Evaluation of planning policy to regulate takeaway food outlets for improved health in England: Synopsis.

内容摘要

Takeaway food outlets ('takeaways') sell hot food for consumption off the premises. Takeaway management zones are areas around schools where new takeaways are not allowed to open. They are the most common planning intervention targeting takeaways across local authorities in England to date. We conducted an evaluation of these zones to: model their impact on adult health model their associated economic costs and benefits explore their acceptability and perceived effectiveness among young people investigate support and perceived effectiveness among adults explore barriers to and facilitators of their adoption and implementation among local authority staff. We used a forecast of takeaway growth and a statistical model to estimate the impact of zones on diet-related health outcomes, quality-adjusted life-years and healthcare costs to 2040. We did this for adults aged 25-64 years in six different local authorities. We conducted a linked economic analysis to understand the future costs and benefits of zones to local authorities, the National Health Service and national government. We estimated costs when denial of planning permission results in a 3-, 6- or 12-month vacancy before alternative retail uptake. We asked 46 young people about how acceptable they thought the policy was. By conducting 'go along' interviews, we gained insights into their everyday food habits within and outside the school gates. We used survey data to understand public acceptability and perceived effectiveness of zones. We also asked whether having fewer takeaways near schools could reduce how often young people consume takeaway food. To evaluate adoption and implementation, we interviewed 29 local authority public health and planning officers about what lessons they had learned. Compared to no intervention, future reductions in takeaway exposure ranged from 3 outlets/person in Fenland to 28 outlets/person in Manchester. Obesity prevalence was reduced in both sexes in all local authorities, for example, in Manchester, by 2.3 percentage points for males. We observed reductions in disease incidence, for example, in Manchester, by 964 type II diabetes cases/100,000 males. Zones produced a positive net economic impact of, for example, £8.49-12.78M in Manchester. Despite objections on economic grounds, zones are associated with economic benefits for local authorities, the National Health Service and national government. Young people found zones to be acceptable and perceived them to have some positive impacts. But, a wider policy, including other types of outlets selling convenience food, may better limit dietary risk. Out of 3323 adults, 51% supported zone adoption. Almost three-quarters believed that zones would help young people to eat better. Among those aged 16-17 years, 33% agreed that young people would consume takeaway food less often if there were fewer takeaways near schools. Effective working relationships between local authority colleagues were important for adoption and implementation. Some local authorities ensured this by developing cross-departmental roles and policy 'champions'. A formal implementation process ensured confidence and consistency in implementation. Takeaway management zones around schools were forecast to reduce obesity prevalence and disease incidence by 2040, with no net economic costs. The public see zones as acceptable and potentially effective. However, the reality of adopting and implementing zones is challenging, while other aspects of food retail also influence the behaviours of young people. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR130597. There are many ways in which our neighbourhoods can make it hard to make healthy choices. Having more takeaway outlets means people tend to eat more of the unhealthy foods they sell. Designating zones around schools where new takeaways are not allowed to open is one way that local councils can encourage healthier lifestyles in children and adults. By 2019, 41 of 325 local councils in England had takeaway ‘management’ zones around schools. However, these councils have been working in the absence of evidence of their impact and acceptability. These evidence gaps have made it difficult for councils to demonstrate the value of management zones, curtailing further adoption and successful implementation. We used a computer model to estimate the impact of takeaway management zones on health to 2040. We also wanted to understand the costs and benefits of zones to local and national economies and the National Health Service over this period. We ran a survey to understand how acceptable and effective people thought zones would be and spoke to young people directly about what they thought of the policy overall. Finally, we asked public health and planning colleagues in local councils about their experiences of zones and what lessons they had learned. Although imperfect, takeaway management zones around schools were forecast to reduce obesity and related disease. For example, in Manchester, we forecast obesity prevalence for males to reduce by 2.3 percentage points. These health benefits were achieved with no overall economic harm. In fact, in Manchester, we forecast their adoption to save the council between £8M and £12M. Local communities saw zones as acceptable and potentially effective. However, the reality of adopting and managing the ongoing implementation of zones was a challenge for councils, while other aspects of high street food retail also influence young people’s diets.