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

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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

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environmentPuska 2001