diabetes atlas for the region of peel - chapter 7 - the local retail food … · 2014-03-21 ·...

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insidE

Highlights

Introduction

List of Exhibits

Exhibits and Findings

Discussion

Conclusions and Implications

Appendix 7.A – Research Methodology

References

autHors

Jane Y. Polsky

Jonathan T. Weyman

Maria I. Creatore

Anne-Marie Tynan

Peter Gozdyra

Richard H. Glazier

Gillian L. Booth

Chapter7

The Local Retail Food EnvironmEnt and Diabetes

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HigHligHtsissue• Healthyeatingisessentialtomaintaininggood

healthandpreventingmanychronicdiseases,includingtype2diabetes.

• Foodchoicesareshapednotonlybyindividualcharacteristics,butalsobytheenvironmentinwhichthosechoicestakeplace.

• Inthischapter,geographicaccesstocommonretailfoodoutletsacrossPeelandratesoffruitandvegetableintakeamongresidentsareexamined.LevelsofeconomicdisadvantageandratesofdiabetesamongPeelresidentsarealsoassessedrelativetoaccesstofoodretail.

Key Findings

• InPeel,sourcesofhealthyfood(i.e.,super-marketsandgrocerystores)andlesshealthyfood(i.e.,fast-food/take-outrestaurantsandconveniencestores)weregenerallylocatedinthesameareas.Inallareas,sourcesoflesshealthyfoodgreatlyoutnumberedsourcescontainingmorehealthyfoodbyafactorofatleastfivetoone.

• AccesstobothhealthyandlesshealthyfoodoutletswasverygoodnearBolton,throughoutcentralBramptonandinmanypartsofMississauga.LimitedaccessexistedinCaledon,northeastBramptonandinsouthMississauga.Thispatternoffoodoutletdistributioncoincidedwithlocationsofothercommercialandretailservicesandwithpat-ternsofpopulationdensityinPeel.

• UnlikemanycitiesintheUnitedStates,economicallydisadvantagedareasofPeelgen-erallyhadbetteraccesstosourcesofhealthyfoodcomparedwiththewealthiestareas.However,theseareasalsohadbetteraccesstosourcesoflesshealthyfood.

• Areashometoahighproportionofresidentslivingwithdiabetesweregenerallywellservedbybothsourcesofhealthyandlesshealthyfood.Incontrast,lowerdiabetesareashadreducedaccesstofoodretailofanytype.

• InmostareasofPeel,only40%–45%ofresidentsreportedconsumingfruitsand/orvegetablesatleastfivetimesaday.TheseratesweresimilartoOntarioandCanada,overall.

• Ratesoffruitand/orvegetableintakevariedlittleacrossPeel.Therewasnoapparentassociationbetweenratesoffruitandvegetableintakeandratesofdiabetes.

implications • Accesstobothhealthyandlesshealthyfood

shapesindividuals’eatingbehaviours.

• Whilemanyforcesthatshapethefoodenvi-ronmentareoutsidethelocalsetting,manyimportantinitiativescanbeundertakenatthecommunityleveltoencourageandbettersupporthealthyeating.

• Giventherisingratesofoverweight/obesityandtype2diabetesinPeelandacrossCanada,publichealthmeasurestoencourageandsup-porthealthyeatingmustbeconsideredmajorpriorities.

introductionHealthanddiet(i.e.,whatweeatanddrink)areinextricablylinked.Individualswhoconsumeahealthydiet(e.g.,onethatishighinfreshfruits,vegetablesandwholegrains)havealowerriskofdevelopingchronicdiseasessuchastype2diabetes,cardiovasculardiseaseandsomecan-cers.1Inaddition,forpeoplelivingwithdiabetesorcardiovasculardisease,eatingahealthydietisamongthekeystrategiestobettermanagetheircondition.1Unfortunately,majortechnologicalandeconomicchangesinthefoodsystemoverpastdecadeshaveresultedinafoodsupplythatishigherinsugarandmoreenergy-dense,andrepletewithhighly-processedfoods.2ThesechangeshaveverymuchshapedtheWesterndiet,whichischaracterizedbyfrequentconsumptionofhighly-processedenergy-densefoodsthatarelowinfibreandhighinfat,addedsugars,refinedgrainsandsodium.IndividualswhoconsumetheWesterndietareathigherriskofdevelopingchronicdiseases,includingtype2diabetes.1

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What are canadians eating? AlthoughfoodavailabilitydatasuggestthatCanadianshavebeenconsumingmorefruitsandvegetablesoverthepasttwodecadesandfewercaloriesperdaybetween2001and2009,3theoverallqualityofmostpeople’sdietscontinuestobeofgreatconcern.ArecentnationalsurveyofCanadians’eatinghabitsshowedthatsevenoutof10Canadianchildrenandhalfofadultsatelessthanthehistoricallyrecommendedfiveserv-ingsofvegetablesandfruiteachday.4Thistrendisworrisomeconsideringthatin2007Canada’sFoodGuideincreasedtherecommendeddailyintakeoffruitsandvegetablestoarangeofsevento10servingsforteensandadults.5TheoveralldietqualityoftheaverageCanadianhasbeenclassifiedas“poor,”withlessthan1%ofCanadiansfollowingadietconsistentwithCanada’sFoodGuide.6

OneconcernisthatCanadiansareconsumingtoomany“otherfoods”(eg.sweetenedbeveragesandfoodssuchassaladdressingsandpotatochipsthatarenotpartofthefourmajorfoodgroups)–foodsthatarehighincaloriesandverylowinnutrients.4ThesefoodscomprisedaquarteroftotaldailycaloriesamongCanadianteenagers.4Furthermore,reflectingthegrowingavailabilityandpopularityofready-to-eatconveniencefoods,oneinfourCanadiansreportedeatingatleastonefast-fooditemonthepreviousday.4Teenagersandyoungmenweremostlikelytohaveeatensomethingfromafast-foodrestaurant(30%and39%,respectively).Thisisatroublingtrendbecausecommonfastfoodslikepizza,hotdogsandsoftdrinkstendtobehighincalories,salt,andlowinnutrients.Frequentconsumptionoffastfoodshasbeenassociatedwithlowerintakeofhealthyfoodsandincreasedriskofbecomingobeseanddevelopingtype2diabetes.7-9

What shapes a person’s diet?Individuals’dietarypreferencesandchoicesarehighlycomplexandareshapedbymanydiffer-entfactors.Attheindividuallevel,thesefactorsincludeage,sex,familycompositionandsocio-culturalfactors(e.g.,socioeconomicstatus,

ethnoculturalorreligiousbackground).10-13Householdincomeisparticularlyimportantbecauseadiethighinfreshfruitandvegetables,leanmeatsandfishtendstocostmorethanaless-healthydiethighincaloriesandhighly-pro-cessedfoods.14Canadianhouseholdswithhigherlevelsofincomeandeducationconsistentlypurchasemorenutritiousfoodsandhaveabetterqualitydiet.15-17Purchasingfruitandvegetablesisparticularlysensitivetofinancialconstraints:Canadianswithlowerlevelsofeducationorthoselivinginlowerincomehouseholdstendtobuyandeatfewerfruitandvegetablescomparedwithindividualswithhigherlevelsofeducationorincome.13,16Limitedtimeforgroceryshop-pingandcookingisoftenanotherimportantinfluenceonfoodintakeamonglow-incomeindividualsworkinglonghoursormultiplejobs,andparticularlyforsingle-parenthouseholds.18Highersocioeconomic(SES)groupstendtobemoreresponsivetodietaryrecommendations,havemoreknowledgeaboutnutritionandmaybemoreawareoftherelationshipbetweendietandhealthcomparedtolowerSESgroups.16,19

