Environmental approaches to promote healthy eating: Is ensuring affordability and availability enough?

Abstract

Improving diet is a key goal of public health, as a substantial fraction of global morbidity and mortality is attributable to dietary imbalances. These imbalances include insufficient consumption of vegetables, fruits, and whole grains, and excessive intake of refined carbohydrates and meat. Moreover, inequities in health are driven in part by inequities in diet, and tackling them is a key dimension to improving diet and health at the population level. The past 20 years have seen increasing concern over structural factors that promote unhealthy dietary patterns and undermine the adoption of healthy eating. This trend has paralleled a growing understanding of the multifactorial “causes of the causes” of the modern pandemics of obesity and non-communicable disease, and interest in the physical, economic, and social environments that cue and shape behavioural risk factors. For food selection and diet specifically, there is recognition of the importance of affordability and availability, two dimensions of a wider conceptualisation of food access . The general consideration of “access to healthy food” is now a central pillar of policy, systems, and environments (PSE) interventions as well as so called “whole systems” approaches to improve nutrition and reduce obesity and chronic disease. As policy makers and communities act to forge more healthful, sustainable, and equitable food systems and environments, researchers recognise the uneven evidence base and debate the importance of economic and geographical factors as population level determinants of diet and health.