Improving Public Health With Healthy Food Environments - NCCEH

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www.ncceh.caImproving Public Health with Healthy FoodEnvironmentsTina Chen, MPH, CPHI(C)Environmental Health and Knowledge Translation ScientistProject Collaborator: Ellen Gregg, Public Health Nutritionist,Region of Waterloo Public HealthTOPHCMarch 22, 2018

Non-Conflict DisclosuresThe presenter and project collaborator did not receive externalfinancial or in-kind support and do not have any conflicts ofinterest to declare

What is a healthy food Equitable access to healthy foods such as fruits,vegetables, whole grains, and healthy snackoptions

Types of food environmentsCommunity foodenvironment Geographic food access,which refers to the locationand accessibility of foodoutlets

Types of food environmentsCommunity foodenvironmentConsumer foodenvironment Geographic food access,which refers to the locationand accessibility of foodoutlets Food availability, foodaffordability, food quality,and other aspectsinfluencing food choices inretail outlets

Types of food environmentsCommunity foodenvironmentConsumer foodenvironment Geographic food access,which refers to the locationand accessibility of foodoutlets Food availability, foodaffordability, food quality,and other aspectsinfluencing food choices inretail outletsOrganizational foodenvironment Access to food in settingssuch as workplaces andschools

Types of food environmentsCommunity foodenvironmentConsumer foodenvironment Geographic food access,which refers to the locationand accessibility of foodoutlets Food availability, foodaffordability, food quality,and other aspectsinfluencing food choices inretail outletsOrganizational foodenvironmentInformationenvironment Access to food in settingssuch as workplaces andschools Food marketing, media,advertising

Within community food environments:Most commontype in CanadaFooddesertsFoodswampsFoodmirages

Current diet quality in CanadaLess than 1% of the Canadian populationfollow nutrition recommendationsLow intakes of vegetables,fruits, and whole grainsRelatively large amount ofultra-processed food andbeveragesHigher risk of developingdiet-related chronicdiseases and conditions

Burden of poor diet and diet-related chronicdiseases Poor diet is linked to the risk of developing diet-relatedchronic diseases and conditions– Cancer, coronary heart disease, stroke– Hypertension, diabetes, obesity– Symptoms of depression and anxiety

Burden of poor diet and diet-related chronicdiseases Poor diet is linked to the risk of developing diet-relatedchronic diseases and conditions– Cancer, coronary heart disease, stroke– Hypertension, diabetes, obesity– Symptoms of depression and anxiety Reduced productivity and life expectancy Unsustainable increase in healthcare expenditure

Burden of poor diet and diet-related chronicdiseases Poor diet is linked to the risk of developing diet-relatedchronic diseases and conditions– Cancer, coronary heart disease, stroke– Hypertension, diabetes, obesity– Symptoms of depression and anxiety Reduced productivity and life expectancyUnsustainable increase in healthcare expenditureChronic diseases represent 89% of all deaths in CanadaDirect healthcare costs of treating diabetes,cardiovascular disease, and cancer 19.8 BILLION(2015 data)

Factors that influence food choicesIncome Primary determinant of diet quality 2012 data shows almost 13% of Canadianhouseholds experienced food insecurity Impacts ability to maintain adequateconsumption of healthy foods and beverages

Factors that influence food choicesFood DesertsDifficult to access healthy foodsand beverages due to: Lack of nearby healthy foodoutlets Lack of easily accessible publictransit Lack of vehicle to drive to esunhealthiest-neighborhoods-dubbed-food-deserts

Factors that influence food choicesFood swamps Overabundance of opportunities to access less healthy foodoptions Relies on personal willpower to make healthy choices Willpower is impaired due to mental states such as stressor negative moods Making too many choicesmay lead to “willpower ordecision fatigue” Hunger impacts willpower

Factors that influence food choicesPersonal perceptions– “I’m not eating too much unhealthy food. I don’t need toimprove my diet quality.”– “I believe my unhealthy food intake is moderate. I don’tneed to improve my diet.”– “I exercised for an hour today. I can indulge in some lesshealthy food!”

