Access to Healthy Food Bellamy Road Estate, Mansfield
Contents 01 Introduction 1.0 Commissioning 1.1 Partners 1.2 Aims, Objectives & Outputs
p5 p6 p8
02 The Access to Healthy Food Agenda 2.0 Food Poverty 2.1 Access to Healthy Food 2.2 Virtuous Foods 2.3 Food Access Literature Review 2.4 Accessibility Planning
p10 p12 p14 p16 p19
03 Choosing Bellamy Road Estate 3.0 Background 3.1 Practical Considerations 3.2 Public Health Factors 3.4 Applicability in other Geographical Localities
p21 p25 p27 p29
04 Methodology 4.0 Methodology Overview 4.1 Desk Based Research 4.2 Quantative Practical Investigations: Food mapping Shopping Baskets Surveys 4.3 Qualitative Practical Investigations: Questionnaires Focus Groups
p32 p33 p34
05 Findings 5.0 Quantative Findings: Food Outlet Mapping Shopping Baskets Surveys 5.1 Qualitative Findings: Questionnaires Focus Groups
08 Appendices i) Food Questionnaire ii) Food Questionnaire Publicity
1.0 Commissioning NHS Nottinghamshire County (Nottinghamshire County teaching Primary Care Trust) commissioned the Food Initiatives Group (FIG) to undertake this study to investigate access to healthy food in an area of Mansfield Town, north Nottinghamshire. The study was carried out as part of the NHS Nottinghamshire County Service Level Agreement with Groundwork Greater Nottingham who manage the FIG project. Additional funds from NHS Nottinghamshire County were made available to carry out the study, which began in November 2009 and was completed in April 2010. NHS Nottinghamshire County and the East Midlands Public Health Observatory (EMPHO) had identified Mansfield as having a population with a poor public health profile when compared nationally, regionally and at a county level. Non-communicable food related diseases such as obesity, diabetes and heart disease were considered at high levels. It was therefore thought appropriate to investigate barriers to healthy eating in an area of Mansfield with high levels of multiple deprivation. Practical recommendations were asked of this study that could help reduce any barriers to a healthy diet that were found through the research.
1.1 Partners Food Initiatives Group The Food Initiatives Group is a Groundwork Greater Nottingham based food partnership funded by NHS Nottingham City and NHS Nottinghamshire County. Since 2001 FIG has brought together local government, health agencies, food business and community food initiatives to promote healthy, local and good food from sustainable sources. A food strategy “Food for Thought” has been developed for any organisation seeking to work towards a more sustainable food system. FIG works to raise awareness of the eleven interconnected key food issues within this strategy: • • • • • • • • • • •
Food, Health and Nutrition Food Safety Food and Mental Health Inequality and Food Access Organic Production Genetically Modified Foods Food Production and Biodiversity Animal Welfare Waste and Composting Local Food The Global Perspective On Food
NHS Nottinghamshire County NHS Nottinghamshire County lead the local NHS and plan and pay for health services for 660,000 people in: Ashfield Broxtowe Gedling Mansfield Newark and Sherwood Rushcliffe The trust spends a billion pounds a year on healthcare for the people of Nottinghamshire in order to: • Identify the health needs of local people, and then meet those needs. • Commission the entire range of health services, from check-ups to life-saving operations. • Improve people’s length and quality of life. • Encourage everyone to live healthily. • Police services to keep them high-quality and safe. • Ensure the local NHS gives best value for money. • Give people a say in what the local NHS does. 6
7 Groundwork Greater Nottingham Groundwork Greater Nottingham is a charity that inspires people to create sustainable communities that are vibrant, healthy and safe. Communities are encouraged to respect the local and global environment where individuals and enterprise prosper. Creating those sustainable communities means developing initiatives which cut across economic, social and environmental issues. East Midlands Public Health Observatory (EMPHO) FIG received support with GIS mapping, as well as information on health and diet in Nottinghamshire, from the East Midlands Public Health Observatory (EMPHO).The East Midlands Public Health Observatory is one of nine regional Public Health Observatories funded by the Department of Health in England. EMPHO is the regional health intelligence organisation providing information and analysis to support those working to improve health and reduce health inequalities in the East Midlands. The key roles of Public Health Observatories are:
