International Journal of Health Policy and Management

International Journal of Health Policy and Management

Retailer Responses to Public Consultations on the Adoption of Takeaway Management Zones Around Schools: A Longitudinal Qualitative Analysis

Document Type : Original Article

Authors
Matthew Keeble 1, 2
Michael Chang 3
Daniel Derbyshire 4
Martin White 1
Jean Adams 1
Ben Amies-Cull 5
Steven Cummins 6
Suzan Hassan 6
Bochu Liu 1, 7
Antonieta Medina-Lara 4
Oliver Mytton 8, 1
Tarra L. Penney 9
John Rahilly 1, 8
Nina Rogers 1
Bea Savory 6
Annie Schiff 1
Richard Smith 4
Claire Thompson 10
Thomas Burgoine 1
1 MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
2 Department of Marketing, Faculty of Business and Economics, University of Antwerp, Antwerp, Belgium
3 Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
4 Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
5 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
6 Population Health Innovation Lab, Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
7 Department of Urban Planning, College of Architecture and Urban Planning, Tongji University, Shanghai, China
8 Great Ormond Street Institute of Child Health, University College London, London, UK
9 Global Food System and Policy Research, School of Global Health, Faculty of Health, York University, Toronto, ON, Canada
10 School of Health and Social Work, University of Hertfordshire, Hatfield, UK
10.34172/ijhpm.8294
Abstract
Background 
Takeaway food is often high in calories and served in portion sizes that exceed public health recommendations for fat, salt and sugar. This food is widely accessible in the neighbourhood food environment. As of 2019, of all local authorities in England (n = 325), 41 had adopted urban planning interventions that can allow them to manage the opening of new takeaway outlets in “takeaway management zones around schools” (known elsewhere as “exclusion zones”). Before adoption, local authorities undertake mandatory public consultation where responses objecting to proposals can be submitted. Evidence on common objections could be insightful for practitioners and policy-makers considering this intervention.
 
Methods 
We included 41 local authorities that adopted a takeaway management zone around schools between 2009 and 2019. We identified and analysed objections to proposals submitted by or on behalf of food retailers and local authority responses to these. We used reflexive thematic analysis with a commercial determinants of health lens to generate themes, and investigated if and how objections and responses changed over time.
 
Results 
We generated four themes: The role of takeaways in obesity, Takeaway management zone adoption, Use and interpretation of evidence, and managing external opinions. Despite not being implicated by the adoption of takeaway management zones around schools, planning consultants objected to proposals on behalf of transnational food retailers, however, independent takeaways did not respond. Objections attempted to determine the causes of poor diet and obesity, suggest alternative interventions to address them, undermine evidence justifying proposals, and influence perspectives about local authorities and their intervention. Objections consistently raised the same arguments, but over time became less explicit and expressed a willingness to partner with local authorities to develop alternative solutions.
 
Conclusion 
Objections to local authority proposals to adopt an urban planning intervention that can stop new takeaways opening near schools featured strategies used by other industries to delay or prevent population health intervention adoption. Practitioners and policy-makers can use our findings when developing proposals for new takeaway management zones around schools. By using knowledge about their local context and addressing arguments against specific aspects of the intervention, they can pre-empt common objections.
