Measuring food access in Melbourne: access to healthy and fast foods by car, bus and foot in an urban municipality in Melbourne

Access to healthy food can be an important determinant of a healthy diet. This paper describes the assessment of access to healthy and unhealthy foods using a GIS accessibility programme in a large outer municipality of Melbourne. Access to a major supermarket was used as a proxy for access to a healthy diet and fast food outlet as proxy for access to unhealthy food. Our results indicated that most (>80%) residents lived within an 8–10 min car journey of a major supermarket i.e. have good access to a healthy diet. However, more advantaged areas had closer access to supermarkets, conversely less advantaged areas had closer access to fast food outlets. These findings have application for urban planners, public health practitioners and policy makers.

Neighbourhood socioeconomic inequalities in food access and affordability

This study investigated whether the availability and accessibility of supermarkets and fruit and vegetable stores, and the availability, variety and price of foods within these stores, varied across areas of different levels of socioeconomic disadvantage in Melbourne, Australia. Data on food store locations, and food variety and price within stores were obtained through objective audits of 45 neighbourhoods of varying socioeconomic disadvantage. Geographical accessibility of healthy food stores was mostly better amongst those living in more advantaged neighbourhoods. Availability of healthy foods within stores only slightly favoured those in advantaged neighbourhoods. However food prices favoured those living in disadvantaged areas.

Reduced food access due to a lack of money, inability to lift and lack of access to a car for food shopping : a multilevel study in Melbourne, Victoria

Objective: To describe associations between demographic and individual and arealevel socio-economic variables and restricted household food access due to lack of money, inability to lift groceries and lack of access to a car to do food shopping.
Design: Multilevel study of three measures of restricted food access, i.e. running out of money to buy food, inability to lift groceries and lack of access to a car for food shopping. Multilevel logistic regression was conducted to examine the risk of each of these outcomes according to demographic and socio-economic variables.
Setting: Random selection of households from fifty small areas in Melbourne, Australia, in 2003.
Subjects: The main food shoppers in each household (n 2564).
Results: A lack of money was significantly more likely among the young and in households with single adults. Difficultly lifting was more likely among the elderly and those born overseas. The youngest and highest age groups both reported reduced car access, as did those born overseas and single-adult households. All three factors were most likely among those with a lower individual or household socio-economic position. Increased levels of area disadvantage were independently associated with difficultly lifting and reduced car access.
Conclusions: In Melbourne, households with lower individual socio-economic position and area disadvantage have restricted access to food because of a lack of money and/or having physical limitations due difficulty lifting or lack of access to a car for food shopping. Further research is required to explore the relationship between physical restrictions and food access.

“Come and live in my Shoes”: Food Access and social isolation for People living in poverty IN GANANOQUE, Ontario

This community-based research project, in collaboration with the Gananoque and Area Food Access Network (GAFAN), gathered data from self-reported food insecure residents of Gananoque and area to determine how to improve their access to healthy, personally acceptable food. In March 2016, I recruited 14 participants for three focus groups and one personal interview with those struggling to put food on the table for themselves and others in the household. Participants were single parents, adults over the age of 50, and adults who could benefit from improved access to healthy food but do not currently use existing services. Health issues, social isolation, scraping by, and lack of income were four themes that underscored the impact of poverty on the lives of participants. Lack of income, transportation, cost of food, lack of affordable or accessible childcare, and inadequate access to support services proved to be major barriers to food security: strongly influenced by the impact of rurality. The results of this research have the potential to help GAFAN improve food access for those living in this community. It may also have implications for enhancing food security in other rural Canadian communities.

Fast food purchasing and access to fast food restaurants : a multilevel analysis of VicLANES

Background : While previous research on fast food access and purchasing has not found evidence of an association, these studies have had methodological problems including aggregation error, lack of specificity between the exposures and outcomes, and lack of adjustment for potential confounding. In this paper we attempt to address these methodological problems using data from the Victorian Lifestyle and Neighbourhood Environments Study (VicLANES) – a cross-sectional multilevel study conducted within metropolitan Melbourne, Australia in 2003.
Methods : The VicLANES data used in this analysis included 2547 participants from 49 census collector districts in metropolitan Melbourne, Australia. The outcome of interest was the total frequency of fast food purchased for consumption at home within the previous month (never, monthly and weekly) from five major fast food chains (Red Rooster, McDonalds, Kentucky Fried Chicken, Hungry Jacks and Pizza Hut). Three measures of fast food access were created: density and variety, defined as the number of fast food restaurants and the number of different fast food chains within 3 kilometres of road network distance respectively, and proximity defined as the road network distance to the closest fast food restaurant. Multilevel multinomial models were used to estimate the associations between fast food restaurant access and purchasing with never purchased as the reference category. Models were adjusted for confounders including determinants of demand (attitudes and tastes that influence food purchasing decisions) as well as individual and area socio-economic characteristics.
Results : Purchasing fast food on a monthly basis was related to the variety of fast food restaurants (odds ratio 1.13; 95% confidence interval 1.02 – 1.25) after adjusting for individual and area characteristics. Density and proximity were not found to be significant predictors of fast food purchasing after adjustment for individual socio-economic predictors.
Conclusion : Although we found an independent association between fast food purchasing and access to a wider variety of fast food restaurant, density and proximity were not significant predictors. The methods used in our study are an advance on previous analyses.

