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School of Community and H lth S iHealth Sciences
CMartin CaraherProfessor of food and health policy
Centre for food policyCity University, London
Proliferation of Fast Food O l H l h I li i dOutlets, Health Inequalities and Local PolicyLocal Policy
The lifeworld
Southampton General Hospital
Life world is the locus of experience: social, psychological and physical
Sweetness Preference was Essential to Survive: now the amounts
SweetnessSweetness
Because sweet foods are naturally good and are safe sources of energy and nutrients, adaptive evolutionary development has resulted in a preference for them p f f
Of the five most widely acknowledged tastes, three generally signal acceptance (sweet, salty, and umami*), while two generally signal avoidance(sour and bitter).
These early responses are modified by life experiences,producing adult tastes preferences. p f
Biology vs Technology: Shift fromBiology vs Technology: Shift from Water to Caloric Beverages with No
Food Calorie Compensation
Fat Preference Key for Survival:Fat Preference Key for Survival: Technology, Marketing have Utilized
this Preference for Fatty Food
So we now have An OBESOGENIC environment where:
– Unhealthy choices are easier than healthy ones.
– Unhealthy food costs the same if not less than healthy food.
Portion sizes are bigger and cheaper than in– Portion sizes are bigger and cheaper than in the past.
– Food is available at all times.
The last 18 monthsThe last 18 monthsGlobally what has happened in a year to 18 months is
t diextraordinary.
Some changes that have taken over 30 years toSome changes that have taken over 30 years to develop have been reversed.
Some issues of concern
Middle-income consumers are now eating out less and buying fewer luxury goods but buying luxury or niche foods for occasions, this has seen a reduction in people buying specialty chocolate but an increase in sales of Nestle brand chocolate. buy g spec a ty c oco ate but a c ease sa es o est e b a d c oco ate
Also reemergence and re-launching of comfort foods eg tinned goods and thosepopular in the 1970/80sIn the UK for those on low incomes there has been an increase in eating out fromFFOs, as food prices increase and fuel cost many find it makes more sense to buyfrom a FFO as the squeeze on the household budget bites. SEE Tay Barns
Given the lack of healthy options and the calorific and presence of trans fats in thefast food on offer all this points to the danger of this contributing to an increase in theinequality gap.q y g p
Simple rules of heuristics
M th b li tHide the ice cream.
Close the lidRename the food
Move the broccoli to
the start of the queue
Offer a salad
Shrink the bowl
Offer a salad
Pay cash for desert not
Use fruit bowls not
stainless steel
Pay cash for desert not
accepted on cards
Make an express line with
an
emphasis on healthy products
Move salad bar away from
wall
Individualresponsibilityresponsibility
Change in the environment
Puska 2001
The evolution of public health policy
The Gift relationship - the greater good
I di id lIndividualresponsibility
Change in the environmentenvironment
Puska 2001
Tower Hamlets Food Study
Tim Madelin – Public Health, Tower Hamlets PCT
Martin Caraher, Sue Lloyd, City University
Tower Hamlets
3rd most deprived borough in England (2nd in London)Most deprived for income deprivation affecting children14% overcrowding almost 3x rate for London - of 5%Only 15% of year 6, 8 and10 pupils eat 5 or more portions of fruit and vegetables - national figure 23%.15% of reception year children are obese
23% for year 6 pupils obese.Ethnically 34% being Bangladeshi Estimated population of 232,00
Focus Groups (contd)
Obtain food from local shopsMany abstain from school lunches – use dinner money in FFO later Closed-gate policy - FFOs obtained by pupils able to leave for those that couldn’t. Being hungry at the end of the school day– use FFOs on the way homeFelt that school meals poor value compared to FFO
Quality school meals generally OKMuch concern about school canteen environments
Part 2 - Chicken & Chips 98% HH within 10mins walk of grocery typegrocery type store
But…97% HH within 10mins walk ofwalk of FFO
Ditto take aways in Preston
Preston had more fast food outlets (186) [notfood outlets (186) [not including restaurants who operate takeaways] than general groceries outletsgeneral groceries outlets (165).
