School of Community and          Health S i          H lth Sciences                          Martin CCaraher      Professo...
Proliferation of Fast FoodOutlets, Health Inequalities andO l      H lhI         li i    dLocal 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
Sweetness Because sweet foods are naturally good and are safe sources ofenergy and nutrients, adaptive evolutionary develo...
Biology vs Technology: Shift fromWater to Caloric Beverages with No   Food Calorie Compensation
Fat Preference Key for Survival:Technology, Marketing have Utilized   this Preference for Fatty Food
So we now haveAn OBESOGENIC environment where: – Unhealthy choices are easier than healthy   ones. – Unhealthy food costs ...
The last 18 monthsGlobally what has happened in a year to 18 months isextraordinary.  t    diSome changes that have taken ...
Some issues of concernMiddle-income consumers are now eating out less and buying fewer luxury goodsbut buying luxury or ni...
Simple rules of heuristics
Move th b                                M    the broccoli t                                               li to          ...
Individual               responsibility             Change in the             environmentPuska 2001
The evolution of public health policy
The Gift relationship - the greater good
Individual               I di id l               responsibility             Change in the             environmentPuska 2001
Tower Hamlets Food Study       Tim Madelin – Public Health,           Tower Hamlets PCTMartin Caraher, Sue Lloyd, City Uni...
Tower Hamlets 3rd most deprived borough in England (2nd in London) Most deprived for income deprivation affecting children...
Focus Groups (contd) Obtain food from local shops Many abstain from school lunches – use dinner money in FFO later Closed-...
Part 2 - Chicken & Chips 98% HH within 10mins walk of grocery type store
But…  97% HH  within  10mins  walk of  FFO
Ditto take aways in Preston                              Preston had more fast                              food outlets (...
Take-aways in Tower Hamlets Using the School Food Trust methodology we found there were 41.8 junk food outlets to every sc...
SoSo cannot be left to industry, the approachbased on food industry setting the solutionNor can it be left to social enter...
Some solutions Supplementary guidance to ban any new openings within 400m of a school. In highly dense city areas applying...
Some solutionsLeicester City Council has introduced supplementary planningguidance which states that no more than 20% of t...
Some solutions limit or zoneFFOs d/ d iFFO and/or drive through outlets.                      h    h     l  ‘Formula’ outl...
Some solutions limit or zone Making h link between registration f f d h i M ki the li k b          i     i for food hygien...
So Legislate? So the concern is to improve healthy food on the high street Scores on the doors Messages consistent Tax HF ...
The cover of "The Economist", Dec. 13-19, 2003.
Changes in planning NICE PDG on spatial planning Regional planning abandoned Eric Pickles local planning to be made less b...
SWOT So Opportunities          But threats Local food plans can            p              Big business can wait           ...
Individual                   responsibility                  Changes in the             Change in the                  env...
Takeaways unwrapped event 070411   prof martin caraher presentation - proliferation of fast food outlets health inequaliti...
Takeaways unwrapped event 070411   prof martin caraher presentation - proliferation of fast food outlets health inequaliti...
Takeaways unwrapped event 070411   prof martin caraher presentation - proliferation of fast food outlets health inequaliti...
Takeaways unwrapped event 070411   prof martin caraher presentation - proliferation of fast food outlets health inequaliti...
Takeaways unwrapped event 070411   prof martin caraher presentation - proliferation of fast food outlets health inequaliti...
Takeaways unwrapped event 070411   prof martin caraher presentation - proliferation of fast food outlets health inequaliti...
Takeaways unwrapped event 070411   prof martin caraher presentation - proliferation of fast food outlets health inequaliti...
Takeaways unwrapped event 070411   prof martin caraher presentation - proliferation of fast food outlets health inequaliti...
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Takeaways unwrapped event 070411 prof martin caraher presentation - proliferation of fast food outlets health inequalities and local policy

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Takeaways unwrapped event 070411 prof martin caraher presentation - proliferation of fast food outlets health inequalities and local policy

