Research articleNeighborhood Deprivation and Access to Fast-Food Retailing: A National Study
Introduction
The increasing prevalence of obesity in many countries has generated considerable concern about health burdens. For example, it has been estimated that 64% of Americans are overweight (34%) or obese (30%),1 causing somewhere between about 100,0002 and 300,0003 deaths per year, rivaling smoking as a public health issue.4 The emergence of this “obesity epidemic” has been linked to a range of health outcomes including rising rates of heart disease, hypertension, various types of cancer, and non–insulin-dependent diabetes.5 Further, a strong and growing social gradient in obesity has been noted, with higher rates among lower socioeconomic groups and for those living in areas of social disadvantage.6, 7, 8 New Zealand is no exception to these trends, as the prevalence of obesity has doubled over the past 25 years.9 Rates of obesity are twice as high in the most-deprived quintile of neighborhoods in New Zealand compared to the least-deprived quintile,10 probably contributing to increasing social and geographic inequalities in health status.11, 12, 13, 14 While not an estimate of the independent contribution of overweight and obesity, it has been estimated that two of every five deaths in New Zealand are attributable to nutrition-related factors.15 As a result, improving nutrition and reducing obesity are two of 13 priority objectives in the New Zealand Health Strategy.16
Explanations for increasing rates of obesity in areas of greater socioeconomic disadvantage are likely to be multifaceted and to include characteristics relating to individuals (composition) and those associated with the environment or neighborhood in which people live (context).17, 18 It has been suggested that contextual drivers may be more prevalent in deprived neighborhoods, resulting in neighborhoods that support unhealthy eating, or so-called “obeseogenic environments.”18, 19 One possible contextual driver is a higher density of fast-food outlets in socially deprived neighborhoods.20 For example, a cross-sectional analysis of the mean number of McDonald’s restaurants per 1000 people in England and Wales demonstrated that there was greater outlet density in deprived neighborhoods.21 Similarly, people living in the lowest-income communities in Melbourne, Australia, had 2.5 times the exposure to fast-food outlets than people living in the highest-income communities.22 Other studies have focused on specific at-risk groups, particularly the young, as there is strong evidence that exposure to key risk factors early in life is a strong predictor of obesity patterns in adulthood.23, 24 Researchers have noted, for example, that fast-food outlets are often concentrated within short walking distances of primary and secondary schools.25, 26
Although the relationship between area deprivation and the geographic access to fast-food outlets has received some attention, previous studies have often relied on definitions of neighborhoods predefined as administrative areas (often the census unit) for which data are easily available, and analyses have usually been focused on the presence or absence of an outlet in these arbitrary units.27 Further, due to the difficulties of data collection, studies have usually been limited in scope and confined to small geographic areas such as cities rather than, for example, considering accessibility at a national level.27 In this study, these previous limitations were addressed by adopting a geographic information systems (GIS) approach to provide a measure of location accessibility to fast food outlets in small areas throughout New Zealand. Access was calculated for both residential neighborhoods and for schools across the country. For comparison, and to examine the overall neighborhood “foodscape,” access to other types of food outlets that potentially sell “healthier food” (including supermarkets and locally operated food shops) was also calculated. This is the first study in New Zealand and one of the first national studies anywhere to use GIS methods to examine accessibility to fast-food retailing by neighborhood socioeconomic status (SES).
Section snippets
Methods
Data on fast-food outlets were obtained from all 74 local Territorial Authorities (TAs) across New Zealand during the latter part of 2005. TAs have regulatory responsibility for safety inspections of all premises in respective regions used in the manufacture, preparation, and/or storage of food for sale. For each outlet, information was requested on the street address as well as its name. The data were verified using the online telephone directory (i.e., Yellow Pages)28; in cases of missing
Results
Median travel distance to the nearest fast-food outlet varied by neighborhood deprivation (p<0.001), with travel distance being at least twice as far (i.e., worse access) in the least-deprived compared to the most-deprived areas (Figure 1). The median distance to all types of fast-food outlets peaks in deprivation Decile 2 (1870 m), and then gradually decreases to its lowest value in Decile 9 (714 m), followed by a slight rise in decile 10 (742 m). A similar trend can be noted for both
Discussion
Earlier studies have proposed environmental (contextual) explanations, including access to fast food outlets, for the rising rates and social gradient of obesity. The key finding of this study is that access to fast-food outlets in New Zealand is patterned by deprivation. At the national level, access to both multinational and locally operated fast-food outlets is better in more-deprived neighborhoods and around more socioeconomically disadvantaged schools, although the patterns are not linear.
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