Shaping Healthier Food Environments - Part 2

Poor nutrition is a significant health concern in Australia, with many people not meeting recommended dietary guidelines.1 Unhealthy eating patterns coupled with physical inactivity is a key driver of obesity, which has now overtaken smoking as the leading risk factor for preventable health conditions in South Australia, including heart disease, diabetes, and some cancers.2   


In addition to the growing prevalence of chronic diseases, health outcomes vary significantly between different population groups and geographic areas in Australia.3 Recent evidence suggests that the neighbourhood in which a person lives is one of the greatest predictors of life expectancy.4


Land use and transport planners, together with urban designers and others, play a pivotal role in tackling public health challenges. By creating safe, accessible, and socially connected environments, they help promote active lifestyles and healthier dietary choices. Increasing access to these supportive settings can help to combat rising rates of cardiovascular disease, obesity, and related health issues, ultimately enhancing the quality of life for people living in Australia. 


Our food choices are influenced by a complex array of psycho-social, cultural, economic and contextual relationships.5 Australia's Food Environment Dashboard4 reveals that households spend approximately 60% of their food budget on unhealthy food and drinks.  Research shows that exposure and access to healthy food in our environments has a significant influence on our eating patterns and that in many areas, energy-dense foods and drinks are easier to obtain than fresh produce.6 


A recent study in Melbourne highlights a concerning trend: in population growth areas, unhealthy food outlets, such as fast-food restaurants and convenience stores, have increased at a much faster rate than supermarkets and fruit and vegetable stores, reaching a ratio as high as 9:1.7 The density of fast-food chain outlets across Melbourne has also nearly doubled from 2008 to 2016, with population growth areas being the hardest hit.7 This is concerning as research indicates increasing BMI as access to healthy outlets decrease.8


By pursuing a ‘health in all policies’ approach9 that integrates health considerations into policy-making across sectors, land use planning has the potential to shape healthier food environments. However, under current Australian planning laws, local governments have limited authority to regulate the distribution of fast-food outlets and convenience stores.10


State-based urban planning reforms are needed in Australia to align urban planning policy with public health goals, empowering local governments to regulate the proliferation of unhealthy food outlets and to incentivise food outlets that sell predominantly fresh and healthy options. Australia’s state planning systems variably assign broad land use definitions to planning approvals. Land uses for food outlets might include: ‘shop’ or ‘restaurant’ or ‘retail fuel outlet’ but there is no consideration for the types of food sold. In the 1980s, Byron Council in NSW took an alternative approach and banned drive-through services11,12, addressing potential traffic and noise impacts on the locality, in lieu of food outlet categorisations.


Internationally, local authorities have implemented stronger planning mechanisms to shape food environments.

In England, land use classifications are assigned at a more detailed level, including ‘Class A5 – Hot food and takeaway’ which allows local authorities to refuse applications for new developments that fall under this category where policies permit.13   


Local authorities in the UK13, South-Central Los Angeles14 and other US cities have also used planning mechanisms in various ways to create exclusion zones around schools or limit the over concentration of hot food takeaways in key areas.12 


Governments can play a role in increasing access to healthy foods by incentivising retailers through grants, planning or tax concessions. In New York, full-service grocery stores have been encouraged to operate through a combination of financial incentives and planning concessions such as reduced parking requirements.12


To address healthy food access disparities in low-income neighbourhoods, the New York state government established the Green Cart Scheme and issued 1,000 new permits for mobile vendors selling fresh fruit, vegetables and plain nuts, whilst capping pre-existing permits for vendors offering less healthy food options.12,15


A report commissioned by VicHealth12 reviewed the above international efforts to improve food environments and further explored how governments and planners can positively influence access to nutritious food while discouraging the proliferation of unhealthy food retailers. The Heart Foundation supports the key recommendations from the report as below: 

  1. Food retail classification system: Implement a food retail classification system and use data visualisation tools to assess the distribution of retailer types and identify areas with poor healthy food accessibility. 
  2. Combined approaches: Encourage retailers selling healthy options while simultaneously discouraging those selling unhealthy options to ensure a balance of food choices. 
  3. Reducing inequalities: Use planning tools to understand the spatial distribution of food retailers and select policies that address community needs, particularly in socioeconomically disadvantaged areas. 
  4. Health in all policies: Foster cross-sector collaborations between health, planning, and transport departments to share evidence and provide technical assistance, with a focus on reaching stakeholders at the local level. 
  5. Overcoming barriers: When introducing a healthy food neighbourhood initiative, document and share relevant strategies, implementation processes, barriers, and enablers to inform future interventions. 
  6. Stronger evaluation: Conduct robust evaluations of land-use initiatives aimed at improving the food environment to assess their effectiveness. 