Aperson’sethnoculturalcharacteristicsalsoplayanimportantroleinfoodchoices.CanadiansbelongingtoAboriginal,SoutheastAsianandChineseethnicgroupswerelesslikelytoreporteatingfruitandvegetablesatleastfivetimesadaycomparedwithotherethnicgroupsincludingLatinAmerican,White,SouthAsianandBlack.11

Individuals’foodchoicesareguidednotonlybypersonalfactors,butalsobythechoicesavailabletothemwithindifferentsettings(e.g.,work,school,community).Messagesthatencouragethesechoicesfromotherindividuals,themediaandinstitutionsarealsoveryinfluential.Tobetterunderstandtheseinfluences,researchersareincreasinglystudyingtherolethatthe“foodenvironment”(i.e.,thefoodchoicesavailabletoindividualsinvarioussettingsofdailylife)playsinpromotingorhinderinghealthyeating.20Thesesettingsincludetheorganizationalfoodenvironment(e.g.,school,work,home),theconsumerenvironment(i.e.,availability,quality,portionsizeandpriceoffoodsinstoresandeatingplaces),thecommunityenvironment(i.e.,

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availabilityandaccessibilityofvarioustypesofstoresandeatingplacesincommunities)andtheinformationenvironment(i.e.,mediaandadvertising).21Theconsumerandcommunityenvironmentsareparticularlyimportantbe-causeanychangesinthesedomainswillhavebroad-reachingeffectsonthepopulation.Forthisreasonandbecausedataonvarioustypesofsettingsaredifficulttoobtain,theanalysesinthisatlasfocusonlyonthecommunityor“local”foodenvironment.Inthischapter,theterm“lo-calfoodenvironment”isusedinterchangeablywiththeterm“communityfoodenvironment”.

the local food environment and diet Sourcesoffresh,healthyandaffordablefoodareessentialresourcesforhealthyeatingincom-munities.Ifanareadoesnothavegoodaccesstohealthyaffordablefood,residentsmusttravelsomedistanceoutsidetheirneighbourhoodtoobtainthesefoods,orrelyonmorereadilyavail-ableandoftenlesshealthyoptionssoldinnearbyconveniencestoresoreatingplaces.Inmanyurbansettings,convenientaccesstobothhealthyandless-healthyfoodinneighbourhoodscanbeparticularlyimportantforlowerincomegroupsandindividualswithlimitedaccesstoaprivatevehicleforfoodshoppingpurposes.22

Todate,thereisalackofCanadianresearchthatexaminestheeffectsofthelocalfoodenviron-mentonindividuals’diets.ThemajorityofpublishedstudiesonthistopicwereconductedintheUnitedStates(U.S.),EuropeandAustralia,andpresentconflictingevidenceontheextenttowhichthelocalretailfoodenvironmentshapesdietarypatterns.Whilesomestudiesdidnotfindthathavingbetteraccesstohealthyfoodwasrelatedtohealthiereating,othersshowedthatresidentslivingnearsupermarketsorlargegrocerystoreshadbetterqualitydiets.20,23,24

Researchersarealsoincreasinglypayingattentiontoretailsourcesoflesshealthyfood,suchasconveniencestoresandfast-foodoutlets.Althoughtheyprovideconvenientlocationsandextendedoperatinghours,conveniencestoresconsistentlystockfewhealthieroptionsandsellfoodsatsignificantlyhigherprices

thanlargergrocers.25,26Canadiansarealsoincreasinglypatronizingfast-foodandtake-outrestaurants(outletsthatlacktableserviceandwherecustomersgenerallypaybeforereceivingtheirmeal).4Suchoutletsareeasilyaccessibleinmostcommunities,provideasourceofrelativelyinexpensivemealsandcommonlyofferlargeportionsofhighly-processedandnutrient-poorfoodsanddrinks.

Accesstofast-foodrestaurantsandconveniencestoresmayplayaroleinshapingthedietsoflocalresidents.23,27U.S.residentswholivednearmorefast-foodrestaurantsweremorelikelytoconsumefastfoodneartheirhomeandwerelesslikelytohaveahealthydietoverall.28InAustraliaandEngland,childrenwithbetteraccesstofast-foodoutletsandconveniencestoresneartheirhomeatefewerfruitsandvegetablesandmoresnackfoodsthanthosewithlessaccesstosuchoutlets.29,30IntheU.S.,low-incomemenwholivednearmorechainfast-foodrestaurants(withinonetothreekilometres)consumedfastfoodmorefrequentlythanthosewithlessaccesstosuchfoodsources.31Thesefindingsreinforcethenotionthatthelocalfoodenvironmentmaybeastrongerinfluenceonthedietandhealthofcertainpopula-tiongroups(e.g.,thosewithlimitedfinancialresourcesortransportationoptions).Additionally,individualswithcertainpersonalitytraits,suchasincreasedsensitivitytoreward,aremoresus-ceptibletoenvironmentalcuesandarethuslessabletoresistthetemptationofhighlyubiquitousunhealthyfoodsthattheyencounterwithintheirdailyactivityspaces.32

the local food environment and health ResidentsofareasintheU.S.,EuropeandAustralia/NewZealandwithbetteraccesstosupermarketsandlessaccesstofast-foodoutletshavelowerprevalenceofoverweight/obesitythanthoselivinginareaswithlimitedaccesstolargegrocersorwithbetteraccesstofastfood.23InOttawa,thereweremoreobeseresidentsinneigh-bourhoodswithahighconcentrationoffast-foodrestaurantsandmorepeoplewithhealthyweightsinareaswithadditionalspecialtystores.33

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Itisnotonlythepresenceorabsenceofparticularfoodretailoutletsinanarea,butalsotherelativeproportionormixofdifferentfoodoutlets,thatmaybeanimportantcomponentofthefoodenvironment.InEdmonton,theprevalenceofobesityamonglocalresidentsincreasedasthenumberofless-healthyfoodoutlets(i.e.,conveniencestoresandfast-foodoutlets)withina10-minutewalkincreasedrelativetohealthieroutlets(i.e.,supermarketsandgrocerystores)inthesamerange.34InCalifornia,therelativeabun-danceofless-healthytohealthyfoodoutletswassimilarlyrelatedtohigherratesofobesity,aswellastohigherratesofdiabetes.35However,thereislimitedresearchintheareaoffoodenvironmentanddiabetes,andfindingsareinconsistent.36,37

neighbourhood socioeconomic status (sEs) and the local food environmentBecausebothdietandhealthdifferbetweengroupsofvaryinglevelsofsocioeconomicstatus(SES)(seeChapter3),itisimportanttoexaminewhetherfeaturesofthelocalenvironmentmaybeshapingthesedifferences.Forexample,researchersinCanada,theU.S.,theUnitedKingdomandAustraliahaveexaminedwhetherlowerincomegroupsorracial/ethnicminoritygroupsaremorelikelytoliveinareaswithlimitedaccesstohealthy,affordablefood(areasknownas“fooddeserts”).22Todate,thereisfairlyconsistentevidencethatintheU.S.,accesstohealthyandaffordablefoods(i.e.,supermarketsorlargegrocerystores)isindeedlimitedinmanyneighbourhoodswithahighproportionoflowerincomeand/orAfricanAmericanresidents.22,38HighlevelsofresidentialsegregationalongSESand/orethnoraciallinesintheU.S.islikelyakeydriverofthispattern.39Theclosingorlackofasupermarketinamarginalizedcommunityoftenindicatesadisinvestmentinthatcommunitywhichcanleadtodisinterestinfurtherinvestment.40