The increasing cost of healthy food

OBJECTIVE: To assess changes in the cost and availability of a standard basket of healthy food items (the Healthy Food Access Basket [HFAB]) in Queensland. METHODS: Analysis of five cross-sectional surveys (1998, 2000, 2001, 2004 and 2006) describes changes over time. Eighty-nine stores in five remoteness categories were surveyed during May 2006. For the first time a sampling framework based on randomisation of towns throughout the state was applied and the survey was conducted by Queensland Treasury. RESULTS: Compared with the costs in major cities, in 2006 the mean cost of the HFAB was $107.81 (24.2%) higher in very remote stores in Queensland, but $145.57 (32.6%) higher in stores more than 2,000 kilometres from Brisbane. Over six years the cost of the HFAB has increased by around 50% ($148.87) across Queensland and, where data was available, by more than the cost of less healthy alternatives. The Consumer Price Index for food in Brisbane increased by 32.5% over the same period. CONCLUSIONS AND IMPLICATIONS: Australians, no matter where they live, need access to affordable, healthy food. Issues of food security in the face of rising food costs are of concern particularly in the current global economic downturn. There is an urgent need to nationally monitor, but also sustainably address the factors affecting the price of healthy foods, particularly for vulnerable groups who suffer a disproportionate burden of poor health.

A vision for attaining food security

Food is fundamental to human wellbeing and development. Increased food production remains a cornerstone strategy in the effort to alleviate global food insecurity. But despite the fact that global food production over the past half century has kept ahead of demand, today around one billion people do not have enough to eat, and a further billion lack adequate nutrition. Food insecurity is facing mounting supply-side and demand-side pressures; key among these are climate change, urbanisation, globalisation, population increases, disease, as well as a number of other factors that are changing patterns of food consumption. Many of the challenges to equitable food access are concentrated in developing countries where environmental pressures including climate change, population growth and other socio-economic issues are concentrated. Together these factors impede people's access to sufficient, nutritious food; chiefly through affecting livelihoods, income and food prices. Food security and human development go hand in hand, and their outcomes are co-determined to a significant degree. The challenge of food security is multi-scalar and cross-sector in nature. Addressing it will require the work of diverse actors to bring sustained improvements inhuman development and to reduce pressure on the environment. Unless there is investment in future food systems that are similarly cross-level, cross-scale and cross-sector, sustained improvements in human wellbeing together with reduced environmental risks and scarcities will not be achieved. This paper reviews current thinking, and outlines these challenges. It suggests that essential elements in a successfully adaptive and proactive food system include: learning through connectivity between scales to local experience and technologies high levels of interaction between diverse actors and sectors ranging from primary producers to retailers and consumers, and use of frontier technologies.

Climate change impacts on global food security

Climate change could potentially interrupt progress toward a world without hunger. A robust and coherent global pattern is discernible of the impacts of climate change on crop productivity that could have consequences for food availability. The stability of whole food systems may be at risk under climate change because of short-term variability in supply. However, the potential impact is less clear at regional scales, but it is likely that climate variability and change will exacerbate food insecurity in areas currently vulnerable to hunger and undernutrition. Likewise, it can be anticipated that food access and utilization will be affected indirectly via collateral effects on household and individual incomes, and food utilization could be impaired by loss of access to drinking water and damage to health. The evidence supports the need for considerable investment in adaptation and mitigation actions toward a “climate-smart food system” that is more resilient to climate change influences on food security.

Food cost and availability in a rural setting in Australia

Introduction: The burden of chronic diseases is rapidly increasing worldwide. In  Australia rural populations have a greater burden of disease. Chronic diseases are largely preventable with diet as a key risk factor. With respect to diet-related chronic disease, dietary risk may be due to poor food access, namely, poor availability and/or the high cost of healthy food. It is likely that poor food access is an issue in rural areas. Objective: To assess food access in rural south-west (SW) Victoria, Australia.

Methods: A total of 53 supermarkets and grocery stores in 42 towns participated in a survey of food cost and availability in the rural area of SW Victoria. The survey assessed availability and cost of a Healthy Food Access Basket (HFAB) which was designed to meet the nutritional needs of a family of 6 for 2 weeks.