Keywords
Childhood Obesity
Commercial Determinants of Health
Fast Food
Obesity
Thematic Analysis
  1. Black C, Moon G, Baird J. Dietary inequalities: what is the evidence for the effect of the neighbourhood food environment? Health Place. 2014;27:229-242. doi:1016/j.healthplace.2013.09.015
  2. 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):1321. doi:3390/ijerph17041321
  3. Hobbs M, Mackenbach JD, Wiki J, Marek L, McLeod GF, Boden JM. Investigating change in the food environment over 10 years in urban New Zealand: a longitudinal and nationwide geospatial study. Soc Sci Med. 2021;269:113522. doi:1016/j.socscimed.2020.113522
  4. Pinho MG, Mackenbach JD, den Braver NR, Beulens JJ, Brug J, Lakerveld J. Recent changes in the Dutch foodscape: socioeconomic and urban-rural differences. Int J Behav Nutr Phys Act. 2020;17(1):43. doi:1186/s12966-020-00944-5
  5. Taillie LS. Who's cooking? Trends in US home food preparation by gender, education, and race/ethnicity from 2003 to 2016. Nutr J. 2018;17(1):41. doi:1186/s12937-018-0347-9
  6. Maguire ER, Burgoine T, Monsivais P. Area deprivation and the food environment over time: A repeated cross-sectional study on takeaway outlet density and supermarket presence in Norfolk, UK, 1990-2008. Health Place. 2015;33:142-147. doi:1016/j.healthplace.2015.02.012
  7. Huang Y, Burgoine T, Essman M, Theis DRZ, Bishop TRP, Adams J. Monitoring the nutrient composition of food prepared out-of-home in the United Kingdom: database development and case study. JMIR Public Health Surveill. 2022;8(9):e39033. doi:2196/39033
  8. Jaworowska A, Blackham TM, Long R, et al. Nutritional composition of takeaway food in the UK. Nutr Food Sci. 2014;44(5):414-430. doi:1108/nfs-08-2013-0093
  9. Robinson E, Jones A, Whitelock V, Mead BR, Haynes A. (Over)eating out at major UK restaurant chains: observational study of energy content of main meals. BMJ. 2018;363:k4982. doi:1136/bmj.k4982
  10. Barnes TL, French SA, Mitchell NR, Wolfson J. Fast-food consumption, diet quality and body weight: cross-sectional and prospective associations in a community sample of working adults. Public Health Nutr. 2016;19(5):885-892. doi:1017/s1368980015001871
  11. Gesteiro E, García-Carro A, Aparicio-Ugarriza R, González-Gross M. Eating out of home: influence on nutrition, health, and policies: a scoping review. Nutrients. 2022;14(6):1265. doi:3390/nu14061265
  12. Hillier-Brown FC, Moore HJ, Lake AA, et al. The effectiveness of interventions targeting specific out-of-home food outlets: protocol for a systematic review. Syst Rev. 2014;3:17. doi:1186/2046-4053-3-17
  13. Hillier-Brown FC, Summerbell CD, Moore HJ, et al. A description of interventions promoting healthier ready-to-eat meals (to eat in, to take away, or to be delivered) sold by specific food outlets in England: a systematic mapping and evidence synthesis. BMC Public Health. 2017;17(1):93. doi:1186/s12889-016-3980-2
  14. Hillier-Brown FC, Summerbell CD, Moore HJ, et al. The impact of interventions to promote healthier ready-to-eat meals (to eat in, to take away or to be delivered) sold by specific food outlets open to the general public: a systematic review. Obes Rev. 2017;18(2):227-246. doi:1111/obr.12479
  15. Egger G, Swinburn B. An "ecological" approach to the obesity pandemic. BMJ. 1997;315(7106):477-480. doi:1136/bmj.315.7106.477
  16. Story M, Kaphingst KM, Robinson-O'Brien R, Glanz K. Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health. 2008;29:253-272. doi:1146/annurev.publhealth.29.020907.090926
  17. Ministry of Housing Communities & Local Government. National Planning Policy Framework. 2018. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/728643/Revised_NPPF_2018.pdf. Accessed May 21, 2023.
  18. Theis DR, White M. Is obesity policy in England fit for purpose? Analysis of government strategies and policies, 1992-2020. Milbank Q. 2021;99(1):126-170. doi:1111/1468-0009.12498
  19. NHS Digital. National Child Measurement Programme, England 2020/21 School Year. 2021. https://digital.nhs.uk/data-and-information/publications/statistical/national-child-measurement-programme/2020-21-school-year#. Accessed June 28, 2023.
  20. Greater London Authority. Takeaways Toolkit. 2012. https://www.london.gov.uk/sites/default/files/takeawaystoolkit.pdf. Accessed April 3, 2023.
  21. Local Government Association. Tipping the Scales: Case Studies on the Use of Planning Powers to Limit Hot Food Takeaways. 2016. https://www.local.gov.uk/sites/default/files/documents/tipping-scales-case-studi-bff.pdf. Accessed June 5, 2023.
