Neighbourhood food environment and diet: Time for improved conceptual models?

  • Cummins S
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Powell et al.'s (2007) paper is one of a number of recent studies, similar in approach and method, which assesses spatial variations in exposure to aspects of the local food environment as an underlying explanatory factor for social and spatial inequalities in diet and related health outcomes. These studies, though useful and interesting in their own right, only take us part of the way in understanding exactly how 'environment' influences dietary behaviour. While the methodological limita-tions and challenges of investigating contextual risk factors for diet and other health outcomes and behaviour have been well covered elsewhere (see for example Ball et al., 2006; Diez-Roux, 2004), there has been much less effort directed at developing more sophisticated and robust theoretical constructs which may be used for empirical hypothesis testing. The conceptual model which currently underpins the majority of current epidemiological work in this field is one of 'deprivation–amplification', an extension of the 'inverse care law', where poorer and minority neighbourhoods tend to have fewer health-promoting resources compared to their wealthier and whiter counterparts (Macintyre, in press). This lack of resources may, in turn, impact on the health of individual residents through limiting their ability to adopt healthy behaviours. Neighbourhood effects on diet have been chiefly conceived as the product of two related pathways concerned with local accessibility to food: access to foods for home consumption from grocery stores and supermarkets and access to ready-made food from 'fast-food' outlets and restaurants for home and out-of-home consumption. Thus the spatial organisation of these physical environmental resources is thought to exert an effect on diet, and ultimately health, independent of individual personal characteristics. The net result of which is a suggestion that improving food retail provision in poor and minority neighbourhoods will have a positive influence on diet. Two recent UK studies have evaluated the impact on fruit and vegetable consumption of new or improved large-scale food retail provision in poor communities. These studies have yielded mixed results with one study in Leeds demonstrating a modest improvement in intake (Wrigley et al., 2003) while the other, undertaken in Glasgow, finding no improvement (Cummins et al., 2005). These studies assume a population effect of new provision, that residents of poor and minority communities have similar behaviours and shopping preferences and are assumed to be spatially constrained in terms of their ability to access and purchase food, with any local improve-ments in provision modifying consumption accordingly. Though there are important methodological limitations to these two studies, the mixed results also raise a more fundamental question—is a simple 'deprivation–amplification' conceptual model a reasonable or accurate one? Early work by Dobson et al. (1994) suggested that families do not routinely use better quality retail provision even when locally available and instead shop little and often at local discount grocery stores as they did not have the financial resources to commit income to bulk-buy in advance from large supermarkets or food co-operatives. Work on shopping practices by Williams and Hubbard (2001) has suggested that socio-economically disadvantaged consumers tend to use 'traditional' facilities rather than newer stores or shopping centres. Here, the importance of the social, rather than the physical, environment was emphasised—the social experience of shopping was seen as a key mediating role in the use of local food retail resources. Disadvantaged consumers tended to avoid supermarket provision as it was associated with more affluent consumers and was thus 'not for them'. In the Glasgow Superstore Study, interviews with local residents of a deprived area where new retail facilities had been built raised questions of boundary and ownership of neighbourhood food resources; that is, what constituted local and appropriate food access for different individuals (Cummins et al., in press). Though the new provision was acknowledged to have improved the range, choice and quality of food locally, there were also concerns over the temptation to spend beyond household economic means. Even the construction of what was 'local' differed. In one case, a respondent constructed their 'local' shopping as several miles from their current address as this was where the respondent had grown up and lived for many years. For this individual though the neighbourhood food resource was physically distant it was socially proximate, and thus any change in local provision had little impact on shopping behaviour. The implication for studies like Powell et al.'s (2007) is clear. Current theories which form the basis of increasingly sophisticated empirical investigations of environmental influ-ences on diet often do not take into account the social processes and symbolic relations between individuals and their environ-ments. Without a deeper and more complex understanding of how 'environment' gets into the 'body' interventions based exclusively upon existing theoretical models will never be able to fulfil their public health potential. Acknowledgments

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  • Steven Cummins

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