Results: Seventy-two percent of the eligible shops in SW Victoria were surveyed. The study found that the complete HFAB was significantly more likely to be available in a town with a chain-owned store (p<0.00). The complete HFAB was less likely to be available from an independently owned store in a town with only one grocery shop (p<0.004). The average cost of the HFAB across SW Victoria was AU$380.30 ± $25.10 (mean ± SD). There was a mean range in difference of cost of the HFAB of $36.92. In particular, high variability was found in the cost of fruits and vegetables.

Conclusions: Cost and availability of healthy food may be compromised in rural areas. Implications: Improvements in food access in rural areas could reduce the high burden of disease suffered by rural communities.

Food security measurement in cultural pluralism : missing the point or conceptual misunderstanding?

Objective : Food Security has become a global concern, yet its measurement has varied considerably across disciplines and countries. We examined the current discrepancies in the definitions of food security and propose a framework for understanding and measuring food security.

Methods : This conceptual review draws from a range of works published in Medline and the gray literature to advance the understanding of food security concepts. We begin by examining the historical background of food security and then move on to examine its various definitions and interpret food through cultural lenses in terms of food access and utilization. We finish by examining various measurements and indicators of food security and reviewing implications for public health.

Results : We argue that the reliance on coping strategies as surrogate measurements of food insecurity without taking into account the social, cultural, and political contexts in which they occur is misleading, and viewing food insecurity solely from a food access or availability perspective, without taking into account food utilization and asset creation as pillars of food security, paints an incomplete picture. Although this review does not claim to provide solutions to the discrepancies in the conceptual definition of food security, it attempts to highlights areas of concern and provide a way forward.

Conclusion : When coping strategies are used as an indicator of food insecurity, they need to be culturally relevant and focus tested, and together with objective measurements of nutritional outcomes, would allow policy makers to make evidence-based decisions to inform social and nutrition policies.

Individual and area-level socioeconomic associations with fast food purchasing

Background It has been suggested that those with lower socioeconomic characteristics would be more likely to seek energy-dense food options such as fast food because of cheaper prices; however, to date the evidence has been inconsistent. This study examines both individual- and area-level socioeconomic characteristics and their independent associations with chain-brand fast food purchasing.

Methods Data from the 2003 Victorian Lifestyle and Neighbourhood Environments Study (VicLANES); a multilevel study of 2547 adults from 49 small-areas in Melbourne, Australia, were used. Multilevel multinomial models adjusted for confounders were used to assess associations between individual socioeconomic position (education, occupation and income) and area socioeconomic characteristics in relation to fast food purchasing from five major fast food chains with outcome categories: never, at least monthly and at least weekly. The study finally assessed whether any potential area-level associations were mediated by fast food access.

Results Increased fast food purchasing was independently associated with lower education, being a blue-collar employee and decreased household income. Results for area-level disadvantage were marginally insignificant after adjustment for individual-level characteristics, although they were suggestive that living in an area with greater levels of disadvantage increased an individual's odds of more frequent fast food purchasing. This effect was further attenuated when measures of fast food restaurant access were included in the models.

Conclusion Independent effects of lower individual-level socioeconomic characteristics and more frequent fast food purchasing for home consumption are demonstrated. Although evidence was suggestive of an independent association with area-level disadvantage this did not reach statistical significance.

Comparing the availability, price, variety and quality of fruits and vegetables across retail outlets and by area level socioeconomic position

Abstract Objective: To explore whether area-level socioeconomic position or the form of retail stream (conventional versus farmers’ market) are associated with differences in the price, availability, variety and quality of a range of fresh fruit and vegetables. Design: A multi-site cross-sectional pilot study of farmers’ markets, supermarkets and independent fruit and vegetable retailers. Each was surveyed to assess the price, availability, variety and quality of 15 fruit and 18 vegetable items. Setting: Retail outlets were located in South-East Queensland. Subjects: Fifteen retail outlets were surveyed (five of each retail stream). Results: Average basket prices were not significantly different across the socioeconomic spectrum however prices in low socioeconomic areas were cheapest. Availability, variety, and quality did not differ across levels of socioeconomic position however the areas with the most socioeconomic disadvantage scored poorest for quality and variety. Supermarkets had significantly better fruit and vegetable availability than farmers’ markets however price, variety and quality scores were not different across retail streams. Results demonstrate a trend to fruit and vegetable prices being more expensive at farmers’ markets, with the price of the Fruit basket being significantly greater at the organic farmer’s market compared with the non-organic farmers’ markets. Conclusions: Neither area-level socioeconomic position nor the form of retail stream was significantly associated with differences in the availability, price, variety and quality of fruit and vegetables, except for availability which was higher in supermarkets than farmers’ markets. Further research is needed to determine what role farmers’ markets can play in affecting fruit and vegetable intake.