  22. London Healthy Urban Development Unit. Using the Planning System to Control Hot Food Takeaways: A Good Practice Guide. 2013. https://www.healthyurbandevelopment.nhs.uk/wp-content/uploads/2013/12/HUDU-Control-of-Hot-Food-Takeaways-Feb-2013-Final.pdf. Accessed May 10, 2023.
  23. O'Malley CL, Lake AA, Townshend TG, Moore HJ. Exploring the fast food and planning appeals system in England and Wales: decisions made by the Planning Inspectorate (PINS). Perspect Public Health. 2021;141(5):269-278. doi:1177/1757913920924424
  24. Keeble M, Burgoine T, White M, Summerbell C, Cummins S, Adams J. Planning and Public Health professionals' experiences of using the planning system to regulate hot food takeaway outlets in England: a qualitative study. Health Place. 2021;67:102305. doi:1016/j.healthplace.2020.102305
  25. Town and Country Planning. The Town and Country Planning (Local Planning) (England) Regulations 2012. 2012. https://www.legislation.gov.uk/uksi/2012/767/made. Accessed June 7, 2023.
  26. Sacks G, Swinburn BA, Cameron AJ, Ruskin G. How food companies influence evidence and opinion – straight from the horse’s mouth. Crit Public Health. 2018;28(2):253-256. doi:1080/09581596.2017.1371844
  27. McKevitt S, White M, Petticrew M, et al. Characterizing restrictions on commercial advertising and sponsorship of harmful commodities in local government policies: a nationwide study in England. J Public Health (Oxf). 2023;45(4):878-887. doi:1093/pubmed/fdad155
  28. Wood B, Lacy-Nichols J, Sacks G. Taking on the corporate determinants of Ill-health and health inequity: a scoping review of actions to address excessive corporate power to protect and promote the public's health. Int J Health Policy Manag. 2023;12:7304. doi:34172/ijhpm.2023.7304
  29. Gilmore AB, Fabbri A, Baum F, et al. Defining and conceptualising the commercial determinants of health. Lancet. 2023;401(10383):1194-1213. doi:1016/s0140-6736(23)00013-2
  30. Lacy-Nichols J, Marten R, Crosbie E, Moodie R. The public health playbook: ideas for challenging the corporate playbook. Lancet Glob Health. 2022;10(7):e1067-e1072. doi:1016/s2214-109x(22)00185-1
  31. Jawad A, Savona N, Penney T, White M. Industry responses to the UK government’s public consultation on the proposed soft drinks industry levy: qualitative documentary analysis using the framework method and a systems perspective. Food Policy. 2023;118:102498. doi:1016/j.foodpol.2023.102498
  32. Penney TL, Jones CP, Pell D, et al. Reactions of industry and associated organisations to the announcement of the UK Soft Drinks Industry Levy: longitudinal thematic analysis of UK media articles, 2016-18. BMC Public Health. 2023;23(1):280. doi:1186/s12889-023-15190-0
  33. Friel S, Collin J, Daube M, et al. Commercial determinants of health: future directions. Lancet. 2023;401(10383):1229-1240. doi:1016/s0140-6736(23)00011-9
  34. Chilet-Rosell E, Hernández-Aguado I. It is not enough to assess conflicts of interest when we bring the commercial sector to the policy table: Comment on "Towards preventing and managing conflict of interest in nutrition policy? An analysis of submissions to a consultation on a draft WHO tool." Int J Health Policy Manag. 2022;11(3):394-397. doi:34172/ijhpm.2021.148
  35. Keeble M, Burgoine T, White M, Summerbell C, Cummins S, Adams J. How does local government use the planning system to regulate hot food takeaway outlets? A census of current practice in England using document review. Health Place. 2019;57:171-178. doi:1016/j.healthplace.2019.03.010
  36. Rahilly J, Williams A, Chang M, et al. Changes in the number and outcome of takeaway food outlet planning applications in response to adoption of management zones around schools in England: a time series analysis. Health Place. 2024;87:103237. doi:1016/j.healthplace.2024.103237