Incontrast,theexistenceoffooddesertsinotherdevelopedcountries,includingCanada,ismuchlessconsistent.Forexample,inMontreal,accesstosupermarketsandotherstoressellingfruitsandvegetablesdidnotdifferbetweenneighbourhoodsofdifferentincomelevels.41-43

SimilarpatternsexistedinEdmontonandinmetropolitanareasofBritishColumbia,wherelow-incomeareasgenerallyhadsimilarorevenbetteraccesstosupermarketsthanwealthierareas.44-46InQuebecCity,thequantityandvarietyoffruitandvegetablessoldinsupermarketsandgreengrocerswasthesameregardlessoflevelsofneighbourhooddeprivation.25However,differentpatternswereseeninotherCanadiancities.Forexample,severalinner-city,low-SESneighbour-hoodsinLondon(Ontario)hadthepoorestaccesstosupermarkets.Thedifferencesinaccesstosupermarketshadincreasedovertimeasanumberofsupermarketsintheinnercityhadcloseddownandnewsupermarketswerebuiltinthesuburbs.47InEdmonton,althoughthemajor-ityoflow-incomeneighbourhoodshadverygoodaccesstosupermarkets,therewasahandfulofinner-suburbanneighbourhoodswithhighratesoflowincomeandlowvehicleownershipthathadmuchmorelimitedaccess(i.e.,theseareasap-pearedtobefooddeserts).45ThesemixedfindingswithinCanadasuggestthatthefoodenvironmentmaydifferbothacrosscommunitieswithinagivenprovince,aswellasacrossprovincesandcountries,reflectingdifferentsocial,economicandregulatoryenvironmentsandhistoriesthatshapethedistributionoffoodretailoutletsindifferentsettings.

Inthischapter,thegeographicavailability(i.e.,locationsanddensity)andaccessibility(i.e.distancealongthestreetnetwork)ofgrocerystores,supermarkets,conveniencestores,aswellasfast-foodandtake-outrestaurantsareexamined.GeographicaccesstothesecommonfoodretailersasitrelatestolevelsofeconomicdisadvantageandratesofdiabetesamongPeelresidentsisalsoassessed.Finally,ratesoffruitandvegetableintakeinrelationtodiabetesratesacrossPeelareexamined.

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list oF ExHiBitsExhibit 7.1Locationsofsupermarketsandgrocerystores[2011]inPeelregion

Exhibit 7.2Locationsofconveniencestores[2011]inPeelregion

Exhibit 7.3Locationsoffast-foodandtake-outrestaurants[2011]inPeelregion

Exhibit 7.4Locationsoffull-servicerestaurants[2011]inPeelregion

Exhibit 7.5RetailFoodEnvironmentIndex(RFEI,ratioofless-healthytohealthyfood*)[2011],byPeelHealthDataZone(PHDZ)[2006],inPeelregion

Exhibit 7.6Supermarketsandgrocerystores[2011]per10,000population[2006],bycensustract[2006],inPeelregion

Exhibit 7.7Conveniencestores[2011]per10,000population[2006],bycensustract[2006],inPeelregion

Exhibit 7.8Fast-foodandtake-outrestaurants[2011]per10,000population[2006],bycensustract[2006],inPeelregion

Exhibit 7.9Modelledtraveldistancealongtheroadnetwork[2009]tothenearestlocationofasupermarketorgrocerystore[2011],inPeelregion

Exhibit 7.10Modelledtraveldistancealongtheroadnetwork[2009]tothenearestlocationofaconveniencestore[2011],inPeelregion

Exhibit 7.11Modelledtraveldistancealongtheroadnetwork[2009]tothenearestlocationofafast-foodortake-outrestaurant[2011],inPeelregion

Exhibit 7.12Spatialrelationshipbetweenaverageroadnetworkdistancetothenearestsupermarketorgrocerystore[2011]andpercentofthepopulationbelowStatisticsCanada’slowincomecut-off(LICO;after-tax)[2005],bycensustract[2006],inPeelregion

Exhibit 7.13Spatialrelationshipbetweenaverageroadnetworkdistancetothenearestconveniencestore[2011]andpercentofthepopulationbelowStatisticsCanada’slowincomecut-off(LICO;after-tax)[2005],bycensustract[2006],inPeelregion

Exhibit 7.14Spatialrelationshipbetweenaverageroadnetworkdistancetothenearestfast-foodortake-outrestaurant[2011]andpercentofthepopulationbelowStatisticsCanada’slowincomecut-off(LICO;after-tax)[2005],bycensustract[2006],inPeelregion

Exhibit 7.15Spatialrelationshipbetweenaverageroadnetworkdistancetothenearestsupermarketorgrocerystore[2011]andage-andsex-standardizeddiabetesprevalencerate-ratios*[2007],bycensustract[2006],inPeelregion

Exhibit 7.16Spatialrelationshipbetweenaverageroadnetworkdistancetothenearestconveniencestore[2011]andage-andsex-standardizeddiabetesprevalencerate-ratios*[2007],bycensustract[2006],inPeelregion

Exhibit 7.17Spatialrelationshipbetweenaverageroadnetworkdistancetothenearestfast-foodortake-outrestaurant[2011]andage-andsex-standardizeddiabetesprevalencerate-ratios*[2007],bycensustract[2006],inPeelregion

Exhibit 7.18Age-andsex-standardizedrateoffruitandvegetableconsumption*per100peopleaged12+[2003-08]andage-andsex-standardizeddiabetesratesper100personsaged20+[2007],byPeelHealthDataZone(PHDZ)[2006]inPeelregion

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ExHiBits and Findings

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C A L E D O N

B R A M P T O N

Findings:

•

•

•

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Supermarkets and grocery stores were distributed widely across Peel’s residential areas. Higher concentrations were seen along major roads and around major retail centres and industrial areas in Brampton and Mississauga.

Pockets with no supermarkets or grocery stores were visible in east, northeast and northwest Brampton, and in south Mississauga.

There were few supermarkets/grocery stores in Caledon.

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C A L E D O N

B R A M P T O N

M I S S I S S A U G A

Locations of supermarkets/grocery stores

Grocery Store

Residential AreaOther Land Use

Supermarket

Census Tract Boundary

Municipal Boundary

Industrial Area

Freeway or Highway

International Airport

0 5 10 km

0 2.5 5 km

Exhibit 7.1. Locations of supermarkets and grocery stores [2011] in Peel region

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Findings:•

•

A large number of convenience stores were widely distributed across Peel’s residential and industrial areas. Pockets without convenience stores were seen in outlying areas of Brampton (particularly northeast Brampton) and south Mississauga.

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403

401

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427

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Locations of convenience stores

Convenience Store



Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.2. Locations of convenience stores [2011] in Peel region

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Findings:

•

•

The majority of fast-food and take-out restaurants were located along major roads and near major retail and business districts. Similar to food and convenience stores, pockets of limited availability existed in northeast Caledon, outlying areas of Brampton (particularly the northeast area), and south-central Mississauga (near the QEW).

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Locations of fast-food/take-out restaurants

Fast-food/Take-outRestaurant



Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.3. Locations of fast-food and take-out restaurants [2011] in Peel region

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Findings:

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Full-service restaurants were the most numerous foodretail outlets in Peel. The majority of restaurants were located along major roads and within industrial and commercial areas.

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Locations of full-service restaurants

Full-serviceRestaurant



Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.4. Locations of full-service restaurants [2011] in Peel region

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17.0

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Findings:•

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A higher value of the Retail FoodEnvironment Index (RFEI) indicatesa less favourable retail food mix with ahigher density of outlets selling less healthyfoods compared with outlets selling healthy foods. In all PHDZs, there were at least five less healthy outlets for every healthy outlet. The highest RFEI was seen in Caledon. In Brampton and Mississauga, the RFEI was somewhat lower, ranging from about five to 10 less healthy outlets for every healthy outlet.