We know that improvements to foodenvironments require multi-pronged andmulti-sectoral action

but we need to first start within PublicHealth Health promotion and health protectionwithin provincial or regional health agenciesoften work in “silos” Public health can be optimized by identifyingopportunities for collaboration

Working with environmental healthpractitioners Environmental health practitioners (EHPs) may bethe first point of contact for municipal officials,land-use planners, or food service operators

Working with environmental healthpractitioners Environmental health practitioners (EHPs) may bethe first point of contact for municipal officials,land-use planners, or food service operators EHPs are well situated to raise awareness abouthealthy food environments as they conductinspections, provide consultations to operators,and engage community partners

Working with environmental healthpractitioners Environmental health practitioners (EHPs) may bethe first point of contact for municipal officials,land-use planners, or food service operators EHPs are well situated to raise awareness abouthealthy food environments as they conductinspections, provide consultations to operators,and engage community partners In some regions, a small subset of public healthinspectors within health authorities areincreasingly involved in promoting healthy builtenvironments

Potential interventions and initiativesFOOD DESERTSPolicies & legislationFinancial incentivesAdvocacySupport foodenvironmentsPermit temporaryfarmers’ marketsReduce licensing feesfor designated“healthy food outlets”Advocate for changesto land-use zoning toallow community andschool gardensProvide staff supportto implement healthycorner storesprogramsPermit mobile healthyfood vending (i.e.,vegetables and fruit)Advocate for taxincentives forgreengrocers or fullservice grocery storesPromote public transitimprovements toimprove access to fullservice grocery stores,especially for thosewith low income ormobility limitationsProvide staff supportto start and maintaincommunity and schoolgardensEducate localgovernment officialsabout the need forequitable access tohealthy food

Potential interventions and initiativesFOOD SWAMPSPolicies & legislationAdvocacySupport retail foodenvironmentsSupport new zoningregulations or by-lawsfor minimum distancesof fast food andunhealthy food outletsRaise awareness ofthe importance of thedensity and location ofless healthy food retailwithin communitiesProvide nutritionsupport to helprestaurant and foodretail operators createand promote healthierchoicesAdvocate for theinclusion of publichealth professionals inpolicy and legislationconsultationsProviderecommendations toprovincial and localgovernments tosupport healthy foodenvironmentinterventionsEncourage healthygrocery andconvenience storecheck-out lanes inretail food settingsSupport restaurantmenu calorie labelinglegislationConsumer educationProvide food literacyeducation andresources to enableconsumers to makehealthier choices inretail food settings

Practice Gaps Need for additional training in builtenvironment and food environment concepts Lack of legislation to put “health” in newdevelopments, city/community plans, andother policy decisions that may impacthealth Identify and refine zoning policies to reduceexposure to less healthy foods

Conclusion Educating individuals on healthy eating habits isonly part of the solution Ensure adequate access to healthy and affordablefood while reducing exposure to tempting food The role of public health:– Collaborate with public and private sectors to createsupportive and healthy food environments– Advocate for policy to increase availability of healthyvendors and reduce access to less healthy retail outlets– Provide staff support for healthy food environmentprograms and activities

www.ncceh.caTHANK YOU!Questions?tina.chen@bccdc.caNCCEH Resources:NCCEH Food Environments Topic PageFood Deserts and Food Swamps: A PrimerFood Environments: An Introduction for Public Health PracticeProduction of this presentation has been made possible through a financial contribution from the Public Health Agency of Canada

Types of food environments Community food environment Geographic food access, which refers to the location and accessibility of food outlets Consumer food environment Food availability, food affordability, food quality, and other aspects influencing food choices in retail outlets Organizational food environment Access to food in settings

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