  37. Savona N, Thompson C, Smith D, Cummins S. ‘Complexity’ as a rhetorical smokescreen for UK public health inaction on diet. Crit Public Health. 2021;31(5):510-520. doi:1080/09581596.2020.1755421
  38. Ong EK, Glantz SA. Constructing "sound science" and "good epidemiology": tobacco, lawyers, and public relations firms. Am J Public Health. 2001;91(11):1749-1757. doi:2105/ajph.91.11.1749
  39. Lacy-Nichols J, Williams O. "Part of the solution": food corporation strategies for regulatory capture and legitimacy. Int J Health Policy Manag. 2021;10(12):845-856. doi:34172/ijhpm.2021.111
  40. Mialon M, Julia C, Hercberg S. The policy dystopia model adapted to the food industry: the example of the Nutri-Score saga in France. World Nutr. 2018;9(2):109-120. doi:26596/wn.201892109-120
  41. Russell C, Lawrence M, Cullerton K, Baker P. The political construction of public health nutrition problems: a framing analysis of parliamentary debates on junk-food marketing to children in Australia. Public Health Nutr. 2020;23(11):2041-2052. doi:1017/s1368980019003628
  42. Mialon M, Swinburn B, Sacks G. A proposed approach to systematically identify and monitor the corporate political activity of the food industry with respect to public health using publicly available information. Obes Rev. 2015;16(7):519-530. doi:1111/obr.12289
  43. Maani Hessari N, Ruskin G, McKee M, Stuckler D. Public meets private: conversations between Coca-Cola and the CDC. Milbank Q. 2019;97(1):74-90. doi:1111/1468-0009.12368
  44. Hussain Z, van Schalkwyk MCI, Galea S, Petticrew M, Maani N. A qualitative framing analysis of how firearm manufacturers and related bodies communicate to the public on gun-related harms and solutions. Prev Med. 2023;166:107346. doi:1016/j.ypmed.2022.107346
  45. Charmaz K. Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. SAGE Publications; 2006.
  46. Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11(4):589-597. doi:1080/2159676x.2019.1628806
  47. Braun V, Clarke V. Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern-based qualitative analytic approaches. Couns Psychother Res. 2021;21(1):37-47. doi:1002/capr.12360
  48. Braun V, Clarke V. Toward good practice in thematic analysis: avoiding common problems and be(com)ing a knowing researcher. Int J Transgend Health. 2023;24(1):1-6. doi:1080/26895269.2022.2129597
  49. Vila-Henninger L, Dupuy C, Van Ingelgom V, et al. Abductive coding: theory building and qualitative (re)analysis. Sociol Methods Res. 2024;53(2):968-1001. doi:1177/00491241211067508
  50. Oreskes N, Conway EM. Defeating the merchants of doubt. Nature. 2010;465(7299):686-687. doi:1038/465686a
  51. McIntyre L. Framing analysis: its usefulness as a tool for advocacy on public health nutrition problems. Public Health Nutr. 2020;23(11):2053-2055. doi:1017/s1368980020000373
  52. Krefting L. Rigor in qualitative research: the assessment of trustworthiness. Am J Occup Ther. 1991;45(3):214-222. doi:5014/ajot.45.3.214
  53. Crawford HK, Leybourne ML, Arnott A. How we ensured rigor from a multi-site, multi-discipline, multi-researcher study. Forum Qual Soc Res. 2000;1(1):12. doi:17169/fqs-1.1.1122
  54. Goffe L, Penn L, Adams J, et al. The challenges of interventions to promote healthier food in independent takeaways in England: qualitative study of intervention deliverers' views. BMC Public Health. 2018;18(1):184. doi:1186/s12889-018-5096-3
  55. Hillier-Brown F, Lloyd S, Muhammad L, et al. Feasibility and acceptability of a Takeaway Masterclass aimed at encouraging healthier cooking practices and menu options in takeaway food outlets. Public Health Nutr. 2019;22(12):2268-2278. doi:1017/s1368980019000648
  56. Karreman N, Huang Y, Egan N, et al. Understanding the role of the state in dietary public health policymaking: a critical scoping review. Health Promot Int. 2023;38(5):daad100. doi:1093/heapro/daad100
