A recent study indicates that people in Buffalo County may have less access to healthy food than people in any other county in the country.

On Tuesday, the County Health Rankings & Roadmaps (CHR) program released its 2019 data, which ranks counties across the country in a variety of health-related categories, from air pollution to obesity.

One of those categories, which CHR calls the food environment index, is calculated on a scale from 0 to 10 that equally weighs the percentage of the county's population that is low income and doesn't live close to a grocery store and the percentage that didn't have access to a reliable food source in the past year.

In the 2019 CHR, Buffalo County, in which the majority of the population lives on the Crow Creek Reservation, scored a 0. It's the only county in the country to do so, but is followed closely by Oglala Lakota County, which scored a 0.2. The state's average was 6.6, and counties with reservations within them had significantly lower scores, meaning the people there tend to be far less likely to be able to afford and otherwise access consistent, healthy food sources.

The Native American Heritage Association (NAHA) is one organization that delivers food, in addition to clothing and household items, to reservations. Tim Curns, director of operations, said the issue across multiple reservations when it comes to accessing food stems more from lack of income than lack of available food.

"Grocery stores (aren't) the issue. It's the funds, the money available. They get so much EBT, assistance from the state, and that probably only covers about three weeks, if that," said Curns, referencing the government assistance many on tribal reservations receive. "It just depends on how many people are in the house, and stuff like that, and it's not enough for the whole month. That's why we try to help out as much as we can."

In Buffalo County, 76 percent of the population qualifies for programs such as WIC or free school meals, and as of 2016, only three percent was above the income threshold that makes them ineligible for any nutrition assistance programs.

Curns said that NAHA works to fill the gap between what's covered by benefits and income and what's actually needed to keep people fed in a month.

And that gap is not a small one. Feeding South Dakota, a division of Feeding America, tracks what it calls the "meal gap," or the difference between the number of meals per year that are needed to feed everyone in a county and the number of meals that are currently available.

According to the organization's 2016 data, Buffalo County has a meal gap of 82,000 - the equivalent of every person in the county missing 40 meals per year.

While money is the primary issue standing in the way of keeping people in Crow Creek and other reservations well fed, distance is still a contributing factor to food insecurity.

Fort Thompson is the site of the only grocery store on the reservation. Excluding a couple of convenience stores, the next closest place to buy food is in Chamberlain, 22 miles south.

Curns said that as they're in smaller towns, stores in Fort Thompson and Chamberlain tend to have higher prices. To find a grocery store with more affordable food, those who live on the Crow Creek Reservation - many of whom do not own vehicles - would have to go 50 miles west, to Pierre.

Buffalo County's rank in terms of food accessibility varies slightly from list to list, depending on which organization is compiling the information and what criteria is used. But across any number of similar rankings in recent years, the counties in South Dakota that are home to tribal reservations are consistently among those with the lowest accessibility to healthy food close to home, both in the state and across the country.

While the county holds the most extreme spot in terms of CHR's food environment index, it holds South Dakota's fourth-highest spot on Feeding America's list of food insecurity rates at 21.6 percent, based on 2016 data.

In total, five additional South Dakota counties - Oglala Lakota, Todd, Dewey, Corson and Ziebach - have food insecurity rates above 20 percent. Like Buffalo County, all are home to reservations. And though the six counties only contain 4.5 percent of the state's population, they comprise 9.2 percent of the total meal gap.

Food isn't the only health-related issue in Buffalo County. CHR's statistics show that people in the county have more days of poor mental and physical health per year than many other counties across the state and tend to live shorter lives with more health problems.

At 62.6 years, Buffalo County's average life expectancy is 16.4 years below the state average. The county also has the highest age-adjusted mortality rate in the state, meaning that more of its residents can be expected to die before age 75 than those in any other county.

CHR found that 41 percent of adults in Buffalo County are obese, 37 percent smoke and 35 percent aren't getting enough sleep - all of which are between nine and 19 percent higher than the state's averages.

Curns said the six reservations in South Dakota and two in Wyoming that NAHA serves all see the same problems that lead to such a great need for assistance.

"Crow Creek and Lower Brule are much smaller than the other reservations that we deliver to. They have a great need, no matter how small they are," he said. "They all have the same kind of issues: very high unemployment; lots of grandparents taking care of children because the parents aren't available. In proportion, it's all the same as far as who we deliver to. It doesn't matter the size."

To alleviate some of that need, Feeding South Dakota gives food to NAHA, which then distributes it to the reservations. Curns estimated that a couple thousand people are served in Crow Creek every month. According to the Bureau of Indian Affairs, the tribe has an estimated population of 3,429.

Curns said NAHA prides itself on the fact that 96 cents out of every dollar donated is given back to the reservations, while the other four cents are used to operate the company. In January and February, 41,505 pounds of food were delivered to the Crow Creek Reservation, worth more than $65,000.