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17.0

7.9

7.9

4.9

7.9

7.9

5.4

5.7

4.7

9.5

9.55.4

6.6

6.9

9.96.1

6.6

10.5

Ratio of less healthyto healthy food resources (RFEI*)

*RFEI calculated as the ratioof less healthy foodresources (conveniencestores, fast-food and take-out restaurants) to healthy food resources (supermarkets and grocery stores), within a Peel Health Data Zone.

4.7 – 6.06.1 – 8.08.1 – 10.010.1 – 17.0

lessfavourable

Peel Health DataZone (PHDZ) Boundary

Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.5. Retail Food Environment Index (RFEI, ratio of less healthy to healthy food resources*) [2011], by Peel Health Data Zone (PHDZ) [2006], in Peel region

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Findings:•

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In 2011, many residential census tracts (CTs),in Peel contained no supermarket or grocery store. Availability was highest in central and west Brampton, and in various areas of Mississauga, particularly the southeast portion.

CTs with more supermarkets/grocery stores per capita generally coincidedwith areas where fast-food/take-out outlets and convenience stores were alsomore available (Exhibits 7.7 and 7.8).

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Supermarkets/grocery stores per 10,000 people

0.00.1 – 2.02.1 – 5.05.1 – 11.011.1 – 38.3


Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.6. Supermarkets and grocery stores [2011] per 10,000 population [2006], by census tract [2006], in Peel region

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Findings:

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The number of convenience stores per 10,000 residents varied by more than 10-fold between census tracts (CTs). CTs with the highest density of convenience stores were scattered throughout the region; the largest share of such areas was found in Mississauga. Areas with high availability of convenience stores were generally the same areas that had a high density of fast-food and take-out restaurants (Exhibit 7.8).

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Convenience stores per 10,000 people

0.00.1 – 2.02.1 – 5.05.1 – 10.010.1 – 24.1


Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.7. Convenience stores [2011] per 10,000 population [2006], by census tract [2006],in Peel region

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Findings:

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The number of fast-food and take-out outlets per 10,000 population varied greatly across census tracts(CTs) in Peel. Most CTs contained at least one such outlet. Similar to the distribution of convenience stores (Exhibit 7.7), the highest number of fast-food and take-out restaurants per capita was seen in east Caledon, central and west Brampton, and throughout Mississauga.

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Fast-food/take-out restaurants per 10,000 people

0.00.1 – 5.05.1 – 10.010.1 – 20.020.1 – 168.8


Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.8. Fast-food and take-out restaurants [2011] per 10,000 population [2006], by census tract [2006], in Peel region

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Findings:

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A large number of areas throughout Mississauga, in central Brampton and east Caledon had very good access to the nearest store (1,000 metres or less).

Areas with further travel distances existed in most parts of Caledon, fringe areas of Brampton and in central-north, west and south Mississauga.

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Modelled distance (m) to nearest supermarket/grocery store

1,001 – 2,0002,001 – 5,000

13 – 1,000

5,001 – 10,00010,001 – 29,209


Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.9. Modelled travel distance along the road network [2009] to the nearest location of a supermarket or grocery store [2011], in Peel region

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Findings:

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In most areas of Mississauga and to a lesser degree, Brampton, access to the nearest convenience store was very good (1,000 metres or less).

Most areas of Caledon, outlying areas of Brampton and parts of south Mississauga had longer travel distances to the nearest convenience store.

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Modelled distance (m) to nearest convenience store

1,001 – 2,0002,001 – 5,000

45 – 1,000

5,001 – 10,00010,001 – 13,697


Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.10. Modelled travel distance along the road network [2009] to the nearest location of a convenience store [2011], in Peel region

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Fast-food and take-out restaurants were highly accessible in most areas of Mississauga and Brampton (1,000 metres or less).

Access to the nearest fast-food outlet was very similar to that of convenience stores (Exhibit 7.10) and similar to that of supermarkets/grocery stores (Exhibit 7.9).

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Modelled distance (m) to nearest fast-food/take-out restaurant

1,001 – 2,0002,001 – 5,000

42 – 1,000

5,001 – 10,00010,001 – 15,395


Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.11. Modelled travel distance along the road network [2009] to the nearest location of a fast-food or take-out restaurant [2011], in Peel region

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This exhibit highlights only those areas where the percentage of residents below the LICO was either high or low in Peel.

In Mississauga, the majority of areas with a high proportion of residents below the LICO (more than 11.5%) had verygood access to a grocery store or supermarket (1,000 metres or less).In Brampton, access was more mixed.

Only one lower income area was located further than 2,000 metres fromthe nearest supermarket or grocery store.

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% under LICO(after-tax)

330 18,7452,0001,0001.1

28.4

11.5

8.2

Avg distance (m) tonearest supermarket/

grocery store

INCOMELOW


Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.12. Spatial relationship between average road network distance to the nearestsupermarket or grocery store [2011] and per cent of the population below Statistics Canada’s low income cut-off (LICO; after-tax) [2005], by census tract [2006], in Peel region

183

410

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9

Findings:

•

•

•

La k

e

O nt a r

i o

All but one census tract (CT)in the lowest income tertile(more than 11.5% of residentsbelow LICO) were located in fairlyclose proximity to a convenience store(most were within 1,000 metres or less).

Areas with a lower percentage of its residents below the LICO (1.1– 8.2%) in Caledon, fringe areas of Brampton and in various parts of Mississauga generally had less access to a convenience store.

The spatial association between access to convenience stores and the percentage of residents falling below the LICO followed a similar pattern to that of access to supermarkets and grocery stores (Exhibit 7.12).

407

410

10

403

401

QEW

427

409


225 6,6702,0001,0001.1

28.4

11.5

8.2

Avg distance (m)to nearest

convenience store

INCOMELOW


Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.13. Spatial relationship between average road network distance to the nearestconvenience store [2011] and per cent of the population below Statistics Canada’s low income cut-off (LICO; after-tax) [2005], by census tract [2006], in Peel region

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410

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Findings:•

•

•

La k

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All areas with a high percentage of residentsbelow the LICO (more than11.5%) were near a fast-food or take-out outlet (most were within 1,000 metres).

In contrast, access to fast food was much more varied in areas with a low percentage of residents below the LICO (1.1– 8.2%),ranging from very good (less than 1,000 metres) tovery poor (2,000 metres or more).

Access to fast-food or take-out restaurants in areas with either a high or low percentage of residents falling below the LICO was nearly identical to that of convenience stores (Exhibit 7.13) and very similar to that of supermarket/grocery stores (Exhibit 7.12).

407

410

10

403

401

QEW

427

409


326 9,9322,0001,0001.1

28.4

11.5

8.2

Avg distance (m) tonearest fast-food/

take-out restaurant

INCOMELOW


Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.14. Spatial relationship between average road network distance to the nearest fast-food or take-out restaurant [2011] and per cent of the population below Statistic Canada’s low income cut-off (LICO; after-tax) [2005], by census tract [2006], in Peel region

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Dixie RdAirport Rd

King

St

TheGore

Rd

Mayfi

eld R

d

Mississauga Rd

Hurontario St Char

leston

Sr

Winston

ChurchillBv 410

10

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C A L E D O N

B R A M P T O N

Findings:•

•

La k

e

O nt a r

i o

Dixie Rd

Airport Rd

King

St

The Gore Rd

Mayf

ield R

d

Mississauga Rd

HurontarioSt

Derry

RdE

Derry

Rd

W

Stee

les A

ve E

Winston Churchill Bv

Erin

MillsPy

Brita

nnia

Rd W

Bova

ird D

r W

Bova

ird D

r ECawthra Rd

Stee

les A

ve WQu

een

StW

Quee

nswa

y

Lake

shor

eRdMain St

Southdown Rd

Kennedy Rd

Mavis

Rd

Winston

Churchill Bv

Dixie Rd

Qu

een St

E

Hwy 50

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410

10

403

401

QEW

427

409

C A L E D O N

B R A M P T O N

M I S S I S S A U G A

Diabetes Rate-ratio*

330 18,7452,0001,000

≥ 1.20

≤ 0.80

0.81 – 1.19

Avg distance (m) to nearestsupermarket/grocery store

DIABETESHIGH

*Rate-ratio calculated as:

Overall Greater Toronto Area (GTA) diabetes rate: 9.0%

census tract rate for pop. aged 20+GTA rate for pop. aged 20+


Municipal Boundary

Industrial Area

Freeway or Highway


In areas where diabetes rates wereat least 20% higher than in the GTAoverall, access to a supermarket/grocerystore was generally very good to fair (330 to 2,000 m).However, there were a number of newly developed areasin north and east Brampton, and in central and northeastMississauga where access was very poor (2,000 m or more).

