west area mappingfinalexecutive summary

Mapping Access to Healthy Food in Nottingham City

Executive Summary

This study was produced by the Food Initiatives Group (FIG) in partnership with the Transport Strategy and Food Licensing Teams at Nottingham City Council.

‘The stark reality is that living in poverty more often than not leads to poor diet and people dying younger’ (Caraher, Dowler 2005) Foreword

Food is a vital part of our lives and has a direct effect upon our health and environment. Access to a healthy diet can greatly improve people’s overall health and well-being as well as reducing their chances of getting heart disease and cancer. FIG is a local food partnership that aims to encourage organisations and individuals to produce and eat healthy, safe and affordable food from sustainable sources, including locally grown and organic food. As Chair of FIG I am really pleased that this important piece of work has been carried out on behalf of One Nottingham and NHS Nottingham City. It is a step towards supporting communities in changing their lives to enjoy a healthier lifestyle through greater access to healthy food. Helen Ross Public Health Development Manager NHS Nottingham City and NHS Nottinghamshire County Chair Food Initiatives Group

Background to the Report Mapping Access to Healthy Food in Nottingham City was commissioned by One Nottingham and Nottingham City NHS and carried out by the Food Initiatives Group (FIG) in partnership with the Transport Strategy and Food Licencing Teams at the City Council. The project brief was to show visually the ease of access, both on foot and by bus, to both healthy and unhealthy food outlets in the Aspley/Leen Valley area and St Ann’s, all areas identified as being at high risk for heart disease. This work contributed to the Nottinghamshire County Council and Nottingham City Council gaining joint Beacon Status for their work on Improving Accessibility. Food access research investigates issues of food poverty. Food poverty is when people experience great difficulty in obtaining healthy affordable food. Unlike previous generations food poverty is less about getting enough calories and more about obtaining healthy foods in the right quantities. These are difficulties of accessibility to healthy food including psychological ones, availability and affordability of local food as well as awareness of healthy eating often made difficult by confusing messages. These factors hit those on low incomes the hardest. Having a low intake of fruit and vegetables increases the risks from diet-related diseases such as cancer, diabetes, obesity and coronary heart disease. Mapping Access to Healthy Food in Nottingham City is necessary so as to further understand the reasons that drivers that mean parts of Nottingham city’s population are prevented from making healthier food choices. In other words, why do certain communities have poorer access to healthier food? This kind of work is important because by looking at the complex and multiple barriers to accessing healthy food such research can be made available to local authorities, PCT’s, national government and other relevant bodies so that they can effectively formulate strategies to address these problems. FIG will actively encourage such bodies to incorporate the findings here into their relevant health and environment strategies. Increased access to healthier food by reducing the physical, economic, social and psychological barriers to a better diet will create a healthier population in that area. Healthier populations reduce the financial burden for the NHS and other services and contribute to a more equitable and ultimately better society. Better access to healthy food is in line with the targets and desired outputs of current strategies around obesity, CVD, mental health and diabetes.

Methodology The findings were reached via three main methodological techniques:

Desk based research Practical investigations Market research

This included accessing Nottingham City licensing information and current public and private transport links. As well as on the ground surveys of local shops, their stock and prices, shopping bag surveys and important ‘reality checks’ of any analysis (using GIS systems) through the use of surveys and focus groups with local residents. The unreliability of licensing information when related to what actual retailers sold along with the complexity of adjusting for this through market research required the study to be scaled down from its original city wide scope. Scaling the scope of the study down to a single area allowed the community consultation, assessment of the availability and affordability of food within shops, GIS mapping to be carried out within the available resources. Aspley and Leen valley were chosen as subjects of study due to the worse than city wide average transport links and health inequalities in those areas. Main findings and conclusions

This study clearly identifies that availability and affordability are significant barriers to healthy eating. Comparison of the different options shows that the most accessible food retail destinations are the supermarkets, by public transport and then by walking. The least accessible destinations are the local health food shop clusters when traveling by foot. The high numbers of takeaway food outlets in the area are noteworthy. In Aspley and Leen Valley over half the food shops are takeaway food outlets. There is easy access to takeaway food shops for a large proportion of the residents in the area. The majority of residential areas within the study area are within a 15 minute walk of a takeaway. When compared with the other demographic variable groups it is the elderly that have the worst levels of accessibility to healthy shops and supermarkets in terms of journey times. There were many other interesting findings. For example in the Aspley/Leen Valley area: Most of the stores surveyed did not have all the items in our healthy

shopping basket example Takeaway ‘unhealthy’ food outlets generally outnumbering other food

shops had a significant impact on school children. Community consultation found healthy ‘shopping baskets’ to be higher

priced in local food shops compared to those for similar lines in the supermarkets.