  57. Maani N, van Schalkwyk MCI, Filippidis FT, Knai C, Petticrew M. Manufacturing doubt: Assessing the effects of independent vs industry-sponsored messaging about the harms of fossil fuels, smoking, alcohol, and sugar sweetened beverages. SSM Popul Health. 2022;17:101009. doi:1016/j.ssmph.2021.101009
  58. Petticrew M, Maani Hessari N, Knai C, Weiderpass E. How alcohol industry organisations mislead the public about alcohol and cancer. Drug Alcohol Rev. 2018;37(3):293-303. doi:1111/dar.12596
  59. Lee K. Advancing the commercial determinants of health agenda. Lancet. 2023;401(10370):16-17. doi:1016/s0140-6736(22)02578-8
  60. Lauber K, Rutter H, Gilmore AB. Big food and the World Health Organization: a qualitative study of industry attempts to influence global-level non-communicable disease policy. BMJ Glob Health. 2021;6(6):e005216. doi:1136/bmjgh-2021-005216
  61. Petticrew M, Katikireddi SV, Knai C, et al. 'Nothing can be done until everything is done': the use of complexity arguments by food, beverage, alcohol and gambling industries. J Epidemiol Community Health. 2017;71(11):1078-1083. doi:1136/jech-2017-209710
  62. Keeble M, Adams J, White M, Summerbell C, Cummins S, Burgoine T. Correlates of English local government use of the planning system to regulate hot food takeaway outlets: a cross-sectional analysis. Int J Behav Nutr Phys Act. 2019;16(1):127. doi:1186/s12966-019-0884-4
  63. Baker P, Gill T, Friel S, Carey G, Kay A. Generating political priority for regulatory interventions targeting obesity prevention: an Australian case study. Soc Sci Med. 2017;177:141-149. doi:1016/j.socscimed.2017.01.047
  64. Mialon M, Naik A. A discussion of stronger public policies to protect and promote healthy diets: what can the US learn from other countries? World Nutr. 2023;14(1):86-99. doi:26596/wn.202314186-99
  65. Chau JY, Kite J, Ronto R, Bhatti A, Bonfiglioli C. Talking about a nanny nation: investigating the rhetoric framing public health debates in Australian news media. Public Health Res Pract. 2019;29(3):2931922. doi:17061/phrp2931922
  66. Brownell KD. Thinking forward: the quicksand of appeasing the food industry. PLoS Med. 2012;9(7):e1001254. doi:1371/journal.pmed.1001254
  67. Brownell KD, Warner KE. The perils of ignoring history: Big Tobacco played dirty and millions died. How similar is Big Food? Milbank Q. 2009;87(1):259-294. doi:1111/j.1468-0009.2009.00555.x
  68. Brown H, Xiang H, Albani V, et al. No new fast-food outlets allowed! Evaluating the effect of planning policy on the local food environment in the North East of England. Soc Sci Med. 2022;306:115126. doi:1016/j.socscimed.2022.115126
  69. Brown H, Kirkman S, Albani V, et al. The impact of school exclusion zone planning guidance on the number and type of food outlets in an English local authority: a longitudinal analysis. Health Place. 2021;70:102600. doi:1016/j.healthplace.2021.102600
  70. Wakefield District Council. Proposed Main Modifications to Publication Draft Plan. 2023. https://www.wakefield.gov.uk/media/2q3jwqbi/exwdc110-mm-to-publication-draft-plan-volume-1.pdf. Accessed July 19, 2023.
  71. Moore HJ, Lake AA, O'Malley CL, et al. The impact of COVID-19 on the hot food takeaway planning regulatory environment: perspectives of local authority professionals in the North East of England. Perspect Public Health. 2024;144(1):52-60. doi:1177/17579139221106343
International Journal of Health Policy and Management
Volume 13, Issue 1
2024
Pages 1-12

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  • Received Date 22 September 2023
  • Revised Date 10 June 2024
  • Accepted Date 28 July 2024
  • First Published Date 03 August 2024
  • Published Date 01 December 2024