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Open AccessArticle

Snapshots of Urban and Rural Food Environments: EPOCH-Based Mapping in a High-, Middle-, and Low-Income Country from a Non-Communicable Disease Perspective

1
School of Public Health, University of the Western Cape, Bellville 7535, South Africa
2
Centre for Food Policy, City, University of London, London EC1R 1UW, UK
3
Department of Food Studies, Nutrition and Dietetics, Uppsala University, 75122 Uppsala, Sweden
4
Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
5
Chronic Disease Initiative for Africa, University of Cape Town, Cape Town 7925, South Africa
6
Department of Public Health, Vrije Universiteit Brussel, 1090 Brussels, Belgium
7
Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden
8
International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, 75237 Uppsala, Sweden
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
David Sanders died in August, 2019.
Nutrients 2020, 12(2), 484; https://doi.org/10.3390/nu12020484
Received: 28 December 2019 / Revised: 5 February 2020 / Accepted: 10 February 2020 / Published: 14 February 2020
A changing food environment is implicated as a primary contributor to the increasing levels of non-communicable diseases (NCDs). This study aimed to generate snapshots of selected external food environments to inform intervention strategies for NCD prevention in three countries: Uganda (low income), South Africa (middle income) and Sweden (high income), with one matched pair of urban–rural sites per country. Fifty formal and informal food retail outlets were assessed, and descriptive and comparative statistical analyses were performed. We found that formal food retail outlets in these countries had both positive and negative traits, as they were the main source of basic food items but also made unhealthy food items readily available. The Ugandan setting had predominantly informal outlets, while the Swedish setting had primarily formal outlets and South Africa had both, which fits broadly into the traditional (Uganda), mixed (South Africa) and modern (Sweden) conceptualized food systems. The promotion of unhealthy food products was high in all settings. Uganda had the highest in-community advertising, followed by South Africa and Sweden with the lowest, perhaps related to differences in regulation and implementation. The findings speak to the need to address contextual differences in NCD-related health interventions by incorporating strategies that address the food environment, and for a critical look at regulations that tackle key environment-related factors of food on a larger scale. View Full-Text
Keywords: food environment; low-, middle- and high-income countries; food retail outlets; food promotion food environment; low-, middle- and high-income countries; food retail outlets; food promotion
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Spires, M.; Berggreen-Clausen, A.; Kasujja, F.X.; Delobelle, P.; Puoane, T.; Sanders, D.; Daivadanam, M. Snapshots of Urban and Rural Food Environments: EPOCH-Based Mapping in a High-, Middle-, and Low-Income Country from a Non-Communicable Disease Perspective. Nutrients 2020, 12, 484.

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