The convenience versions of the larger supermarkets (Tesco Express and Sainsbury’s Convenience) have higher prices than their larger counterparts.

The research also indicated that pricing was a barrier to healthy eating. The qualitative evidence brought together in this project indicates that diet is poor and consumption of fruit and vegetables in Aspley is very low. The reasons why are not clear-cut. However access to, and affordability of, healthy foods, combined with easy access to cheap unhealthy foods would appear to be key factors. This combination, together with lack of knowledge about eating a healthy diet and lack of skills around preparing healthy food from basic ingredients also indicated in the earlier study ‘Health and Life in the West’, add to the range of barriers around healthy eating that will need multi-agency intervention to overcome. The conclusions around accessibility and affordability of healthy foods in Aspley are likely to apply to other disadvantaged areas of the City where car

ownership is low and there are a limited number of shops with very little competition between them. At a strategic level there needs to be a much greater awareness of the cost of a healthy diet and the impact that rising food prices and rising energy prices will have on the diet of people already on low incomes.

Recommendations for future actions This combination, together with lack of knowledge about eating a healthy diet and lack of skills around preparing healthy food from basic ingredients also indicated in the earlier study ‘Health and Life in the West’, add to the range of barriers around healthy eating that will need multi-agency intervention to overcome. This study clearly identifies that availability and affordability are significant barriers to healthy eating and FIG aims to use this evidence to get support for lowering these barriers. An example of positive actions coming from food access work is in Greenwich where the local Primary Care Trust and Council support a food co-op and this looks set to become profitable next year. At a strategic level there needs to be a much greater awareness of the cost of a healthy diet and the impact that rising food prices and rising energy prices will have on the diet of people already on low incomes. It is clear from this study that those who most suffer from the effects of diet related ill health are the most likely o suffer from food access issues that exacerbate the problem. Local authorities should be aware that retail premise licensing regulations, planning regulations, transport links all impact on this issue and options should be considered that in order to both increase access to healthy food as well as reduce proliferation of cheap unhealthy food. This is especially pertinent in the areas around schools.

Community consultation quotations The buses only run on Derby Road. For some people it is too far to

walk to Derby Road. Would like a bus that goes to Beeston but comes to the end of Church Street to pick up people.

One young person informed that a punnet of cherry tomatoes was her only fresh produce purchase, which would last her and partner

for 2 weeks.

One said it was cheaper to use a taxi to Tesco than shop in the Coop.’

Whilst the level of interest in a veg box or bag scheme and a local

delivery van was reasonably high at 49% and 44%, the prices used in these schemes is likely to influence take up.

Conversations indicated that ‘affordable’ was the key issue rather

than locally produced, the concept of which was not really understood. “Easily buy”, i.e. have in local shops again appeared a

key issue with most people wanting local shops to increase their ranges of affordable fresh produce.

St Anns is a large and hilly area, extending beyond the easily

walkable 400 metre distance from The Chase.

A significant proportion appeared to spend very little per week on fruit and vegetables. (One respondent only using her Healthy Start vouchers and not actually spending any money on fruit and veg)

Raise awareness of what is in food – salt, fibre etc. (E.g. one person

thought cornflakes were a good thing –“ the adverts says so”)

Chip shop on Broxtowe Lane is a magnet for secondary children at lunch time. Very large numbers – up to 150 children buying chips.

Coming from Ellis Guilford School

Trinity School – don’t let kids out at lunch time.

If have to pay for school meals, expensive, works out at £7.60 per child for week.

Price definitely influences food choices.

Nuthall Road takeaways and chip shops – open at lunch time to get kids.

Women’s Group in St Theresa’s Church Hall Thursday 30th January, 2008 These comments were written down from an informal group discussion.

‘Coops expensive and old fashioned’

‘Would like Asda’

‘Need sitting area/café area for elderly people in large Coop shop’

‘Spar has lots of cheap alcohol’

‘No fish shops anywhere’

‘Market one day per week at Bracebridge Drive has a fish stall but is

very expensive’

Comments about the Strelley Rd Coop:

‘Lights in car park vandalized. Won’t go in after dark as fear of

crime.’

‘Shutters drawn down at night, don’t make it very inviting

‘Security is good at Asda in Hyson Green

‘Recycling facility for glass has now gone from the area due to

vandalism’

‘Won’t walk to Flamstead/Strelly because of fear of crime’

The small shops, including the small Coops and Sainsburys are

more expensive

Greggs – offers cheap sausage rolls. Children come into baby clinics sucking on puff pastry sausage rolls.

