Browsing by Author "Brownell, Kelly"

Protecting public health is the most legitimate use of zoning, and yet there is minimal progress in applying it to the obesity problem. Zoning could potentially be used to address both unhealthy and healthy food retailers, but lack of evidence regarding the impact of zoning and public opinion on zoning changes are barriers to implementing zoning restrictions on fast food on a larger scale. My dissertation addresses these gaps in our understanding of health zoning as a policy option for altering built, food environments.

Chapter 1 examines the relationship between food swamps and obesity and whether spatial mapping might be useful in identifying priority geographic areas for zoning interventions. I employ an instrumental variables (IV) strategy to correct for the endogeneity problems associated with food environments, namely that individuals may self-select into certain neighborhoods and may consider food availability in their decision process. I utilize highway exits as a source of exogenous variation .Using secondary data from the USDA Food Environment Atlas, ordinary least squares (OLS) and IV regression models were employed to analyze cross-sectional associations between local food environments and the prevalence of obesity. I find even after controlling for food desert effects, food swamps have a positive, statistically significant effect on adult obesity rates.

Chapter 2 applies theories of message framing and prospect theory to the emerging discussion around health zoning policies targeting food environments and to explore public opinion toward a list of potential zoning restrictions on fast-food restaurants (beyond moratoriums on new establishments). In order to explore causality, I employ an online survey experiment manipulating exposure to vignettes with different message frames about health zoning restrictions with two national samples of adult Americans age 18 and over (N1=2,768 and N2=3,236). The second sample oversamples Black Americans (N=1,000) and individuals with high school as their highest level of education. Respondents were randomly assigned to one of six conditions where they were primed with different message frames about the benefits of zoning restrictions on fast food retailers. Participants were then asked to indicate their support for six zoning policies on a Likert scale. Subjects also answered questions about their food store access, eating behaviors, health status and perceptions of food stores by type.

I find that a message frame about Nutrition and increasing Equity in the food system was particularly effective at increasing support for health zoning policies targeting fast food outlets across policy categories (Conditional, Youth-related, Performance and Incentive) and across racial groups. This finding is consistent with an influential environmental justice scholar’s description of “injustice frames” as effective in mobilizing supporters around environmental issues (Taylor 2000). I extend this rationale to food environment obesity prevention efforts and identify Nutrition combined with Equity frames as an arguably universal campaign strategy for bolstering public support of zoning restrictions on fast food retailers.

Bridging my findings from both Chapters 1 and 2, using food swamps as a spatial metaphor may work to identify priority areas for policy intervention, but only if there is an equitable distribution of resources and mobilization efforts to improve consumer food environments. If the structural forces which ration access to land-use planning persist (arguably including the media as gatekeepers to information and producers of message frames) disparities in obesity are likely to widen.

This project provides recommendations for how the Global Alliance for Improved Nutrition (GAIN) can assist urban governments and stakeholders to implement institutional healthy food procurement in low- and middle-income countries (LMIC). Public food procurement refers to when governments purchase and provide food to defined populations. Institutional food procurement refers to food purchasing and provision by organizations like schools, hospitals, care homes, youth clubs, prisons, and workplaces. Urban governments often manage public food procurement at these institutions, serving food to students, patients, employees, and their families. Institutional food provision can benefit an individual’s experience at that institution while improving their health and nutritional status. For instance, a student’s nutrition status affects school performance. A hospital patient’s food access may affect their recovery. Healthy food procurement refers to designing food procurement to prioritize the purchase and provision of nutritious food. Since food procurement programmes serve a high volume of people, healthy food procurement represents an opportunity for institutions to promote nutrition, whilst also reshaping the broader food system to be healthier and more sustainable. Many countries face the double burden of malnutrition, with high rates of undernourishment and obesity, especially in urban areas. Urban policymakers are increasingly recognizing institutional healthy food procurement as an opportunity to address malnutrition. However, there is a need to share more experiences and best practices on healthy food procurement among urban stakeholders in LMIC. This report presents a synthesis of literature analysis and key stakeholder interviews on urban public food procurement. This report discusses:

1. Why urban public food procurement is an important tool to improve food and nutrition security

2. A proposed implementation framework / menu of actions for healthy food procurement, with key themes on design and implementation of healthy food procurement policies taken from literature analysis and interviews on successful examples such as New York City and Brazil

3. Two urban public food procurement case studies to explore enabling factors and barriers for healthy food procurement: A city government-led school feeding programme in Addis Ababa, Ethiopia and a hospital feeding programme at Sassoon General Hospital in Pune, India. This section discusses the two case studies through the lens of the proposed implementation framework. These two case studies were selected because they demonstrate success stories in LMIC and illustrate key policy considerations around healthy food procurement.

Key Messages

1. GAIN can support urban healthy food procurement with a nutrition-sensitive approach.

2. Best practices in healthy food procurement include dedicated food procurement governance, use of dietary guidelines in menu-planning, universal coverage and inclusivity, and private sector participation.

3. Invest in institutional food safety; water, sanitation, and hygiene (WASH); and cold chain infrastructure for fresh foods.

4. Create political buy-in for healthy food procurement by highlighting win-win opportunities from perspectives of “customers” and non-nutrition sectors.