• Promoting and delivering health intelligence to decision-makers to improve health and reduce health inequalities • Acting as advocates for population health information, ensuring that high-quality, relevant information is available to a range of stakeholders • Being a single port of call for those who need such information developing a skilled health intelligence workforce EMPHO is the designated Public Health Observatory lead on food and diet related work. Mansfield District Council Mansfield District Council’s Environmental Health Department supported this study with information about food outlets in Mansfield by making food licensing data available. Bellamy Road Stakeholders Group The broad local partnership represented by Bellamy Road Stakeholders Group allowed this study to access local organisations in order to carry out qualitative research and provided valuable background knowledge to the area. Stakeholders included Mansfield District Council, NHS Nottinghamshire County, Nottinghamshire Police, Connexions, housing agencies, a number of local charities as well as local resident representatives. Bellamy Road Tenants and Residents Association Bellamy Road Tenants and Residents Association (Bellamy Road TARA) gave FIG valuable insight into the Bellamy Road Estate and rapid access to local residents and businesses for both the qualitative and qualitative research. Particular thanks are due to the Chair of the Bellamy Road TARA, Richard Dabell for his time and expertise.
1.2 Aims, Objectives & Outcomes Project Aims The aim of the research project was to consider the issues of access to a healthy diet, rather than simply access to food in Mansfield. The project focused on an area of Mansfield that experiences poor health and higher levels of obesity. The barriers that limit access to healthy food were to be assessed. The research project, through NHS Nottinghamshire County, has further aims to obtain the commitment of key local stakeholders to deliver an Action Plan for change.
Project Objectives Establish baseline information on shopping habits including methods of access to food. Establish baseline information on food knowledge, food attitudes, food consumption, availability and prices of healthy foods.
Outputs Identify gaps, or improvements needed, in provision to improve diet and access to healthy food. NHS Nottinghamshire County to use these recommendations to create an Action Plan for change that will identify which organisations should lead or contribute and what resources may be required.
The Access to Healthy Food Agenda
2.0 Food Poverty 2.1 Healthy Food 2.2 Virtuous Food 2.3 Food Access 2.4 Literature Review 2.5 Accessibility Planning
2.0 Food Poverty Understanding Food Poverty
‘If a household or individual are unable to obtain a nutritionally adequate diet, they are typically considered to be living in food poverty.’ i
The World Health Organisation Food define the opposite of food poverty as ‘food security’, describing food security as, “ When all people, at all times, have access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life”. Individuals living in food insecure households are unable to meet these criteria and are therefore subject to food poverty.ii The NHS advice as to what consitutes such a nutritious diet, NHS Choices, the comprehensive healthcare information service for the public reccomend the folowing advice for a healthy diet: • eat plenty of carbohydrates • eat at least five portions of fruit and vegetables every day • cut down on the amount of fat, sugar and salt in your diet • eat enough vitamins and minerals • drink enough fluids NHS Choices draws together the knowledge and expertise of a number of organisations including NHS Evidence: Health Information Resources, the Information Centre for Health and Social Care and the Care Quality Commission.iii The healthy balance of different food types recommended by the Food standards Agency can be seen in Diagram 1 and it is this advice that has informed the Healthy Food Basket for this research. Understanding Food Poverty Food Poverty and Health The link between poor nutrition and ill-health has long been established. It is estimated that poor nutrition is a contributory factor in one third of all cancers; nearly 30% of deaths from coronary heart disease and 30% of years of life lost due to disability or early deathiv in developed countries. Approximately seventy thousand deaths could be avoided in the UK annually if the public consumed diets that adhered to the nutritional guidelines as set out by the statev as described above and it is estimated that two billion pounds are spent each year within the NHS treating diet related illnesses.vi Improvements in dietary intake would have significant benefits to the health of the population and society as a whole.vii 11
Diagram 1: The Eatwell Plate