  1. 1. School of Community and Health S i H lth Sciences Martin CCaraher Professor of food and health policy Centre for food policy City University, London
  2. 2. Proliferation of Fast FoodOutlets, Health Inequalities andO l H lhI li i dLocal Policy
  3. 3. The lifeworld
  4. 4. Southampton General Hospital
  5. 5. Life world is the locus of experience: social,psychological and physical
  6. 6. Sweetness Preference was Essential to Survive: now the amounts
  7. 7. Sweetness Because sweet foods are naturally good and are safe sources ofenergy and nutrients, adaptive evolutionary development has resultedin a preference for them p f fOf the five most widely acknowledged tastes, three generally signalacceptance (sweet, salty, and umami*), while two generally signalavoidance(sour and bitter).These early responses are modified by life experiences,producingadult tastes preferences. p f
  8. 8. Biology vs Technology: Shift fromWater to Caloric Beverages with No Food Calorie Compensation
  9. 9. Fat Preference Key for Survival:Technology, Marketing have Utilized this Preference for Fatty Food
  10. 10. So we now haveAn 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 the past. – Food is available at all times.
  11. 11. The last 18 monthsGlobally what has happened in a year to 18 months isextraordinary. t diSome changes that have taken over 30 years todevelop have been reversed.
  12. 12. Some issues of concernMiddle-income consumers are now eating out less and buying fewer luxury goodsbut buying luxury or niche foods for occasions, this has seen a reduction in peoplebuy g specialty chocolatebuying spec a ty c oco ate but a increase in sa es o Nestle b a d c oco ate an c ease sales of est e brand chocolate.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 BarnsGiven 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 yg p
  13. 13. Simple rules of heuristics
  14. 14. Move th b M the broccoli t li to Rename the food Hide the ice cream. the start of the queue Close the lid Shrink the bowl Offer a saladUse fruit bowls not stainless steel Pay cash for desert not accepted on cards Make an express line withMove salad bar away from an wall emphasis on healthy products
  15. 15. Individual responsibility Change in the environmentPuska 2001
  16. 16. The evolution of public health policy
  17. 17. The Gift relationship - the greater good
  18. 18. Individual I di id l responsibility Change in the environmentPuska 2001
  19. 19. Tower Hamlets Food Study Tim Madelin – Public Health, Tower Hamlets PCTMartin Caraher, Sue Lloyd, City University
  20. 20. Tower Hamlets 3rd most deprived borough in England (2nd in London) Most deprived for income deprivation affecting children 14% 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
  21. 21. Focus Groups (contd) Obtain food from local shops Many 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 home Felt that school meals poor value compared to FFO Quality school meals generally OK Much concern about school canteen environments
  22. 22. Part 2 - Chicken & Chips 98% HH within 10mins walk of grocery type store
  23. 23. But… 97% HH within 10mins walk of FFO
  24. 24. Ditto take aways in Preston Preston had more fast food outlets (186) [not including restaurants who operate takeaways] than general groceries outlets (165).
  25. 25. 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 UK ‘ ‘worst’ l l authorities. ’ local h i i This could be potentially be underestimating the number of food outlets p y g as 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 classified as restaurants (605 in Tower Hamlets) as they have l ifi d ( i l ) h h tables/seating essentially operate predominately as take away premises leading to further potential under counting
  26. 26. SoSo cannot be left to industry, the approachbased on food industry setting the solutionNor can it be left to social enterprise pNot just the LOCAL… as the solutionA raft of initiatives across agencies isneeded not just oneLoss of expertise as we wait…..We need a public health approachNeed to bN d t be careful about l f l b t location as it i ti ismore complex than this – eg 401m;delivery
  27. 27. Some solutions Supplementary 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 being allowed Others proposing a once off £1000 fee to fund health p p g promotion activities
  28. 28. Some solutionsLeicester City Council has introduced supplementary planningguidance which states that no more than 20% of the frontageof any side of a street is allowed in fast food (A5 class) use use.Waltham Forest, in London, has introduced similar guidance toe su e e a protection and balance ofensure retail p o ec o a d ba a ce o use, with the c e a e criteriaflexible to take account of developments in different centres inthe borough.The London Borough of Westminster has identified ‘stressedareas’ where new fast food openings are resisted and they usea joint planning/licensing approach approach.
  29. 29. Some solutions limit or zoneFFOs d/ d iFFO and/or drive through outlets. h h l ‘Formula’ outlets (formula can be defined broadly to includelocal take-ways that have one or more outlets or narrowly to take waysinclude only larger national chains). FFOs in certain areas or by directives specifying distancefrom schools, hospitals etc.. By using q y g quotas in certain areas either by number of shop y pfrontage or by use of density. Restricting opening hours.
  30. 30. Some solutions limit or zone Making h link between registration f f d h i M ki the li k b i i for food hygiene and d licensing more explicit. Introducing labeling in fast food outlets (as has happened in New York City) and the Coalition Government has promised. promised Using ‘choice editing’ and specifying the nutrient content of choice editing food sold, so the choice is made before the consumer purchases.
  31. 31. So Legislate? So the concern is to improve healthy food on the high street Scores on the doors Messages consistent Tax HF Choice diti Ch i editing Nudge effect -train staff ensure there is a healthy affordable /comparable health offer Subsidies and taxation Wider environment issues, healthy workplace but unhealthy shops on high street.
  32. 32. The cover of "The Economist", Dec. 13-19, 2003.
  33. 33. Changes in planning NICE 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 involved DPHs to LAs. DPH t LA
  34. 34. SWOT So Opportunities But threats Local food plans can p Big business can wait g incorporate food issues out the planning People are concerned p process with the concentration Small businesses may of FFOs be disadvantaged Supplementary guidance
  35. 35. Individual responsibility Changes in the Change in the environment environmentPuska 2001

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