Snapshots of Urban and Rural Food Environments: EPOCH-Based Mapping in a High-, Middle-, and Low-Income Country from a Non-Communicable Disease Perspective.

Mark Spires,Thandi Puoane,Francis Xavier Kasujja,Meena Daivadanam,Peter Delobelle,Aravinda Berggreen-Clausen,David Sanders

doi:10.3390/nu12020484

Abstract

A changing food environment is implicated as a primary contributor to the increasing levels of non-communicable diseases (NCDs). This study aimed to generate snapshots of selected external food environments to inform intervention strategies for NCD prevention in three countries: Uganda (low income), South Africa (middle income) and Sweden (high income), with one matched pair of urban–rural sites per country. Fifty formal and informal food retail outlets were assessed, and descriptive and comparative statistical analyses were performed. We found that formal food retail outlets in these countries had both positive and negative traits, as they were the main source of basic food items but also made unhealthy food items readily available. The Ugandan setting had predominantly informal outlets, while the Swedish setting had primarily formal outlets and South Africa had both, which fits broadly into the traditional (Uganda), mixed (South Africa) and modern (Sweden) conceptualized food systems. The promotion of unhealthy food products was high in all settings. Uganda had the highest in-community advertising, followed by South Africa and Sweden with the lowest, perhaps related to differences in regulation and implementation. The findings speak to the need to address contextual differences in NCD-related health interventions by incorporating strategies that address the food environment, and for a critical look at regulations that tackle key environment-related factors of food on a larger scale.

Highlights

Mapping and research of food environments in general has to date primarily been carried out in high-income country (HIC) settings in response to the high prevalence of obesity and associated diet-related non-communicable diseases (NCDs) like type 2 diabetes [1,2,3]
With regard to in-store advertisements we found that the formal food retail outlets played the main role in promoting unhealthy products, while informal outlets had negligible advertising
The food environment has an important role in population health through influencing food choices and making foods available

Summary

Introduction

Mapping and research of food environments in general has to date primarily been carried out in high-income country (HIC) settings in response to the high prevalence of obesity and associated diet-related non-communicable diseases (NCDs) like type 2 diabetes [1,2,3]. Food environment evaluations are imperative in socioeconomically disadvantaged or otherwise vulnerable areas in HICs to promote equitable health outcomes, yet these diet-related diseases are becoming increasingly prevalent in low- and middle-income countries (LMICs) [4,5]. Food choices are affected by many factors in both the external food environment—presence of outlets and food availability within these, and factors related to the in-store environment, including quality, price, placement, and promotion [8,9]. A LMIC-specific food environment conceptual framework developed by the Food Environment Working Group at the Agriculture, Nutrition and Health

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