2.1 Access to Healthy Food Food poverty is caused by poor access to healthy food. There are a number of interrelated factors that reduce the chances of individuals and communities accessing healthy food which can be brought together under four broad headings, often referred to as the 4 ‘A’s’ of Food access.viii Accessibility Physical accessibility looks at where shops are in a neighborhood and how they can be reached by foot, car, taxi or public transport. For those who do not have access to adequate public or private transport, not being able to get to the shops is a defining factor in their ability to buy healthy affordable food. Issues that direct affect accessibility are: • Economic – whether public transport or car ownership is affordable. • Physical – Whether shops are accessible to people of differing physical abilities. A 20 minute walk to the shops may become inaccessible for people with difficulties in mobility, for example due to age or disability. The journey from the shops to home with heavy shopping bags can also be an issue. • Planning and transport strategies – The frequency and regularity of public transport affects accessibility. The provision of safe walking or cycling routes is also a factor particularly where access to shops has been designed primarily for car users. Defining Physical Accessibility This report has adopted the physical access to healthy food standard developed by Government Office for the West Midlands (GOWM) for use across the West Midlands region and nationally. In September 2009 GOWM commissioned the Department for Health West Midlands to carry out the research in partnership with the Metropolitan Area Accessibility Planning Working Group, the West Midlands Food Policy Group and the Metropolitan Area’s Planning Officers Group. The final report ‘Developing a physical accessibility standard for healthy food in the West Midlands’ix recommended the following standard: Percentage of households within 20 minutes, by walking, cycling or using public transport, of a place where fruit and vegetables are sold. This standard, and the approach used to define it, is an improvement on previous ways of measuring access to food for the following reasons:
Measuring access to ‘healthy’ food i.e. fruit and vegetables rather than simply ‘fresh’ food. It allows for comparisons across and between regions. It captures a wider range of food outlets in order that access solutions are not skewed to promoting travel to large out-of-town outlets at the expense of smaller, community outlets.
14 Local authorities are expected to assign a percentage of households able to access within 20 minutes a place selling fruit and vegetables appropriate to their local area. A travel time of twenty minutes was adopted as this equates to around a one mile walk distance. The evidence for the unit of time is based on wider research, reviewed for this commission, and roughly calibrated for the West Midlands population by the market research results and the multi-agency steering group, which sought to find a balance between the needs of pedestrians and public transport users and people in urban and rural areas. The reports authors expect the accessibility modeling to be used by public health professionals for interrogating public health issues and targeting health promotions. Availability Access to healthy food is reduced if shops do not stock a reasonable range of healthy foods on a regular basis. Just stocking potatoes and onions for example is not sufficient for provision of a healthy diet. Local shops may not stock healthy options, such as fruit and vegetables, due to a shorter shelf life, lower profit, a perceived lack of interest or a shortage of storage options. This in turn may reduce sales and so create a self-reinforcing cycle. Another issue around availability can be the minimum amounts that can be bought of healthy foods. If pack sizes are too large it may discourage smaller households from purchasing those items. Affordability Expenditure on food is the most flexible part of household budgets as the amount spent on food is often whatever is left over when all the essential bills or other financial commitments have been dealt with. When sudden or unexpected costs happen, the amount available to spend on food is reduced. Many people also perceive healthy food (especially fruit and vegetables) to be more expensive and therefore avoid them. In many cases, particularly in convenience stores, this can be the case. Low-income food purchasers may find it easier to guarantee enough calories for their household by buying low cost, high energy foods that store for long periods without perishing. This has been borne out by the Office for National Statistics when investigating consumption of nonmilk extrinsic sugars (NMES). â€˜The percentage of energy from NMES is strongly dependent on income, decreasing as income rises. Households in the lowest 30% income bracket may in some cases derive more than 20% of their energy intake from NMES.â€™x These types of foods, consumed at these levels are detrimental to the consumerâ€™s health. Awareness This factor is very powerful and has often been overlooked in public policy until recent NHS and Food Standards Agency campaigns. Life pressures, an understanding of a healthy a diet and a lack of concern about personal current and future health can all be barriers to accessing a healthy diet. Many individuals lack the knowledge, skills or desire to buy and cook foods from scratch. There is also confusing and contradictory messages about nutrition and healthy foods in the media and from manufacturers. This is compounded by lack of consistently and clarity regarding food labeling. In addition, some people are reluctant to purchase food they are unfamiliar with.
