Research article
Neighborhood Deprivation and Access to Fast-Food Retailing: A National Study

https://doi.org/10.1016/j.amepre.2007.01.009Get rights and content

Background

Obesogenic environments may be an important contextual explanation for the growing obesity epidemic, including its unequal social distribution. The objective of this study was to determine whether geographic access to fast-food outlets varied by neighborhood deprivation and school socioeconomic ranking, and whether any such associations differed to those for access to healthier food outlets.

Methods

Data were collected on the location of fast-food outlets, supermarkets, and convenience stores across New Zealand. The data were geocoded and geographic information systems used to calculate travel distances from each census meshblock (i.e., neighborhood), and each school, to the closest fast-food outlet. Median travel distances are reported by a census-based index of socioeconomic deprivation for each neighborhood, and by a Ministry of Education measure of socioeconomic circumstances for each school. Analyses were repeated for outlets selling healthy food to allow comparisons.

Results

At the national level, statistically significant negative associations were found between neighborhood access to the nearest fast-food outlet and neighborhood deprivation (p<0.001) for both multinational fast-food outlets and locally operated outlets. The travel distances to both types of fast food outlet were at least twice as far in the least socially deprived neighborhoods compared to the most deprived neighborhoods. A similar pattern was found for outlets selling healthy food such as supermarkets and smaller food outlets (p<0.001). These relationships were broadly linear with travel distances tending to be shorter in more-deprived neighborhoods.

Conclusions

There is a strong association between neighborhood deprivation and geographic access to fast food outlets in New Zealand, which may contribute to the understanding of environmental causes of obesity. However, outlets potentially selling healthy food (e.g., supermarkets) are patterned by deprivation in a similar way. These findings highlight the importance of considering all aspects of the food environment (healthy and unhealthy) when developing environmental strategies to address the obesity epidemic.

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.

References (51)

  • A. Drewnowski

    Obesity and the food environment: dietary energy density and diet costs

    Am J Prev Med

    (2004)
  • K.M. Flegal et al.

    Prevalence and trends in obesity among US adults, 1999–2000

    JAMA

    (2002)
  • K.M. Flegal et al.

    Excess deaths associated with underweight, overweight, and obesity

    JAMA

    (2005)
  • D.B. Allison et al.

    Annual deaths attributable to obesity in the United States

    JAMA

    (1999)
  • A. Must et al.

    The disease burden associated with overweight and obesity

    JAMA

    (1999)
  • L.N. Oliver et al.

    Neighbourhood socio-economic status and the prevalence of overweight Canadian children and youth

    Can J Public Health

    (2005)
  • L.R. Mobley et al.

    Environment, obesity, and cardiovascular disease risk in low-income women

    Am J Prev Med

    (2006)
  • J. Wardle et al.

    Sex differences in the association of socioeconomic status with obesity

    Am J Public Health

    (2002)
  • Tracking the obesity epidemic: New Zealand 1977–2003

    (2004)
  • A Portrait of Health: Key Results of the 2002/03 New Zealand Health Survey

    (2004)
  • T. Blakely et al.

    Decades of disparity II: socioeconomic mortality trends in New Zealand, 1981–1999

    (2005)
  • J. Pearce et al.

    Increasing geographical inequalities in health in New Zealand, 1980–2001

    Int J Epidemiol

    (2006)
  • Healthy eating—healthy action: a strategic framework

    (2003)
  • New Zealand health strategy

    (2000)
  • S. Cummins et al.

    Food environments and obesity—neighbourhood or nation?

    Int J Epidemiol

    (2006)
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