Lower diabetes areas (with rates at least 20% below the GTA) in Caledon and south Mississauga had consistently poorer access. In these areas, the nearest supermarket/grocery store was more than 1,000 m away.

0 5 10 km

0 2.5 5 km

Exhibit 7.15. Spatial relationship between average road network distance to the nearestsupermarket or grocery store [2011] and age- and sex-standardized diabetes prevalence rate-ratios* [2007], by census tract [2006], in Peel region

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Findings:

•

•

•

The majority of areaswith high rates of diabetesamong residents (at least 20%higher than the GTA average) inBrampton and Mississauga werewithin very good or fair proximity ofa convenience store (2,000 m or less).

Lower diabetes areas in Caledon and south Mississauga (with rates at least 20% lower than the GTA average) had more varied access. The majority of such areas were at least 2 km away from a convenience store.

Most areas with good access to a convenience store also had relatively good access to a supermarket or grocery store (Exhibit 7.15) and very good access to fast food (Exhibit 7.17).

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427

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La k

e

O nt a r

i o


225 6,6702,0001,000

≥ 1.20

≤ 0.80

0.81 – 1.19

Avg. distance (m) tonearest convenience store

DIABETESHIGH





Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.16. Spatial relationship between average road network distance to the nearestconvenience store [2011] and age- and sex-standardized diabetes prevalence rate-ratios* [2007], by census tract [2006], in Peel region

187

410

10

9

Findings:•

•

•

The spatial relationship between access to fast-food/take-out outlets and diabetes prevalence was almost identical to that of convenience stores (Exhibit 7.16) and very similar to that of supermarkets/grocery stores (Exhibit 7.15).

The majority of high-diabetes areas (with rates atleast 20% higher than the GTA average) were within2,000 m of fast food.

Lower diabetes areas (with rates at least 20% below the GTA average) were generally further away from a fast-food/take-out restaurant. Most such areas in Mississauga and all of Caledon were at least 2,000 m away.

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410

10

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401

QEW

427

409

La k

e

O nt a r

i o


326 9,9322,0001,000

≥ 1.20

≤ 0.80

0.81 – 1.19

Avg distance (m) to nearestfast-food/take-out restaurant

DIABETESHIGH





Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.17. Spatial relationship between average road network distance to the nearest fast-food or take-out restaurant [2011] and age- and sex-standardized diabetes prevalence rate-ratios* [2007], by census tract [2006], in Peel region

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410

10

9

47.7

39.8

Findings:

•

•

La k

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a ri o

Rates of fruit and/or vegetable intake were lowand varied little across PHDZs: in 11 of 15 PHDZs,only about 40 to 45 of 100 residents reported consumingfruit and/or vegetables 5+ times a day. The lowest ratewas seen in central-west Mississauga (33.3 per 100 persons).

There was no clear relationship between consuming fruit and/or vegetables5+ times a day and rates of diabetes prevalence.

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409

47.7

43.8

43.8

44.7

42.4

42.4

51.9

48.2

42.5

42.9

44.3

42.9

43.3

43.2

33.3

41.1

Fruit and vegetable consumption* rate per 100 aged 12+

33.3 – 39.739.8 – 45.045.1 – 51.9

* Consumption of fruit and/or vegetables 5+ times a day

Diabetes rate per 100 aged 20+

7.1 – 9.1

9.2 – 10.9

11.0 – 12.9

Peel Health DataZone (PHDZ) Boundary

Municipal Boundary

Industrial Area

Freeway or Highway


0 5 10 km

0 2.5 5 km

Exhibit 7.18. Age- and sex-standardized rate of fruit and vegetable consumption* per 100 people aged 12+ [2003 – 08] and age- and sex-standardized diabetes prevalence rates per100 persons aged 20+ [2007], by Peel Health Data Zone (PHDZ) [2006], in Peel region

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discussion the local food environment in Peel: availability and accessibility of various food retail outlets Theavailabilityandaccessibilityofsupermarkets,grocerystores,conveniencestores,full-servicerestaurantsandfast-food/take-outrestaurantsvariedacrossPeel,withsomeareashavingmuchhigheravailabilityofoutletsthanothers.Ingeneral,bothsourcesofhealthyfoods(i.e.,su-permarketsandgrocerystores)andless-healthyfoods(i.e.,conveniencestoresandfast-foodortake-outrestaurants)werelocatedinthesameareas(e.g.,withinasingleshoppingcentre).Thereversewasalsotrue:areaswithfewerstoresofonetypealsohadfeweroutletsofothertypes.ThispatternofavailabilityparalleledthegenerallandusagepatternsacrossPeel,whereretailersclusterinshoppingcentresandstrip-mallsthatareseparatedfromresidentialareasbybusyroadsandlargeparkinglots.Thistypeofzoningpat-terndiscourageswalkingandpromotestheuseofcars(formoreinformation,seeChapter5).

In2011,supermarketsandgrocerystoreswerewidelydistributedacrossresidentialareasinPeel.WithinmanyareasofMississaugaandBrampton,residentslivedwithin330metresto2,000metresofthenearestgrocerystoreorsupermarket,whichrepresentsverygoodtofairaccess.AreaswithverypooraccesstothesestoreswerefoundthroughoutCaledon,infringeareasofBramptonandinsouthMississauga.Thesewerethesameareaswithverypooraccesstoothertypesofretailservices(seeChapter5),aswellasrecreationalfacilities(seeChapter6).Alloftheseareashadlowpopulationdensity(seeChapter1)andweregenerallymoreaffluent(seeChapter3);someareaswererecentlydevelopedsubdivisions(i.e.,northandeastBrampton).

Fast-food/take-outrestaurantsandconveniencestoreswerehighlyprevalentandaccessibleinmostpartsofPeel.IneastCaledon,centralBramptonandthroughoutmuchofMississauga,residentshadveryeasyaccesstothenearestfast-foodortake-outrestaurantandconveniencestore(within1,000morless).Thesefoodretailers

wereconsistentlyclusteredtogether;theywerealsogenerallylocatednearsupermarketsandgrocerystores.

