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. Proliferation of Fast Food
Outlets, Health Inequalities and
O l H lhI li i d
Local Policy

3. The lifeworld

5. Southampton General Hospital

6. Life world is the locus of experience: social,
psychological and physical

7. Sweetness Preference was Essential
to Survive: now the amounts

8. Sweetness
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

9. Biology vs Technology: Shift from
Water to Caloric Beverages with No
Food Calorie Compensation

10. Fat Preference Key for Survival:
Technology, Marketing have Utilized
this Preference for Fatty Food

13. 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
the past.
– Food is available at all times.

15. The last 18 months
Globally what has happened in a year to 18 months is
extraordinary.
t di
Some changes that have taken over 30 years to
develop have been reversed.

16. 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
buy g specialty chocolate
buying 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 those
popular in the 1970/80s
In the UK for those on low incomes there has been an increase in eating out from
FFOs, as food prices increase and fuel cost many find it makes more sense to buy
from 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 the
fast food on offer all this points to the danger of this contributing to an increase in the
inequality gap.
q yg p

21. Simple rules of heuristics

22. 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 salad
Use fruit bowls not
stainless steel
Pay cash for desert not
accepted on cards
Make an express line with
Move salad bar away from an
wall emphasis on healthy products

23. Individual
responsibility
Change in the
environment
Puska 2001

24. The evolution of public health policy

25. The Gift relationship - the greater good

26. Individual
I di id l
responsibility
Change in the
environment
Puska 2001

27. Tower Hamlets Food Study
Tim Madelin – Public Health,
Tower Hamlets PCT
Martin Caraher, Sue Lloyd, City University

28. 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

29. 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

30. Part 2 - Chicken & Chips
98% HH within
10mins walk of
grocery type
store

31. But…
97% HH
within
10mins
walk of
FFO

32. Ditto take aways in Preston
Preston had more fast
food outlets (186) [not
including restaurants who
operate takeaways] than
general groceries outlets
(165).

33. 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

34. So
So cannot be left to industry, the approach
based on food industry setting the solution
Nor can it be left to social enterprise
p
Not just the LOCAL… as the solution
A raft of initiatives across agencies is
needed not just one
Loss of expertise as we wait…..
We need a public health approach
Need to b
N d t be careful about l
f l b t location as it i
ti is
more complex than this – eg 401m;
delivery

35. 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

36. Some solutions
Leicester 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) use
use.
Waltham Forest, in London, has introduced similar guidance to
e su e e a protection and balance of
ensure retail p o ec o a d ba a ce o use, with the c e a
e criteria
flexible 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 approach
approach.

37. Some solutions limit or zone
FFOs d/ d i
FFO and/or drive through outlets.
h h l
‘Formula’ outlets (formula can be defined broadly to include
local take-ways that have one or more outlets or narrowly to
take ways
include only larger national chains).
FFOs in certain areas or by directives specifying distance
from schools, hospitals etc..
By using q
y g quotas in certain areas either by number of shop
y p
frontage or by use of density.
Restricting opening hours.

38. 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.

39. 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.

40. The cover of "The Economist", Dec. 13-19, 2003.

41. 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

42. 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

43. Individual
responsibility
Changes in the
Change in the
environment
environment
Puska 2001