Take-aways in Tower Hamlets Using the School Food Trust methodology we found there were 41.8 junk food outlets to every school, this compares to the national average ratio of 25 outlets per school, 36.7 for inner London, and 38.6 for the ten
‘ ’ l l h i iUK ‘worst’ local authorities.
This could be potentially be underestimating the number of food outlets p y gas a number of food premises classed as off-licences (44 in Tower Hamlets) will be selling sweets and confectionary and many operate in a similar fashion to grocer/mini markets additionally some premises l ifi d ( i l ) h hclassified as restaurants (605 in Tower Hamlets) as they have
tables/seating essentially operate predominately as take away premises leading to further potential under counting
SoSo cannot be left to industry, the approach based on food industry setting the solutionNor can it be left to social enterprisepNot just the LOCAL… as the solutionA raft of initiatives across agencies is needed not just oneneeded not just oneLoss of expertise as we wait…..We need a public health approachN d t b f l b t l ti it iNeed to be careful about location as it is more complex than this – eg 401m; delivery
Some solutionsSupplementary guidance to ban any new openings within 400m of a school. In highly dense city areas applying limits to take-aways within a 10 minutes (400m) walking distance of schools and youth clubs would results in no opening beingand youth clubs would results in no opening being allowed Others proposing a once off £1000 fee to fund health p p gpromotion activities
Some solutionsLeicester City Council has introduced supplementary planning guidance which states that no more than 20% of the frontage of any side of a street is allowed in fast food (A5 class) useof any side of a street is allowed in fast food (A5 class) use. Waltham Forest, in London, has introduced similar guidance to ensure retail protection and balance of use, with the criteria e su e e a p o ec o a d ba a ce o use, e c e aflexible to take account of developments in different centres in the borough. The London Borough of Westminster has identified ‘stressed areas’ where new fast food openings are resisted and they use a joint planning/licensing approacha joint planning/licensing approach.
Some solutions limit or zoneFFO d/ d i h h lFFOs and/or drive through outlets.‘Formula’ outlets (formula can be defined broadly to include
local take ways that have one or more outlets or narrowly tolocal take-ways that have one or more outlets or narrowly to include only larger national chains). FFOs in certain areas or by directives specifying distanceFFOs in certain areas or by directives specifying distance
from schools, hospitals etc.. By using quotas in certain areas either by number of shop y g q y p
frontage or by use of density.Restricting opening hours.
Some solutions limit or zoneM ki h li k b i i f f d h i dMaking the link between registration for food hygiene and licensing more explicit.
Introducing labeling in fast food outlets (as has happened in New York City) and the Coalition Government has promisedNew York City) and the Coalition Government has promised.
Using ‘choice editing’ and specifying the nutrient content ofUsing choice editing and specifying the nutrient content of food sold, so the choice is made before the consumer purchases.
SoLegislate?So the concern is to improve healthy food on the high streetScores on the doorsScores on the doorsMessages consistentTax HFCh i ditiChoice editing Nudge effect -train staff ensure there is a healthy affordable /comparable health offerSubsidies and taxationWider environment issues, healthy workplace but unhealthy shops on high street.
The cover of "The Economist", Dec. 13-19, 2003.
Changes in planningNICE PDG on spatial planning
Regional planning abandoned
Eric Pickles local planning to be made less burdensome danger of a Easy Jet approach
Local communities to be involvedDPH t LADPHs to LAs.
SWOTSo OpportunitiesLocal food plans can
But threatsBig business can wait p
incorporate food issuesPeople are concerned
gout the planning processp
with the concentration of FFOs
Small businesses may be disadvantaged
Supplementary guidance
IndividualIndividualresponsibilityresponsibility
Change in the environmentChange in the environment
Changes in the environment environment
Puska 2001
environmentPuska 2001