritious, and culturally acceptable foods for Burmese-Americans, while seeking to highlight and support the ability of Burmese-Americans to be forces of change within Buffalo’s neighborhoods.

DDFAR is a transdisciploinary exploration of the influence of social, environmental, cultural and personal determinants on food acquisition practices among the Burmese Americans. This project was funded by the Community for Global Health Equity with an aim to examine how Burmese-American residents acquire healthy, affordable, and culturally acceptable foods in the city of Buffalo.  In particular, DDFAR focuses on examining how Burmese-Americans adapt food acquisition practices in a new country, how they perceive health risks that are tied to these practices, and how these practices may change their food environment.

Articles and Reflections

When I started my first week of primary care as a resident physician, I was not expecting to use greetings such as “Bonjour” and “Ahlan wa Sahlan” as part of my interactions with my patients, but that was the reality of working in a city that is ranked among the top ten places for refugee resettlement.

Publications and Presentations

Alexandra Judelsohn, Heather Orom, Daniela Leon & Samina Raja (2020) Refuge in new food environments? The role of urban planning in facilitating food equity for new Americans, Journal of Urban Affairs, DOI: 10.1080/07352166.2019.1705845


In the United States, resettled refugees arrive in designated resettlement cities where they can in theory start a new life with support systems in place. Although refugee resettlement agencies are the main point of contact upon arrival, agencies are mandated to work with refugees for 90 days. Traditionally, local governments have not had purposeful contact with resettled refugee populations, yet the policies they enact and built environments they shape impact the lives and health of resettled refugees in myriad ways. As resettled refugees adjust to new ways of life, local governments can support plans and policies that reinforce healthy lifestyles. Multiple studies show that, among resettled refugee populations, acculturation of diet leads to increased risk of chronic disease. Furthermore, resettled refugee populations may be especially susceptible to experiencing cultural and economic inequities that ultimately contribute to food disparities, possibly leading to detrimental health outcomes. We explore the extent to which local governments in major U.S. resettlement cities consider the needs of resettled refugee populations in planning, particularly in regard to how planning influences food security, nutrition, and food-related and health concerns. Using a mixed-methods approach, we first conduct a review of the comprehensive plans of 10 cities that resettled the most refugees between 2012 and 2016 to determine if and how local governments are planning for resettled refugee populations. With an in-depth case study of the city of Buffalo, we explore the nuances of the findings from the review of comprehensive plans. For this deep-dive case study, interviews and a focus group were conducted with refugees from Burma to gain an understanding of how local governments and civil society groups plan for new American populations, particularly in terms of their food and health. Results carry implications as to how local governments can better serve resettled refugee populations through comprehensive planning.

Orom, H., Judelsohn, A., Raja, S., Kim, I., Diaz Del Carpio, R. (November, 2018). Opportunities for supporting a healthy diet among refugees from Burma. Paper to be presented at the annual meeting of the American Public Health Association, San Diego, CA.


Background: Over the past decade, refugees from Burma have been the largest single refugee group resettled to the US. There is concern that food insecurity and dietary acculturation will increase morbidity and mortality from chronic disease in this population. The purpose of this study was to explore opportunities for promoting healthy eating in refugees from Burma. Method: We conducted 28 semi-structured interviews and 1 focus group with 33 refugees from Burma living in Buffalo (5 ethnicities, 85% female, aged 28-72). We examined beliefs about the relationship between food and health and participants’ dietary habits. Interviews were conducted in in Karen, Burmese or English and were simultaneously transcribed and translated. We used a structured codebook and thematic analysis to analyze the transcripts. Results: Participants’ perception of the relationship between food and health was both similar and divergent from that of Western healthcare. Most, but not all participants perceived an important relationship between diet and health and discussed the value of eating vegetables and limiting sugar and fat. However, they did not attribute heart disease risk to diet, and risks associated with white rice and high salt foods were not discussed. Cost of vegetables, dental problems, and growing preference for processed American foods were barriers to heating a healthy diet. Discussion: Given conceptualizations of sugar and fat as unhealthy, health education about processed and convenience foods may be well-received. Community gardens and economic development may have downstream effects on promoting healthy eating and chronic disease prevention in this population.

Orom, H., Schmit, L., Judelsohn, A., Sosnowski, N. A., Aye Nay Na Sa, Kim, L., Diaz Del Carpio, R., Raja, S. (April, 2018). Awareness of chronic disease risk is low among Burmese refugees. Poster presented at the annual meeting of the Society of Behavioral Medicine, New Orleans, LA.

Refugees and Food Experiences Publication, Growing Food Connections, April 2018.

Entress, Sharon, Alexandra Judelsohn, Brenda Stynes and Samina Raja. “Refugees and Food Experiences: Insights from Research in Buffalo, NY.” Translating Research for Policy Series. Growing Food Connections Project, 2018.

Local governments can build capacity of individuals and networks in refugee communities to improve access to culturally preferred, nutritious foods in resettlement cities.

Planning the City of Good (and New) Neights, Journal of Built Environment.

Judelsohn, A., Orom, H., Kim, I., Sa, A., Khan, H., DeVito, R., Diaz, R., Raja, S. (2017) Planning the City of Good (and New) Neighbours: Refugees' Experiences of the Food Environment in Buffalo, New York. Built Environment 43(3), 426-224.


The United States has resettled an average of 62,000 refugees per year over the past decade, one-quarter of whom originate from Burma. Although refugees from Burma sometimes migrate from places lacking food-related resources, their resettlement in the United States, where processed foods are abundant, may have unanticipated negative dietary and health consequences. Studies suggest that refugees decrease their intake of fruits and vegetables after they have resided in the United States for a certain length of time, which constitutes an Americanization of diet. With little preparation for navigating Western-oriented food environments, resettled refugees from Burma may be especially susceptible to cultural and economic inequities that ultimately worsen food-related disparities.

We explore the experiences of refugees from Burma in navigating food environments in the United States, and explore the extent to which local governments are supporting or hindering their access to culturally preferred, nutritious foods. This paper presents a qualitative case study of Buffalo, New York, based on open-ended interviews with refugees originating from Burma, local government officials, and representatives from civil-society groups. The results suggest that resettlement cities may create food inequities for refugees from Burma, but that civic and social networks help refugees to adapt to their new food environments. Local government efforts are lagging in planning for and with refugee communities. We conclude with suggestions for how local governments and researchers can promote food equity for resettled residents.

Our Team

Heather Orom

Associate Professor and Director of Graduate Studies

Department of Community Health and Health Behavior

304 Kimball Tower Buffalo, NY 14214

Phone: 716-829-6682; Fax: 716-829-6040



Alex Judelsohn

UB Alumna

Food Systems Planning and Healthy Communities Lab

Samina Raja

Co-Director and Founding Co-Lead, Community for Global Health Equity; Co-Lead, Food Equity Team; Project Lead, Plan REFUGE; Professor

Urban and Regional Planning

233C Hayes Hall

Phone: 716-829-5881


Isok Kim

Associate Professor

School of Social Work

667 Baldy Hall

Phone: 716-645-1252


Roberto Diaz Del Carpio

Clinical Assistant Professor

Department of Medicine

Hertel Elmwood Internal Medicine Center 900 Hertel Ave. Buffalo, NY 14216

Phone: 716-871-1571