TheanalysisusingtheRetailFoodEnvironmentIndex(indexofrelativeavailabilityofless-healthyandhealthierfood)outletsacrossPeelHealthDataZones(PHDZs)showedthatinallareas,sourcesofless-healthyfoodoutnumberedsourcesofmorehealthyfoodbyaratioofatleastfivetoone.Thisfindingisnotsurprisingandconfirmsthewell-documentedubiquityofready-madeconveniencefoodsacrossNorthAmerica.Manyexpertsbelievethatlimitingtheabundanceofless-healthyfoodswithinthevarioussettingsofdailylifewillserveasakeystepincreatingsupportivefoodenvironmentsthatmakethehealthyfoodchoicethedefaultchoice.2

Thelocationsoffull-service(i.e.,dine-in)restau-rantswerealsoverysimilartothatofotherfoodretailoutlets,withafewminorexceptions–mostrestaurantswerelocatedalongmajorroadsandalargenumberwereconcentratednearorwithinindustrialareasinBramptonandMississauga.Thistypeofdistributionprovideseasyaccesstorestaurantsalongmajortrafficroutes,aswellaseasyaccesstopeoplewhoworkinnearbyareas.Noexaminationofwhetherbetteraccesstofull-servicerestaurantswasrelatedtoratesofdiabeteswasconducted.Researchtodatehasnotshownaconsistentlinkbetweenweightgainandrelatedhealthoutcomes,andeatingatdine-inrestaurants.7,48

the local food environment and socioeconomic status InPeel,therewasanassociationbetweenlevelsofsocioeconomicstatus(SES)incensustractsandaccesstofoodretail.Censustractswiththehighestproportionofeconomicallydisadvan-tagedresidents(asdefinedbylowincomecut-off(LICO);seeAppendix7A)hadbetteraccesstoalltypesoffoodretail(i.e.,supermarkets,grocerystores,conveniencestoresandfast-food/take-outrestaurants).Infact,alllowerincomeareashadfairaccesstoasupermarketorgrocerystore,withnoarealocatedmorethan2,000metresawayfromsuchastore.Similarly,alllower

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incomeareaswerelocatedwithinverygoodorfairproximitytoaconveniencestoreorfast-foodoutlet.Incontrast,accesstofoodretailvariedmuchmorewidelywithinthemostaffluentareasinpartsofMississauga,Bramptonandthrough-outCaledon,withverygoodaccessinsomeareasandmuchmorelimitedaccessinotherareas.

Housingoptionsforlowerincomeresidentsaregenerallymoreavailableincloserproximitytomajorretailcentreswhichcontainfoodstoresandeatingplaces(e.g.,nearMississaugaCityCentre).Incontrast,moreaffluentresidentsofPeelhavetheoptiontosettleinpurelyresiden-tialareaslocatedfarfromanycommercialorretailactivity(e.g.,insouthMississauga).Sincezoningandcommercialsitingprocessesarekeydeterminantsofhowfoodretailoutletsbecomedistributed,itispossiblethatinwealthierareas,residentsmaymoreeffectivelyadvocatetheen-forcementofzoninglawsthatkeepareaspurelyresidential.46Additionally,wealthierareastendtobemoresparselypopulatedwhichisanotherkeyfactorthatmaydiscouragestoresfrommovingin(i.e.,asmallerpopulationprovidesasmallercustomerbase).LowpopulationdensityverylikelyaccountsforthelowavailabilityofsupermarketsandgrocersacrossCaledonandinsouthMississauga.

ThefindingthatlowerincomeresidentsinPeelgenerallyhadfairlygoodaccesstosourcesofhealthyandaffordablefoodisconsistentwithfindingsfromotherCanadiancitiesthatfailtoidentifypervasivefooddeserts(i.e.,apatternwherebyareaswithahighproportionofsociallyoreconomicallydisadvantagedresidentsconsis-tentlyhavelimitedaccesstosourcesofhealthyandaffordablefoods).41-46Furthermore,thefindingthatlowerincomeresidentsinPeelwereexposedtomoresourcesofunhealthyfoodthanresidentsofmoreaffluentareasisalsoconsistentwithfindingsfromseveralotherCanadiansettings.44,49,50Forexample,inEdmonton,moreeconomicallydisadvantagedneighbourhoods(e.g.,withhigherproportionsoflow-incomeresidentsandrenters)hadmuchbetteraccesstofastfoodthanmoreadvantagedareas.44,49Thispatternisconcerningbecauseanumberofrecent

studiesfoundthatresidentsofareaswithbetteraccesstofastfoodandconveniencestoreshadworsequalitydietsandheavierbodyweights.23,27,34Additionally,lowerincomeresidentsmaybemoresensitivetoalocalfoodenvironmentofferingabundantunhealthyfoodchoicesduetolimitedtransportationoptions,timeconstraintsandvalueformoney(i.e.,tasty,fillingandready-to-eatfoodssoldatlowcost).31,49

the local food environment and rates of diabetesInPeelin2011,areasthathadahighproportionofresidentslivingwithdiabetesweregenerallywellservedbyfoodretailofalltypes(i.e.,super-markets,grocerystores,fast-food/take-outoutletsandconveniencestores),withafewexceptionsinpartsofBramptonandMississauga.Incontrast,lowerdiabetesareas,whichwerehometoahigherproportionofwealthierandnon-visibleminorityresidents(seeChapters3and4),hadloweravailabilityofandlimitedaccesstobothhealthierandlesshealthyfoodretailoutlets.Oneexplanationforthispatternmaybethatwealthierindividualshaveaccesstoothermeansoftrans-portationforfoodshopping,includingcarsandtaxis.Interestingly,evenneighbourhoodswithfewerphysicalactivityresourceshadlowerratesofdiabetesiftheywereaffluent(seeChapter6).Thispatternoffindingssuggeststhatindividualswithhigherincomesmayhavemoreopportuni-tiestoachieveahealthierlifestyleregardlessoftheresourcesavailable(orunavailable)neartheirhomes,andthismayprotectthemagainstdevel-opingtype2diabetes.40Additionally,residentsofhigherincomeareasmayhavealowerriskofdiabetesduetoasmallerpopulationofresidentsbelongingtoethnicgroupswithincreasedgeneticsusceptibilitytodevelopingtype2diabetes(seeChapter4).

Patterns of fruit and vegetable intake Theself-reportedratesofconsumingfiveormorefruitsand/orvegetablesperdaywerelowandvariedlittleacrossPHDZsfrom2003to2008.InthemajorityofPHDZs,between40%and45%ofPeelresidentsaged12yearsorolderreportedconsumingfruitsand/orvegetablesfive

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ormoretimesperday.Thisrepresentsamuchlessthanideallevelofconsumption,butonethatisverysimilartoaveragelevelsinOntarioandthecountryasawhole.51InPeel,therewaslittleassociationbetweenratesoffruitandvegetableconsumptionwithratesofdiabetes.

limitations of these analysesSeveralimportantlimitationsoftheseanalysesdeservemention.Inthisanalysis,ratesoffruitand/orvegetableconsumptionwerebasedonasurveyquestionthatmeasuredthenumberoftimesrespondentsreportedconsumingfruitsand/orvegetables,ratherthanthequantitycon-sumed.Thus,thismeasuredoesnotreflectthenumberofservingsoffruitsandvegetablesthatanindividualconsumedperday,whichformsthebasisofCanada’sFoodGuide.Therewerenoadditionalmeasuresofdietquality,suchastheamountoftotalcaloriesconsumedorhowoftenapersonconsumedenergy-denseorhighly-processedfoods.Canadiandataofthistypearecurrentlyverylimited,butwillbeveryimportanttocollectandmonitor,sothatfuturestudiescanusemorespecificandsensitivemeasuresofaper-son’sdietinordertobetterassessitsrelationshipwithdiabetesandotherdiet-relatedconditions.