Choice and price are barriers to healthy eating especially if can’t

drive and on a limited budget

References Nutrition and Food poverty – a toolkit for those involved in developing or implementing a local nutrition and food poverty strategy. National Heart Forum, Faculty of Public Health et al. 2004 Shopping for Food: Accessing Healthy, Affordable Food in 3 areas of Hackney, City University 2006, Bower, Caraher, Duane and Carr-Hill Motoring towards 2050 – Shopping and Transport Policy. RAC Foundation for Motoring 2006 Accessing healthy food. A sentinel mapping study of healthy food retailing in Scotland. FSA. January 2008. http://www.communities.gov.uk/documents/localgovernment/pdf/505713 Cardiovascular Disease Factsheet. May 2007. Available from NomadPlus. www.nomadplus.org.uk Source: Nottingham City Health Floor Target Action Plan . Available from NomadPlus. www.nomadplus.org.uk Health and Life in the West 2006 A Community Health Profile Available on NomadPlus www.nomadplus.org.uk The Greater Nottingham Retail Study (DTZ Consultants, January 2008) Food deserts, Mosaic data analysis (Nottingham City Council, September 2007) Presentation by Dr A. Wadge, Director of the Food Standards Agency Nottingham City Council School Meals Catering, Eastcroft, March 2008) Greater Nottingham Retail Study Nottingham City Council Ward Profiles for Areas 3,6 and 8 Nottingham City Health Floor Target Action Plan Baseline Assessment (2006) Dr Martin Caraher & Dr Elizabeth Dowler The Great food divide, BBC online 10.8.05

Contents of Appendices A1 Nottingham City Licenced Food Retailers A3 Aspley Licenced Food Retailers A7 Bilborough Licenced Food Retailers A12 Leen Valley Licenced Food Retailers B1 Public Transport Access to Markets B2 Public Transport Access to Shopping Clusters B3 Public Transport Access to ‘Healthy Shops’ B4 Walking Access to ‘Healthy Shops’ B5 Public Transport Access to Supermarkets B6 Walking Access to Supermarkets B7 Walking Access to Takeaways C6 Cardio Vascular Disease Demographics

This map is reproduced from Ordnance Survey material with the permission of Ordnance Survey on behalf of the Controller of Her Majesty’s Stationery Office © Crown copyright. Unauthorised reproduction infringes Crowncopyright and may lead to prosecution or civil proceedings. Nottingham City Council 100019317. 2008.

Map A1 Nottingham City food retail outletsMap produced on:07/04/08

Matthew PriceTransport Strategy

S:transport/public/strategy/matthewprice/FIG/final maps/Nottingham City food retailers

1:45,000Scale±Environment and Regeneration

Key

USAGEWards

Market stall (63)

Takeaway (353)

Supermarkets (64)

Greengrocers (13)

Health food shop (9)

!(Other food retail (271) when viewed at A3

inc. butchers, bakers, grocers etc.

Aspley

BilboroughLeen Valley

Bulwell

Basford

Bulwell Forest


Map A3 Aspley food retail outletsMap produced on:07/04/08


S:transport/public/strategy/matthewprice/FIG/final maps/Aspley food retailers


Key

USAGE

Wards

Market stall

Takeaway

Supermarkets

Greengrocers

Health food shop

!( Other food retail when viewed at A3

Bilborough

Aspley

Wollaton West

Leen Valley

Basford


Map A7 Bilborough food retail outletsMap produced on:07/04/08


S:transport/public/strategy/matthewprice/FIG/final maps/Bilborough food retailers


Key

USAGE

Wards

Market stall

Takeaway

Supermarkets

Greengrocers

Health food shop


Leen Valley

AspleyBasford

Wollaton West

Bilborough

Radford and Park

Arboretum

Wollaton East and Lenton Abbey

Berridge

Dunkirk and Lenton


Map A12 Leen Valley food retail outletsMap produced on:07/04/08


S:transport/public/strategy/matthewprice/FIG/final maps/Leen Valley food retailers


Key

USAGE

Wards

Market stall

Takeaway

Supermarkets

Greengrocers

Health food shop


(Tu, Fr, Sa)

(Th)(We)

(Tu)

(Fr, Sa)

(Mo, Sa)

Clifton

Bulwell

St Ann's

Sneinton

BilboroughHyson Green


Map B1 Accessibility of outdoor markets by public transportMap produced on:01/04/08

Map produced by:Matthew PriceTransport Strategy

Parameters:Tues 10:00-12:00Max interchange - 400mMax walk - 400mWalk speed - 3.2km.h

