On the United States’ largest Native American reservation, there are 13 full-service grocery stores. To many Americans, this number might seem like enough — a reservation is like a town, right?

For the Navajo Nation, 13 stores is a devastatingly inadequate number. If the reservation was located in New England, it would almost entirely cover the states of Massachusetts, New Hampshire, and Vermont. This land, where the Navajo people were forcibly resettled by the U.S. government in 1868, covers over 27,000 square miles stretching from northeastern Arizona into Utah and New Mexico and is home to more than 300,000 people.

With so few full-service grocery stores, the reservation is a food desert on a massive scale. The average resident has to drive three hours just to buy food at the grocery store, and extreme poverty on the reservation limits access to many foods like fresh produce. Most caloric needs are met by shopping for chips and soda at trading posts and picking up treats like piccadilly at roadside stands and trading posts.

On the national level, a quarter of Native Americans are experiencing food insecurity. Native Americans are over two times more likely than white Americans to have diabetes. Health struggles among the Navajo people are no different, as half of Navajo children are unhealthily overweight. One in five Navajo adults have diabetes — the third highest rate in the world.

Many of the Najavo people’s economic and health struggles can be directly traced to the neglectful and violent way the U.S. government has treated the tribe for centuries. For example, the Navajo Taco dish has a dark history, as it was created out of necessity when the Bureau of Indian Affairs was rationing the tribe’s access to food staples like flour and salt.

But far from passively accepting this assault on their health and their lives, the Navajo people are taking actions to increase their access to nutritious food. The Navajo Nation Council eliminated produce taxes and passed the United States’ first tax applying to both sugary beverages and low-nutrition snacks in 2015.

Even more revolutionary is that reservation residents can get prescriptions for fresh produce from their doctors. With the Fruits and Vegetables Prescription Program (FVrX), doctors give patients vouchers that they can use at the store and receive a month’s worth of free produce for their families. The program is paid for by grants from the Centers for Disease Control and Prevention and other organizations.

As of 2018, nearly 1,700 Navajo people had benefited from the FVrX program, and a third of overweight children in the program reached a healthy weight after six months. It was adopted by 15 health clinics, and produce prescriptions can be filled at 26 grocery stores and trading posts.

Programs like FVrX can help fill the gaps in populations like the Navajo that suffer from widespread and extreme poverty. But it’s reaching less than 1% of residents after three years in operation, and it’s not a sustainable solution for food insecurity across the whole reservation.

Resource scarcity on the Navajo Nation is a systemic problem that requires systemic solutions. Residents who live too far from a full-service grocery store to regularly shop there won’t benefit much from reduced taxes and free produce. And with at least 10% of people on the reservation living without electricity and/or access to safe water, struggles with storing and cleaning produce may prevent FVrX from reaching its full potential.

In a different climate, growing one’s own produce might be a solution for many households, but the reservation’s location in the desert makes that more difficult. Difficult, but not impossible, as programs like the Adopt-A-Sonoran-Desert Crop Program allow Arizonans to grow and eat their own sustainable, desert-resistant crops and could potentially be adapted to the Navajo​​​​​​​ Nation.

On the systemic level, the answer seems glaringly obvious: the reservation needs more than 13 grocery stores. But it’s unlikely that new grocery stores or healthy restaurants will start popping up in the rural corners of the reservation, especially since many businesses offering more pricey wares like fresh produce are unlikely to invest in a population with a median household income of around $27,400.

For now, programs like FVRx will attempt to fill the gaps left by American colonialism and systemic violence against the Navajo people. But more structural changes are required to ensure that no one must drive three hours just to buy vegetables for dinner.