Additionally,geographicavailabilityandacces-sibilityoffoodretailoutletsareonlytwoofthemanyfactorsthatshapewhen,whereandhowindividualsaccessfood.Otherimportantfac-torsthatwerenotconsideredintheseanalysesincludeaperson’sphysicalmobilitystatus,financialresourcesandattitudes/beliefsaboutfoodandfoodpreparation,aswellaswidersocialandculturalnormsshapinghowindividualsaccessfoodandtheirdietarypatterns.41Forexample,familieswithalimitedbudgetwholivenearasupermarketsuchasLoblawsmayrarelyshopatthisstoreandinsteadtraveloutsideoftheirlocalareainordertodothebulkoftheirgroceryshoppingatadiscountsupermarket(e.g.,NoFrillsorFoodBasics).Furthermore,inthischapter,onlyasinglesettingwithintheoverallfoodenvironment(i.e.,thelocalorcommunityfoodenvironment)wasexamined.Otherim-portantsettingsincludethefoodenvironmentwithinorganizationsandinstitutions,within

storesandrestaurants,aswellastheinformationenvironment(e.g.,foodmarketing).

Althoughseveraltypesoffoodstoresandcom-monlypatronizedeatingplaceswereexamined,theavailabilityandaccessibilityofothertypesofretailfoodoutlets(e.g.,bakeries,specialtystores,farmers’markets,cafeterias)wereoutsidethescopeofthisanalysis.Furthermore,theclassifica-tionofhealthierandless-healthyfoodoutletswasbasedsolelyonthevenuetypeandnotontheinventoryoffoodsactuallysoldwithineachoutlet.34,35ThisclassificationschememayhaveinaccuratelyclassifiedasubsetofPeel’sstoresoreatingplaces.Theclassificationofhealthierfoodoutletswasintendedtoidentifystoreswhereavarietyoffreshproduceiscommonlyavailableatareasonablecost,whileless-healthyoutletswerethosewheresuchfoodsareinverylimitedsupplyandwherethebalanceoffoodchoicesweighsheavilytowardlesshealthyones.Thus,althoughmostsupermarketsandlargegrocerystorescarryavarietyoflesshealthyfoodproducts,thesestoresalsotendtobeareliableandaffordablesourceofawidevarietyoffreshproduce.Incontrast,themenusofmostfast-foodandtake-outrestaurantsaredominatedbyfoodsand/orbeverageshighincalories,fat,sodiumandsugarandlowinfibre.Eventhoughmanysuchoutletsofferalimitednumberofhealthieror“better-for-you”choices,traditionalless-healthyfoods,foodsand/orbeverageshighincalories,fat,sodium,sugarandlowinfibre,remainthedominantdefaultwithinmanyfastfoodrestaurants;thesefoodsarealsothemostheavilymarketedbothinsideandoutsideofrestaurants.52Additionally,thesalevolumeofhealthierfoodslikesaladswithinmanymajorchainfast-foodfranchisessuchasMcDonald’slagsfarbehindthesaleoflesshealthymenuchoices,suggestingthattraditionalfastfoods(e.g.,burgersandfries)continuetobethemostpopularchoicesamongpatronsoffast-foodestablishments.53

Finally,convenientaccesstostoressellingethnically-specificfoodsisanotherkeyissueforthemanyethnoculturallydiversegroupslivinginPeel.Unfortunately,therewasnodataonthelocationsofvariousethno-specificfoodstoresinPeel.

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conclusions and iMPlications Ahealthydietisessentialforboththepreven-tionandcontroloftype2diabetes;itisalsoakeycomponentofmaintainingahealthybodyweight.

InPeel,sourcesofhealthyfood(i.e.,supermar-ketsandgrocerystores)andlesshealthyfood(i.e.,fast-food/take-outrestaurantsandconve-niencestores)weregenerallylocatedinthesameareas.Inallareas,sourcesoflesshealthyfoodgreatlyoutnumberedsourcesofhealthyfoodbyafactorofatleastfivetoone.AccesstoalltypesoffoodretailoutletswasverygoodnearBolton,throughoutcentralBramptonandinmanypartsofMississauga,whilelimitedaccessexistedinotherpartsofCaledon,northeastBramptonandinsouthMississauga.Thepatternsoffoodoutletdistributionparalleledahighconcentrationofotherretailservicesinthesameareas,aswellaspatternsofpopulationdensityinPeel.

Moreeconomicallydisadvantagedareas,aswellasareashometoahigherproportionofresidentslivingwithdiabetes,weregenerallybetterservedbysourcesofhealthyfoodcomparedwiththewealthiestareas.However,theseareasalsohadbetteraccesstosourcesofless-healthyfood,whichgreatlyoutnumberedsourcesofhealthyfood.Incontrast,bothhigherincomeandlowerdiabetesareashadreducedaccesstofoodretailofanytype.Thefindingthatareaswithlowerincomeandhigherdiabetesrateswereexposedtomoresourcesofunhealthyfoodisconcerningbecauseofgrowingevidencethatbetteraccesstoless-healthyfoods–regardlessofaccesstohealthyfood–mayberelatedtopoorerdietandweightgain.

InPeel,effortstoensurethatallresidentshaveeasyaccesstosourcesofnutritious,affordablefoodwillcontinuetobeimportant.ManynewlydevelopedandsparselypopulatedareasinPeel,includingseveralareaswithahighproportionofresidentswithdiabetesineastandnorthBrampton,havelimitedaccesstoretailservicesofanykind.Innewdevelopmentsandinrapidlydevelopingareas,thereisarealopportunity

toshapethelocalfoodlandscapebyintroduc-ingeconomicincentivesorchangestozoningregulationstoencouragethelocationofhealthyandculturally-appropriatefoodretailerssuchaslargefoodstoresandsmallerethno-specificorspecialtystores.

AspublicschoolsacrossOntarioadoptanewhealthyfoodpolicywhichshiftsthebalanceoffoodchoicestowardmorehealthyones,54itwillbeequallyimportantforPeel’spublichealthprofessionalsandresidentstore-examinethemenuofretailfoodchoicesavailablewithintheircommunities.Asthischapterillustrates,thecurrentbalanceofthelocalretailfoodenvironmentweighsmuchmoreheavilytowardoutletsofferingenergy-dense,highly-processedandlower-nutrientfoods,suchasthetypesoffoodsmostfrequentlyavailableforpurchaseinfast-foodoutletsandconveniencestores.Thereisclearevidencethatlimitingtheconsumptionofsuchfoodsisimportantforpreventingobesityandbothpreventingandmanagingdiabetes.Giventhecurrentubiquityandpopularityofready-madeconveniencefoodsacrossCanada,policiestopromotehealthierfoodchoicesamongconsumers,aswellasinitiativesthatencouragefast-foodoutletsandothereatingplacestocreatehealthiermenusandreduceportionsizes,shouldbepromoted.

Whilemanyforcesthatshapeourfoodenviron-mentliewelloutsidecommunity-levelsettings(e.g.,foodmarketingpractices;globaltradeandagriculturalpoliciesthatpromotetheproductionofparticularfoodproductssuchashigh-fructosecornsyrup),manyimportantinitiativescouldbeundertakenatthelocalleveltohelpcreatesupportiveenvironmentsforhealthyeatingincommunities.Forexample,workingwithlocalbusinessownerstoincreaseofferingsoffreshproduceand/orethno-specificfoodswithinconveniencestoresorgasstationsisonepromis-ingavenueforfuturecommunity-ledinitiatives.Limitingaccesstoless-healthyfoodthroughchangesinzoningregulationsinsettingssuchasschoolsmayalsobeanavenuetowardcreatingenvironmentsthatencourageandbettersupporthealthyeatingonadailybasis.