2.2 Virtuous Foods Virtuous foods is a term to cover a number of foods that, although seemingly unrelated, all claim some benefit based around concepts of sustainability. These include economic, social (including health) and environmental benefits that exceed the offers of other similar, but not ‘virtuous’. Proof of the claimed benefit is explained by the manufacturer either through certification and labelling. Some scientific or pseudo-scientific support for the claim may also be mentioned. These claims are described in Table 1. These types of food are becoming increasingly popular thorough sales and media exposure: ‘Advertising and information campaigns can be used to reinforce and propose morals associated with food. People tend to think about ‘good’ or virtuous products when deciding what to acquire.’ Furthermore, ‘Consumers find it easier to add foods that are good for them to their diets than to give up foods that are bad for them.’ xi Sales of these types of food have been rising steadily for a number of years and the pressure to consume them, promoted through advertising and popular dietary advice, is likely to be also increasing. For example, Sales of organic food are three times higher than in 1999 and over 50% higher then five years ago and sales of Freedom Food labeled fresh chicken in UK supermarkets rose from £16.4 million to £71.6 million from March 2009 to March 2010.xii ‘Access to Healthy Food in East Mansfield’ looked at attitudes to these foods and what barriers exist within the study area should households wish to consume them. The ‘virtuous’ foods chosen aim to be representative of those foods commonly on sale in major supermarkets.
16 Table 1: Defining Virtuous Food
Defining Virtuous Food Food Type Claim
Plant Stanol Esters
Organic farming is planet-friendly, has the highest animal welfare standards and ensures the food you eat is nutrient rich. The direct environmental, social and economic costs of food transport are over ÂŁ9 billion each year. Since 1974 the proportion of overexploited and depleted stocks has been increasing while stocks that are underexploited and moderately exploited have been consistently decreasing. Marine Stewardship Council labeled seafood comes from, and can be traced back to, a sustainable fishery. Benecol contains Plant Stanol Ester, which helps block the uptake of cholesterol in the gut. Less cholesterol enters the blood stream. Farmers receive a fair price for their products. Extra income for workers to improve their lives. Greater respect for the environment. Closer link between consumers & producers.
Marine Stewardship Council (MSC)xv
British Medical Journalxvi
The Fairtrade Foundationxvii
2.3 Food Access Literature Review Access to Healthy Food research, sometimes called Food Mapping, has been undertaken in England since at least 1996 when the seminal report on food poverty ‘The Making of Modern Malnutrition: An Overview of Food Poverty in the UK.xviii The review below describes the findings from previous FIG work on the subject as well some innovative or influential work from other organisations. xix FIG Access to Healthy Food Research Barriers to Healthy Food, 2002 FIG, in partnership with the Foundation for Local Food Initiatives, focused particularly on the Sneinton and Eastwood areas in Nottinghamshire to compare urban and rural communities. This study identified: • Barriers can be overcome by supporting existing shops • Living alone and being a working parent can act as barriers to a healthy diet • The benefits of social eating e.g. through lunch clubs • Access to Healthy Food in Ashfield, 2007 FIG, in partnership with Ashfield District Council, developed the Access to Healthy Food research project in Ashfield. This study identified: • ‘Healthy food deserts’ existed in many deprived areas where health is poor • How easy it was to access cheap unhealthy food, again in deprived areas that did not have good access to healthy food • How healthy food is both limited in availability and more expensive in shops located in deprived areas Mapping Access to Healthy Food in Nottingham City, 2008 This work contributed to the Nottinghamshire County Council and Nottingham City Council gaining joint Beacon Status for their work on Improving Accessibility. Research was carried out in partnership with Nottingham City Council’s Transport Strategy Team. The study found: • The most accessible food retail destinations are the supermarkets, by public transport and then by walking. The least accessible destinations are the local shops clusters by foot. • The majority of residential areas within the study area are within a 15-minute walk of a takeaway. • The elderly that have the worst levels of accessibility to healthy shops and supermarkets in terms of journey times. • Most of the stores did not have all the items in the healthy baskets. • Takeaway outlets outnumber had a significant impact on school children.
