Retail and Fast Food Outlets
Access to affordable, nutritious food may be an important determinant of a healthy diet. We have explored the location of different types of retail food outlets (multiple chain supermarkets, and convenience, specialist and discount stores, restaurants and fast food stores) in Glasgow, and have also studied the price and availability of a basket of every day foodstuffs.
It has been suggested that the price and availability of food locally may be an important mediating factor between neighbourhood deprivation, poor diet and obesity. However the evidence for such environmental determinants of poor diet is weak in the UK. In 1997 Steven Cummins, a doctoral student in the Unit, conducted a survey of 325 foodstores in Glasgow, collecting data on the price and availability of a pre-selected ‘basket’ of 57 food items via in-person visits.
In 2007 we followed this up with a repeat survey of these 325 shops, using the same food basket. We were able to audit 168 of these stores, many of the others having closed or changed function. We also conducted a new repeat cross-sectional survey to capture the retail environment, with an achieved sample size of 335 stores not included in the 1997 list (plus 73 that were), using the same food items plus additional items from the recently developed Healthy Eating Indicator Shopping Basket used in a project funded by the Food Standards Agency (Scotland). In both 1997 and 2007 we collected food price and availability data from all the major mainstream multiple supermarkets (e.g. Asda, Tesco, Sainsbury’s), plus a sample of discounters (e.g. Aldi, Netto), freezer centres (e.g. Farmfoods, Iceland), independents, and specialist shops (e.g. butchers, fishmongers, fruit & vegetable stores, bakers).
The 2007 project was conducted by a fieldforce under the supervision of Kate Campbell in the Unit’s survey office, and is a collaboration between Sally Macintyre and Steven Cummins, now Senior Lecturer and NIHR Fellow in the Department of Geography, Queen Mary, University of London. He was recently awarded a Philip Leverhulme Prize for his work on the socio-environmental determinants of health, much of which was carried out with researchers within the Unit.
We are exploring changes in the food retail environment, and whether there are any links between deprivation in local areas and the location of foodstores and the price and availability of healthy foods. In both 1997 and 2007 we found no evidence that poorer areas had less access to food shops.
We have reviewed the evidence about ‘food deserts' in the UK and abroad, and have found international variations in the distribution of food stores by deprivation.
We are collaborating on a study funded by the National Institutes of Health Public Health Research Programme to evaluate, via a randomised controlled trial, the convenience store ‘Change4life’ intervention. This has been developed by the Department of Health in collaboration with the Association of Convenience Stores in England, and involves local convenience stores being given encouragement, advice and resources to develop their ability to sell fruit and vegetables. The project is being led by Martin White at the University of Newcastle
Fast food outlets
It has been suggested that eating out, particularly in fast food restaurants, may be contributing to rising rates of obesity. Obesity is more common in poorer areas, so we wondered whether out-of-home eating outlets are more likely to be found in more deprived neighbourhoods. We have looked at fast food chain restaurants, other restaurants, cafes and takeaways in Glasgow City, and found that neither out-of-home outlets in general, nor takeaways or fast food chain restaurants in particular, were more likely to be found in more deprived areas. We did, however, find a statistically significant linear increase in the density of McDonald's restaurants per 1,000 residents from the most affluent to the most deprived quintiles of areas in Scotland and England. We extended this analysis to include the three other most numerous fast food chains in the UK: Burger King, KFC and Pizza Hut restaurants.
We found statistically significant increases in density of outlets from more affluent to more deprived areas for each individual fast-food chain and all chains combined. These results provided support for a 'concentration' effect whereby plausible health-damaging environmental risk factors for obesity appear to be 'concentrated' in more deprived areas of England and Scotland.
Cummins S, Macintyre S. Are secondary data sources on the neighbourhood food environment accurate? Case-study in Glasgow, UK. Preventive Medicine 2009;49:527-8pubmed open access
Macdonald L, Ellaway A, Macintyre S. The food retail environment and area deprivation in Glasgow City. International Journal of Behavioral Nutrition and Physical Activity 2009;6:52pubmed open access
Macdonald L, Cummins S, Macintyre S. Neighbourhood fast food environment and area deprivation: substitution or concentration?. Appetite 2007;49:251-4pubmed open access
Cummins S, Macintyre S. Food environments and obesity: neighbourhood or nation?. International Journal of Epidemiology 2006;35:100-104.pubmed open access
Cummins S C, McKay L, Macintyre S. McDonald's restaurants and neighborhood deprivation in Scotland and England. American Journal of Preventive Medicine 2005;29:308-310pubmed open access
Macintyre S, McKay L, Cummins S, Burns C. Out-of-home food outlets and area deprivation: case study in Glasgow, UK. International Journal of Behavioral Nutrition and Physical Activity 2005;2:16pubmed open access
Cummins S. The local food environment and health: some reflections from the UK [letter]. American Journal of Public Health 2003;93ID - 2321:521
Cummins S, Macintyre S. A systematic study of an urban foodscape: the price and availability of food in Greater Glasgow. Urban Studies 2002;39:2115-2130
Cummins S, Macintyre S. Food 'deserts': evidence and assumption in health policy making. BMJ 2002;325:436-438pubmed open access
Cummins S. Socio-spatial variations in the price and availability of food and their implications for healthy eating [PhD], MRC Social and Public Health Sciences Unit 2001.