Recommendation 1 is supported by The Australian Food Atlas, which has been developed by the Nutrition & Health Innovation Research Institute (NHIRI) to provide quantifiable evidence-based information on a community’s ability to access healthy food and/or an excess of unhealthy foods. The Atlas is currently being updated for Western Australia and expanded to cover Queensland and Victorian community food environments.

According to the NHIRI website, the Atlas “will be used by local and state governments to inform food regulation, food policy and nutrition surveillance, public health plans and strategic planning documents, obesity strategies, urban planning guidelines and assist advocacy to include public health as a deemed provision in planning law, empowering government to improve the health and wellbeing of their residents.”



The Heart Foundation via Healthy Active by Design provides a library of further case studies of actions that enhance the health of our built environments – including access to healthy food. If you have an initiative to share through our platform, please get in touch at healthyactivebydesign@heartfoundation.org.au or submit your case study here. 


References

1.         Australian Institute of Health and Welfare. Diet. 2024; https://www.aihw.gov.au/reports/food-nutrition/diet. Accessed 4 March, 2025.

2.         Preventive Health SA. Obesity now the biggest preventable health risk. 2024; https://www.preventivehealth.sa.gov.au/about/news-announcements/obesity-now-the-biggest-preventable-health-risk.

3.         Australian Bureau of Statistics. Neighbourhood Impacts on Health. 2018; https://www.abs.gov.au/articles/neighbourhood-impacts-health. Accessed 11 October 2024.

4.         VicHealth. Victorian Health Promotion Foundation (VicHealth) submission on a new plan for Victoria. In: Foundation VHP, ed. Melbourne: Victorian Health Promotion Foundation; 2024.

5.         The Obesity Collective. Drivers of Obesity. https://theobesitycollective.org.au/what-is-obesity/. Accessed 8 December, 2024.

6.         Obesity Evidence Hub. Obesity Evidence Hub - Trends. 2024; https://www.obesityevidencehub.org.au/collections/trends. Accessed 23 October, 2024.

7.         Needham C, Orellana L, Allender S, Sacks G, Blake MR, Strugnell C. Food Retail Environments in Greater Melbourne 2008-2016: Longitudinal Analysis of Intra-City Variation in Density and Healthiness of Food Outlets. Int J Environ Res Public Health. 2020;17(4).

8.         Needham C, Strugnell C, Allender S, Alston L, Orellana L. BMI and the Food Retail Environment in Melbourne, Australia: Associations and Temporal Trends. Nutrients. 2023;15(21).

9.         World Health Organization and The Government of South Australia. Adelaide Statement II on Health in All Policies. Outcome Statement from the 2017 International Conference Health in All Policies: Progressing the Sustainable Development Goals. 5 March 2019; https://www.who.int/publications/i/item/adelaide-statement-ii-on-health-in-all-policies. Accessed 6 February 2025.

10.       Bivoltsis A, Christian H, Ambrosini GL, et al. The community food environment and its association with diet, health or weight status in Australia: A systematic review with recommendations for future research. Health Promot J Austr. 2023;34(2):328-365.

11.       Taylor EJ. Fast food planning conflicts in Victoria 1969–2012: is every unhappy family restaurant unhappy in its own way? Australian Planner. 2015;52(2):114-126.

12.       Thornton L, Timperio A, Trapp G. Land use planning as a tool for changing the food environment Melbourne2021.

13.       Whole systems approach to obesity - A guide to support local approaches to promoting a healthy weight [press release]. London, UK: Public Health England2019.

14.       Sturm R, Hattori A. Diet and obesity in Los Angeles County 2007–2012: Is there a measurable effect of the 2008 “Fast-Food Ban”? Social Science & Medicine. 2015;133:205-211.

15.       Leggat M, Kerker B, Nonas C, Marcus E. Pushing produce: the New York City Green Carts initiative. J Urban Health. 2012;89(6):937-938.