The increasing cost of the basic foods required to promote health in Queensland

Objective: To assess changes in the cost and availability of a standard basket of healthy food items (the Healthy Food Access Basket [HFAB]) in Queensland over time. Design and participants: A series of four cross-sectional surveys (in 1998, 2000, 2001 and 2004) describing the cost and availability of foods in the HFAB over time. In the latest survey, 97 Queensland food stores across the five Australian Bureau of Statistics remoteness categories were compared. Main outcome measures: Cost comparisons for HFAB items by remoteness category for the 97 stores surveyed in 2004; changes in cost and availability of foods in the 81 stores surveyed since 2000; comparisons of food prices in the 56 stores surveyed in 1998, 2000, 2001 and 2004. Results: In 2004, the Queensland mean cost of the HFAB was $395.28 a fortnight. The cost of the HFAB was 29.6%($113.89) higher in “very remote” areas than in “major cities” (P<0.001). Between 2001 and 2004, the Queensland mean cost of the HFAB increased by 14.0% ($48.45), while in very remote areas the cost increased by 18.0% ($76.93) (P<0.001). Since 2000, the annualised per cent increase in cost of the HFAB has been higher than the increase in Consumer Price Index for food in Brisbane. The cost of healthy foods has risen more than the cost of some less nutritious foods, so that the latter are now relatively more affordable. Conclusions: Consumers, particularly those in very remote locations, need to pay substantially more for basic healthy foods than they did a few years ago. Higher prices are likely to be a barrier to good health among people of low socioeconomic status and other vulnerable groups. Interventions to make basic healthy food affordable and accessible to all would help reduce the high burden of chronic disease.

Childhood obesity in Ireland: recent trends and modifiable determinants

Background: Childhood obesity is a global epidemic posing a significant threat to the health and wellbeing of children. To reverse this epidemic, it is essential that we gain a deeper understanding of the complex array of driving factors at an individual, family and wider ecological level. Using a social-ecological framework, this thesis investigates the direction, magnitude and contribution of risk factors for childhood overweight and obesity at multiple levels of influence, with a particular focus on diet and physical activity. Methods: A systematic review was conducted to describe recent trends (from 2002-2012) in childhood overweight and obesity prevalence in Irish school children from the Republic of Ireland. Two datasets (Cork Children’s Lifestyle [CCLaS] Study and the Growing Up in Ireland [GUI] Study) were used to explore determinants of childhood overweight and obesity. Individual lifestyle factors examined were diet, physical activity and sedentary behaviour. The determinants of physical activity were also explored. Family factors examined were parental weight status and household socio-economic status. The impact of food access in the local area on diet quality and body mass index (BMI) was investigated as an environmental level risk factor. Results: Between 2002 and 2012, the prevalence of childhood overweight and obesity in Ireland remained stable. There was some evidence to suggest that childhood obesity rates may have decreased slightly though one in four Irish children remained either overweight or obese. In the CCLaS study, overweight and obese children consumed more unhealthy foods than normal weight children. A diet quality score was constructed based on a previously validated adult diet score. Each one unit increase in diet quality was significantly associated with a decreased risk of childhood overweight and obesity. Individual level factors (including gender, being a member of a sports team, weight status) were more strongly associated with physical activity levels than family or environmental factors. Overweight and obese children were more sedentary and less active than normal weight children. There was a dose response relationship between time spent at moderate to vigorous physical activity (MVPA) and the risk of childhood obesity independent of sedentary time. In contrast, total sedentary time was not associated with the risk of childhood obesity independent of MVPA though screen time was associated with childhood overweight and obesity. In the GUI Study, only one in five children had 2 normal weight parents (or one normal weight parent in the case of single parent families). Having overweight and obese parents was a significant risk factor for overweight and obesity regardless of socio-economic characteristics of the household. Family income was not associated with the odds of childhood obesity but social class and parental education were important risk factors for childhood obesity. Access to food stores in the local environment did not impact dietary quality or the BMI of Irish children. However, there was some evidence to suggest that the economic resources of the family influenced diet and BMI. Discussion: Though childhood overweight and obesity rates appear to have stabilised over the previous decade, prevalence rates are unacceptably high. As expected, overweight and obesity were associated with a high energy intake and poor dietary quality. The findings also highlight strong associations between physical inactivity and the risk of overweight and obesity, with effect sizes greater than what have been typically found in adults. Important family level determinants of childhood overweight and obesity were also identified. The findings highlight the need for a multifaceted approach, targeting a range of modifiable determinants to tackle the problem. In particular, policies and interventions at the shared family environment or community level may be an effective mean of tackling this current epidemic.