S:transport/public/strategy/matthewprice/FIG/finalmaps/PT_markets

1:60,00when viewed at A3

0Scale±Environment and RegenerationBandValue

0 to 5 mins

5 to 10 mins

10 to 15 mins

15 to 20 mins

20 to 25 mins

25 to 30 mins

30 to 35 mins

35 to 40 mins

40 to 45 mins

Public market


Map produced on:12/02/08


Parameters:Tues 10:00-12:00Max interchange - 400mMax walk - 400mWalk speed - 3.2km.h

S:transport/public/strategy/matthewprice/FIG/finalmaps/PT_Clusters


Lower Super Output Areas

BandValue0 to 5 mins

5 to 10 mins

10 to 15 mins

15 to 20 mins

20 to 25 mins

25 to 30 mins

30 to 35 mins

35 to 40 mins

40 to 45 mins

Shopping cluster FIG study area

12

3 4

5

67

89

10

when viewed at A3

Map B2 Accessibility of the 10 shopping clusters by public transport

98

7

6

5

432

1

10


Map B3 Accessibility of 6 clusters with "healthy food shops" by public transportMap produced on:11/04/08


Parameters:Tuesday 10:00-12:00Max connection 400mWalk speed - 3.2km/h

S:transport/public/strategy/matthewprice/FIG/finalmaps/PTHealthy Food Shops



BandValue

Shopping cluster FIG study areaHealthy food shop

0 to 5 mins

5 to 10 mins

10 to 15 mins

15 to 20 mins

20 to 25 mins

25 to 30 mins

30 to 35 mins

35 to 40 mins

40 to 45 mins

45 to 50 mins

50 to 55 mins

55 to 60 minswhen viewed at A3

98

7

6

5

432

1

10


Map B4 Accessibility of 6 clusters with "healthy food shops" by walking



Parameters:Walk speed - 3.2km.h

S:transport/public/strategy/matthewprice/FIG/finalmaps/Walk_top_rated_shops



Healthy shop

FIG study areaShopping cluster


5 to 10 mins

10 to 15 mins

15 to 20 mins

20 to 25 mins

25 to 30 mins

30 to 35 mins

35 to 40 mins

40 to 45 minswhen viewed in A3

Co-Op

Tesco Express

Sainsburys

Co-Op

Co-Op

Co-Op Late

Co-Op SuperstoreKwik Save

Co-Op SuperstoreCo-Op Welcome

Co-Op Welcome

Aldi Superstore


Map B5 Accessibility of supermarkets by public transportMap produced on:07/04/08


Parameters:Tues 10:00-12:00Max interchange - 400mMax walk - 400mWalk speed - 3.2km/h

S:transport/public/strategy/matthewprice/FIG/finalmaps/PT_Supermarkets_normal


Lower Super Output AreasSupermarket FIG study area


5 to 10 mins

10 to 15 mins

15 to 20 mins

20 to 25 mins

25 to 30 mins

30 to 35 mins

35 to 40 mins

40 to 45 minswhen viewed at A3

Co-Op

Tesco Express

Sainsburys

Co-Op

Co-Op

Co-Op Late

Co-Op SuperstoreKwik Save

Co-Op SuperstoreCo-Op Welcome

Co-Op Welcome

Aldi Superstore


Map B6 Accessibility of supermarkets by walkingMap produced on:11/04/08


Parameters:Walk speed - 3.2km/h

S:transport/public/strategy/matthewprice/FIG/finalmaps/Walking_Supermarkets_normal



BandValue

Supermarket FIG study area

when viewed at A3

0 to 5 mins

5 to 10 mins

10 to 15 mins

15 to 20 mins

20 to 25 mins

25 to 30 mins

30 to 35 mins

35 to 40 mins

40 to 45 mins

45 to 50 mins

50 to 55 mins

55 to 60 mins


Map B7 Accessibility of takeaways by walking



Parameters:Walk speed - 3.2km.h

S:transport/public/strategy/matthewprice/FIG/finalmaps/Walk_top_rated_shops


Lower Super Output AreasFIG study areaTakeaway


5 to 10 mins

10 to 15 mins

15 to 20 mins

20 to 25 mins

25 to 30 mins

30 to 35 mins

35 to 40 mins

40 to 45 minswhen viewed in A3


Map C6 FIG study area - Number of CVD events per 1,000 (DSR)



S:transport/public/strategy/matthewprice/FIG/finalmaps/DSR


FIG study area - LSOA number of CVD events per 1,000 (DSR)

when viewed at A33 - 4 per 1000

5 - 6 per 1000

7 - 8 per 1000

9 - 10 per 1000

0 - 2 per 1000

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