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GiventhatmostCanadiansdonotfollowhealthyeatingrecommendationsandmorethanhalfareoverweightorobese,publichealthmeasurestoencourageandsupporthealthyeatingmustbeconsideredamajorpriority.Toachievepopula-tion-wideimprovementsineating,suchactionsmustbeundertakenatmultiplelevels(i.e.,local,provincial,federal)andmusttargetthemultiplefoodenvironmentsandconditionsthatinfluencepeople’sdailyfoodchoices.

aPPEndix 7.a – rEsEarcH MEtHodology data sources• Thelocationsofalloutletsservingorselling

foodinPeelin2011wereprovidedbyPeelEnvironmentalHealth.Fromthisfoodpremiselist,weselectedthefivemostcommonfoodretailertypes:supermarkets,grocerystores,convenience/varietystores,fast-foodortake-outrestaurants,andfull-servicerestaurants.Wegenerallyfollowedthesameclassificationofstoresandeatingplacesasthoseprovidedinthefoodpremisedatabase,butcompletedsomeadditionalre-classifyingtosuittheneedsofouranalyses.Table1defineseachtypeoffoodretailvenueincludedinouranalysesandprovidesexamples.

• Thelow-incomecut-off(LICO)isaderivedvariablefromthe2006Canadiancensuswhichreflects2005incomedata.Thelow-incomecut-off(LICO)wasderivedforeconomicfamiliesandpersonsaged15yearsorolderinprivatehouseholdswhowerenotineconomicfamilies.TheLICOreferstoincomelevelswherebyanindividualspendsasignificantlyhigherthanaverageproportionoftheirtotalincomeonfood,shelterandclothing.

• Age-andsex-adjusteddiabetesrateswerecalculatedusingdatafromtheOntarioDiabetesDatabaseandotheradministrativedatasourcesheldattheInstituteforClinicalEvaluativeSciences(seeChapter2,Appendix2.Aforfulldetails).

• Datafromthe2003(cycle2.1),2005(cycle3.1)and2007/2008wavesoftheCanadianCommunityHealthSurvey(CCHS)wereusedtodetermineratesofself-reportedfruitandvegetableconsumptioninPeelHealthDataZones(PHDZs).FruitandvegetableconsumptionwasexaminedbycalculatingthepercentageofthePeelpopulationaged12orolderwhoreportedeatingfruitand/orvegetablesatleastfivetimesperday.Thisvari-ableexaminesthefrequencyofconsumption,andnotthequantityconsumed.Thus,thisvariabledoesnottranslatetonumberofdailyservings.51

• Inordertoremoveanyinfluenceduetodifferencesinthepopulation’sageandsexdistributionacrossPHDZs,westandardizedtheratesoffruitand/orvegetableintaketothe1991Canadacensuspopulation.

• StatisticsCanada’sspecificguidelinesforreportingestimatesbasedonCCHSdatawerefollowed(seeAppendix2.Aformoredetailsaboutthesereportingguidelines).

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analysis

TheavailabilityandaccessibilityofvariousretailfoodestablishmentsthroughoutPeelregionwasexamined.Availabilitywasdepictedintwowaysonmapsincludedinthischapter:

• Thefirstmethodusedsymbolstoshowthelocationsofresources(e.g.,supermarketsacrosstheregion).Thismethodallowedustodeterminewhereserviceswerelocatedandwhethercertainresourcesexistedinspecificcensustracts.

• Thesecondmethodusedchoropleth(shaded)mapstoshowthedensityofresourcesineacharea,takingpopulationintoaccount(i.e.,thenumberofconveniencestoresper10,000residents).Thismethodshowswhereresourceswerelocatedinrelationtowherepeoplelivedandwhichareashadmoreresourcespercapitathanothers.

TheRetailFoodEnvironmentIndex(RFEI)wascalculatedineachPHDZasfollows:

rFEi =

TheRFEIrepresentsthemixorratioofless-healthyretailfoodsourcestohealthierfoodoutletswithinagivengeographicarea.Largerareas(thePHDZs)wereusedtocalculatethismeasurebecausemanysmallerareas(i.e.,censustracts)containednofoodoutletsofanykind,orcontainednohealthyfoodoutlets(whichyields0inthedenominator).

Accessoraccessibilityasshownontheaccessibil-itymapswasmeasuredastheshortestdistancealongthestreetnetworktothenearestresourcelocationfromeachpointina150-metregridofstartingpointslocatedacrossPeelregion.Thatis,thedistancealongthenetworkofstreetsandhighwaysfromeachstartingpointtothenearestfoodretailoutletofeachtypewasmeasured.

Toassessthespatialrelationshipbetweenacces-sibilitytostores/eatingplacesandthelevelofeconomicdisadvantageinPeel,threecategoriesofthepercentofthepopulationbelowtheLICO

atthecensustractlevelwerecreated.AllcensustractswereorderedaccordingtothepercentoftheirpopulationbelowtheLICO(fromlowesttohighest)andthendividedintothreegroupswithanequalnumberofcensustracts.Tocomparetheleastandmosteconomicallydisadvantagedareas,thefirstandthethirdgroup(i.e.,areaswiththelowestandhighestpercentofitspopulationbelowtheLICO)wereselected.Thelevelsofaccessibilitytothenearestsupermarkets/grocerystore,conveniencestoreandfast-food/take-outrestaurantweredepictedforeachgroup.AreaswithamediumpercentageoftheirresidentsbelowtheLICO(8.0%–12.0%)weredepictedinasinglegreycolour.

Thespatialrelationshipbetweenfoodretailaccessibilitymeasuresandratesofdiabetesprevalencethatwereeithermuchhigher(20%ormore)ormuchlower(20%orless)thantheGreaterTorontoArea(GTA)averagediabetesrateof9.0%wereevaluated.ForeachPeelcensustract,thediabetesratewasdividedbytheoverallGTAratetocalculatearate-ratio.CensustractswithdiabetesratesthatweremeaningfullyhigherthanintheGTAasawhole(rate-ratioof≥1.2)weredepictedinshadesofred,whiletractswithratesmuchlowerthanintheGTA(rate-ratioof≤0.80)weredepictedinshadesofblue.AllcensustractswhoseratesdidnotdiffersubstantiallyfromtheGTArate(rate-ratiobetween0.81and1.19)weredepictedusingasinglegreycolour.

Finally,theaveragerateofconsumingfiveormorefruitand/orvegetablesperdaywasdepict-edforeachPHDZusingashaded(choropleth)map.Associatedratesofage-andsex-standard-izeddiabetesprevalenceineachPHDZwereoverlaidonthismapusingproportionalsymbols(circles).Thethreecategoriesofdiabetespreva-lencewerederivedfrompopulation-weightedtertilesofdiabetesprevalenceinPHDZs(i.e.,allPHDZswereorderedfromlowesttohighestdiabetesprevalenceandthendividedintothreegroupswithequalpopulations).Thismethodwasusedinordertocreateareasonabledistributionofratesacrossthesmallnumberoftheserela-tivelylargespatialunits.

supermarkets grocery stores

convenience Fast-food take-out stores restaurants restaurants

+

+ +

195

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Table 1. Food Retail Descriptions

Food outlet type (number of outlets) description

Supermarket (184) Large food stores offering a full line of grocery products and may include specialty departments such as deli, bakery, butcher shop, seafood counter and pharmacy.

Grocery store (60) All other smaller retail food stores, other than a supermarket or convenience store, selling a line of dry grocery, canned goods or perishable food items.

Convenience/variety store (474)

Small establishments selling a limited selection of grocery and other basic daily-living items. These stores are open outside of normal operating business hours. Stores located inside gas stations were included.

Fast-food or take-out restaurant (1,165)

Multi-national and national franchised or locally-owned limited- or quick-service restau-rants (i.e. where there is no table service and where customers pay before receiving their food) that serve either full meals or snacks. Includes pizza shops, coffee shops and food court vendors.

Full-service restaurant (1,223)

Eat-in restaurants with table service where customers generally pay at the end of their meal. Both locally-owned and larger national and multi-national chain restaurants were included.

196

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