Abstract
Many programmes that aim to reduce the prevalence of diet-related disease have chosen to focus on individual behaviour change with little recognition of the influence of the environment. The aim of this thesis was to conduct an in-depth exploration of the local food environments of two socioeconomically disparate areas of Porirua: Eastern Porirua and Whitby, to determine whether there are environmental barriers to healthy food accessibility for residents. The area of Eastern Porirua has been described as a ‘food desert’ – an area where healthy food is virtually inaccessible. This thesis also sought to identify the most appropriate solutions and interventions to improve accessibility of healthy food in Eastern Porirua and determine how useful the application of the ANGELO (Analysis Grid for Environments Linked to Obesity) framework is for identifying and classifying barriers to accessing healthy food.
Three methods were used to answer the research questions. Data were collected on food outlets in both Eastern Porirua and Whitby, and mapped to show the number and type of outlets in each of the neighbourhood areas. The density of each type of food outlet was then calculated for each census area unit (CAU) within the two areas. The Retail Food Environment Index (RFEI) – ratio of ‘unhealthy’ to ‘healthy’ outlets was also calculated. Second, a bread and milk price and availability survey was undertaken for the convenience stores and supermarkets across both areas and also the supermarkets in nearby Porirua Central. Finally, a focus group study was conducted with four ethnically diverse groups of Eastern Porirua residents in order to determine the perceived barriers to healthy food access and to identify potential solutions. The ANGELO framework was used to analyse the focus group results.
It was found that there were more ‘unhealthy’ outlets, fast food outlets and convenience stores, in Eastern Porirua than Whitby and more supermarkets in Whitby than Eastern Porirua. Density of ‘unhealthy’ outlets was lower and the RFEI was lower for almost all neighbourhoods across both areas but food items were more expensive in convenience stores and supermarkets. For both foods the ‘healthy’ option was most often more expensive than the ‘less healthy’ option. The focus group participants identified income, price of foods, and features of the physical environment as the main barriers to accessing healthy food. They also identified sociocultural factors such as lack of skills, knowledge and training as barriers. Solutions suggested by participants included a neighbourhood supermarket, a neighbourhood produce market, increased income, and price subsidies/vouchers for healthy foods.
The results of this research were similar to international and New Zealand studies that have examined food accessibility that have also found a high number and density of fast food outlets and convenience stores in deprived areas. Income and price of food have also been reported widely in the literature as barriers to accessing healthy food. A key strength of this research that separates it from other studies is the mixed methods approach which overlays objectively measured features of the food environment with residents’ perceptions. This thesis concludes that while Eastern Porirua does resemble a ‘food desert’ with its lack of healthy food options, it may be better described as a ‘food swamp’, an area with an abundance of less healthy food options. Further research should investigate solutions across all four environments identified in ANGELO – sociocultural, physical, political and economic – to reduce the barriers to families/whanau being able to access enough healthy food. This thesis recommends that public health organisations continue to engage with local and central government to scope food environments and work together on solutions, including policy options, to improve access, especially in deprived areas. It also recommends that there is support for local initiatives such as community markets, gardens and food cooperatives that have the potential to increase healthy food availability and access and also provide a site to share knowledge and skills.