Healthy Food Zones Around Schools: Evaluating Projected Impacts of a Restrictive Food Planning Policy on Junk Food Availability after 10 years: An Equity- focused Simulation Study

Healthy diets are important for public health and health equity, given that globally, dietary risks currently comprise the largest burden of morbidity and mortality (Afshin et al., 2019). In Canada, diet quality is the poorest among youth ages 14-18 (Garriguet, 2009), which is concerning given that youth quickly develop eating patterns that track throughout their lives (Lien et al., 2001). Similarly, our understanding of the relationship between the built environment and population health outcomes as situated within a social equity lens has grown. Both planning and public health organizations and researchers have recommended restrictive food planning policies that regulate unhealthy food outlets' distribution, density, and proximity around secondary schools (ASPQ, 2011; Einstoss et al., 2015; OPPI, 2011; Robitaille et al., 2016). Several municipalities and cities in Canada and the US have explored and implemented such restrictive urban planning policies in certain public areas, including around schools; however, these policies have not been evaluated, nor have the ethical implications been considered (ASPQ, 2011; Díez et al., 2019; Luan et al., 2016). \n \nThis cross-sectional, quantitative, ecological thesis examines how food environments are projected to change under different restrictive food planning policies over 10 years in the Region of Waterloo (Ontario, Canada) by buffer type, buffer distance and various markers of equity. This manuscript-based thesis uses popular demographic modelling projections and discusses the potential ethical implications of this policy on equity-deserving youth from a health equity perspective to answer the following three research questions: 1) How would high school students’ food environment accessibility be projected to change during the school day if restrictive food planning policies (restricting fast food and convenience stores from opening around schools) were implemented in the Region of Waterloo, Ontario?”, 2) “How does current food environment accessibility differ by the proportion of students at schools identifying as low-income, EAL and newcomer status in secondary schools in the Region of Waterloo, Ontario?”, and 3) “How would projected changes in food environment accessibility after 10 years of restrictive policy implementation differ by these social identity groups?” \nFindings suggest that Euclidean distance policies showed a larger decline in the number of unhealthy outlets at 10 years relative to their network distance counterparts and low- and medium- equity schools (those with high proportions of equity-deserving students across multiple marks of equity) currently have higher accessibility to unhealthy retailers compared to high-equity schools (those with low proportions of equity-deserving students) in the Region of Waterloo, Ontario. Even after 10 years of implementation, low- and medium- equity schools still have higher projected access to unhealthy food retailers relative to high-equity schools. \n \nThis research provides planners, public health practitioners, and policymakers with an understanding of how recommended policies may impact food environments around schools in different contexts to inform decision-making regarding food policy interventions and contributes to the ongoing conversation of social inequities across food systems and highlight ethical implications of restrictive food planning policies. Future public health research should evaluate the effectiveness of existing restrictive food policies and examine the impacts restrictive food planning policies may have across communities, especially equity-deserving communities, through an intersectional and equity lens.

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