Mapping the availability and accessibility of healthy food in rural and urban New Zealand – Te Wai o Rona: Diabetes Prevention Strategy

Abstract

Objective: Uptake of advice for lifestyle change for obesity and diabetes prevention requires access to affordable 'healthy' foods (high in fibre/low in sugar and fat). The present study aimed to examine the availability and accessibility of 'healthy' foods in rural and urban New Zealand. Design: We identified and visited ('mapped') 1230 food outlets (473 urban, 757 rural) across the Waikato/Lakes areas (162 census areas within twelve regions) in New Zealand, where the Te Wai O Rona: Diabetes Prevention Strategy was underway. At each site, we assessed the availability of 'healthy' foods (e.g. wholemeal bread) and compared their cost with those of comparable 'regular' foods (e.g. white bread). Results: Healthy foods were generally more available in urban than rural areas. In both urban and rural areas, 'healthy' foods were more expensive than 'regular' foods after adjusting for the population and income level of each area. For instance, there was an increasing price difference across bread, meat, poultry, with the highest difference for sugar substitutes. The weekly family cost of a 'healthy' food basket (without sugar) was 29?1 % more expensive than the 'regular' basket ($NZ 176?72 v. $NZ 136?84). The difference between the 'healthy' and 'regular' basket was greater in urban ($NZ 49?18) than rural areas ($NZ 36?27) in adjusted analysis. Conclusions: 'Healthy' foods were more expensive than 'regular' choices in both urban and rural areas. Although urban areas had higher availability of 'healthy' foods, the cost of changing to a healthy diet in urban areas was also greater. Improvement in the food environment is needed to support people in adopting healthy food choices. Keywords Food environment Availability AccessibilityIt is estimated that nutrition-related risk factors accounted for 70 % of stroke and heart disease mortality and more than 80 % of diabetes in 1997 in New Zealand (1) . However, nutrition recommendations are often not met. For instance, in the 1990s, fat intake contributed about 35 % of energy in the diet of New Zealanders, with saturated fat comprising 15 % of total energy intake; while daily intake of dietary fibre was lower than the recommended 25-30 g/d, at 23 g/d in men and 18 g/d in women (2) . Although both intervention trials and population studies have demonstrated that type 2 diabetes is preventable by adopting a healthy lifestyle (3) , lifestyle change requires a 'healthy' food environment since food choices are driven by taste, cost and convenience, rather than health and variety (4)

Dietary Intake and Eating Behaviours of Obese New Zealand Children and Adolescents Enrolled in a Community-Based Intervention Programme

“…Some countries, for example Brazil, are now using guidelines as an opportunity to promote the health and well-being of people, an avenue which may garner broad appeal, especially across multiple ethnic groups [29]. Availability and accessibility of healthy food varies [30], as does food security between families based upon their household deprivation and ethnicity. These factors need to be taken into account in any attempt to address eating behaviours in the obese child and adolescent population [31].…”

Unravelling urban–rural health disparities in England

“…A study conducted by Liese et al, (2007) discovered that the availability of healthy food was substantially higher in supermarkets in comparison to independent stores. Hence, Wang et al (2010) found that healthy food was more readily available in urban than in rural environments (Wang et al, 2010). There is also a price penalty with healthy produce costing approximately one-third more in rural environments (Shaw, 2014).…”

Longitudinal change in the diet's monetary value is associated with its change in quality and micronutrient adequacy among urban adults

“…While current research focuses on associations between food prices at the regional, city and neighborhood levels and food consumption behaviors and patterns, [ 17 – 22 ] examining the monetary value of the diet (MVD) and how it is related to various dietary components and quality has gained more recent interest. [ 10 , 23 – 53 ] Most studies reported a direct relationship between MVD and diet quality (or an inverse relationship with consumption of energy-dense foods),[ 10 , 23 – 31 , 33 – 38 , 40 – 42 , 44 – 47 , 50 , 51 , 54 – 60 ], a finding not replicated in other studies. [ 32 , 39 , 43 , 48 , 49 ]…”