Key Health Data for the West Midlands 2002
CHAPTER TEN: ACCESS TO A HEALTHY DIET
List of Tables
List of Figures
Main Body
1: The Geography of the West Midlands
2: Life Expectancy and Inequalities
3: Drinking Water Quality
4: Chemical incidents in the West Midlands
5: Landfill Sites
6: IPPC
7: Fires in the West Midlands
8: Road Traffic Accidents
9: Drownings
10: Access to a healthy diet
11: National Health Service Priority Areas
12: Communicable Disease
13: Older People
10.1 Introduction
Access to an adequate and appropriate diet is a fundamental element of a healthy lifestyle and eating well is a long-term investment in good health (The Scottish Office 2003). Poor diet is linked to heart disease, stroke and cancer as well as tooth decay (Secretary of State for Health 1999). Research suggests that a third of all cancers are the result of a poor diet and increasing fruit and vegetable consumption is considered the second most effective strategy in reducing cancer (Department of Health 2000). Poor nutrition is also implicated in low birth weight, a major issue in some parts of the West Midlands region (Department of Public Health and Epidemiology 1999). It is suggested that eating five or more portions of fruit and vegetables a day could reduce overall deaths due to chronic disease by up to 20% (Department of Health 2000). Inappropriate U.K. diets are characterised, not by shortages per se, but rather by excess in general together with shortages of key dietary elements. Key Health Data for the West Midlands has described and characterised the levels of obesity and inadequate intake of fresh fruit and vegetables by electoral ward identifying the generally poor diet across the region and hot spots of particular problems region (Department of Public Health and Epidemiology 1999).
This is also a social equity issue. The NHS plan identifies the need to increase availability and accessibility of foodstuffs to supply an adequate affordable diet (Department of Health 2000). The diet of deprived people is characterised by deficiencies in essential nutrients but there is considerable potential for health gain if appropriate foods were made more accessible to poor populations (James, 1997). People on low incomes eat the least amount of fruit and vegetables (DEFRA 2000). The annual National Household Food Survey has shown that the lowest income groups are less likely to have adequate nutrient intakes compared to the higher income group (Ministry of Agriculture, Fisheries and Food 1998). Access to a good diet can be affected by social exclusion whereby fresh fruit and vegetables, for example, are unavailable locally or prohibitively expensive. In some areas especially low-income estates, physical access to shops can be limited as facilities withdraw. Local people are low spenders and businesses have concerns about high crime levels. This has led to retailers concentrating on 'Superstores' designed for car access (Department of Health 1996; Dowler, 1999; Office of the Deputy Prime Minister 2001). In addition, where local shops remain, they tend to be more expensive - food costs around 24% more in small stores compared to supermarkets (Paichaud, 1996).
Limited access to healthy foods has been recognised for years with concerns being raised over a decade ago (Whitehead, 1998) although there remains some controversy over the nature of so-called 'food deserts' (Cummins, 2002). Although the research effort has increased, there is still very little published in the peer-reviewed literature. Studies of access to healthy foods have produced variable results with some indicating that physical access is not a problem (Donkin, 2000) and others such as work carried out in Sandwell, suggesting that it is (Dowler, 2001). However, residential proximity is only one dimension of access; shops may be nearby but could be expensive or only stock poor quality goods. We have developed a composite index based on cost, quality and range of fruits and vegetables on sale at each shop that has been successfully piloted in two West Midlands constituencies. In addition, we can map those areas that are within set walking distances of retailers. Taken together these two dimensions enable the visualisation of areas with potential access problems. The pilot study showed that the proportion of the population living within a 15 minute walk of a retailer was 1% in one constituency and 17% in the other. (see Figure 10.1, the higher the index the more 'available' the products).
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Figure 10.1. Map of food access index in six West Midlands wards 2002 |
This intelligence enables public health agencies to target areas for further investigation. The index requires a lot of reliable and up to date information from each shop which can only be obtained through personal visit. In research terms this can be expensive and time consuming. We are accordingly negotiating with local authorities and professional bodies to explore using the routine visits of EHOs to collect these data.
We are currently mapping the rest of Birmingham, Wolverhampton and Walsall and aim to identify funding to take the project region-wide.
References
The Scottish Office 2003 (at http://www.scotland.gov.uk/library/documents/diet-00.htm)
Secretary of State for Health. Saving Lives: Our Healthier Nation. London: Stationery Office, 1999.
Department of Health. NHS Plan. London: Department of Health. 2000. (at http://www.doh.gov.uk/nhsplan/contentspdf.htm)
Department of Public Health and Epidemiology. Key Health Data for the West Midlands, 1998. DPHE Report 3. University of Birmingham, 1999.
James WPT, Nelson M, Ralph A, Leather S. Socioeconomic determinants of health: The contribution of nutrition to inequalities in health BMJ, 314, 1545 1997.
DEFRA. National Food Survey 2000 (at http://www.defra.gov.uk/esg/Work_htm/publications/cf/nfs/nfs.htm.)
Department of Health. Low Income, Food, Nutrition and Health: Strategies for Improvement. A report from the Low Income Project Team to the Nutrition Task Force. London: Department of Health, 1996.
Dowler E. Food Poverty and Food Policy. IDS Bulletin, 29:2, 58-65 1999.
Office of the Deputy Prime Minister 2001 at http://www.cabinet-office.gov.uk/seu/2000/compendium/13.htm)
Paichaud D, Webb J. The Price of Food: Missing Out on Mass Consumption. STICARD Occasional Paper 20. London: London School Of Economics, 1996.
Whitehead M. Food deserts: What's in a name? Health Education Journal, 57, 189-190 (1998).
Cummins S, Macintyre S. "Food deserts" evidence and assumption in health policy making. BMJ, 325, 436-438 2002.
Donkin AJ. Dowler EA. Stevenson SJ. Turner SA. Mapping access to food in a deprived area: the development of price and availability indices. Public Health Nutrition, 3:1,31-8, 2002.
Dowler E, Donkin A, Rex D, Blair A, Grundy C. Measuring Access to Healthy Food in Sandwell Final Report 2001, Sandwell Health Authority, 2001.
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