18 • Healthy ‘shopping baskets’ to be higher priced in local food shops. The conclusions around accessibility and affordability of healthy foods in Aspley are likely to apply to other disadvantaged areas where car ownership is low and there are a limited number of shops with very little competition between them. Other Access to Healthy Food Research Derbyshire Food and Health Needs Assessment, 2009xx • Lone parents and lone pensioners were the main population groups considered to have inadequate access to healthy food outlets. Older adults also had significantly poor access. • A large number of did not have access to private transport and were heavily reliant on public transport, but this was not always seen as an appropriate option. A number of parents with young children reported problems in using this service due to certain buses unsuitable to take pushchairs and a limit on the number of pushchairs allowed at one time. • The weight of groceries was also an important factor for many individuals that impacted on their ability to purchase sufficient amounts of healthy food. • Mobile vans and delivery services were viewed positively in all areas, and this was especially true for older adults. • Increased availability of locally sourced produce in food outlets was seen as an important issue for a large number of the respondents, especially those in the older adult age group. While such produce was available in farmers markets, these did not appeal greatly to some respondents as they were seen as too expensive. • There was a clear need to improve the cooking skills of the local population. • Most people were aware of the types of food that they should be eating as part of a healthy diet, but a large proportion did not feel that they were able to translate this knowledge into practice. Outreach professionals who work with individual families in areas of need identified a number of issues specific to such families. This group were seen to lack even the most basic level of knowledge and skills related to cooking and food hygiene. Healthy eating was not a high priority for some families as other issues took precedence. Most people stated that they had access to sufficient information on healthy eating and what a healthy diet should contain. An exception to this appeared to be when an individual has been diagnosed with a health problem and advised to change their diet accordingly. Most people considered healthy eating to be important. However a few felt that there was an overemphasis on this. Shopping for Food: Accessing healthy affordable food in three areas of Hackney, 2006xxi • Shops within these areas are predominantly run by small independent retailers where fresh fruit and vegetables are widely available. • Healthier options are not accessible in all areas. • Access to healthy food is a problem for some groups. • For some groups, price, affordability and quality of food on offer remains problematic. • Food prices differ depending on the mix of local shops used. • There are wide variations in the prices of healthy food baskets and for some groups, over a one-month period, the difference in price can amount to the price of a weekly shop.
19 • Physical access within shops remains a problem (neither buggy or wheelchair friendly. • Transport is inadequate for many elderly people and young mothers. Retailers in the surveyed areas are not promoting healthy eating messages. Equally, the health campaigners do not appear to be targeting the retailers as purveyors of their messages. Small retailers are an important part of the local economy and regeneration, contributing to local money flows and employment. Small retailers can offer added value in terms of cultural foods, and friendly and accommodating service, some even do home deliveries. Small retailers are struggling in the current retail climate and need support and advice. Mapping the Availability of Healthy Food in Sandwell, 2001xxii •Most residents have poor access to fruit and vegetables. •Most residents live within 500m of a shop selling food. •Most residents live with walking distance of a shop selling cigarettes, chocolate and sweets. •Local shops are struggling to survive and believe that selling fresh fruit and vegetables is too difficult.
2.4 Accessibility Planning Mapping Access to Healthy Food in Nottingham City, 2008 (see above) identified the utility of accessibility planning when addressing access to healthy food barriers. Accessibility planning is an approach largely used by local transport authorities to improve services through development of Accessibility Strategies. However, its core principles are relevant here as a guide making recommendations and formulating an Action Plan based on the findings of this research. Accessibility planning promotes the development of policy and service delivery to better meet the accessibility needs of local communities through an evidence-led approach and improved crosssectoral working. It is a way of working with other organisations to solve local accessibility problems and checking whether people can reach the services they need. These services include employment, education, healthcare, food shopping and leisure facilities. Identifying action to take if these services have poor accessibility is a key feature of the approach. Accessibility planning is not just about transport but about how, when and where key services are delivered. Partnership working with key service providers and other agencies is considered fundamental in order to improve access to these services. This approach will be used when making recommendations based on the findings of this report.xxiii
Choosing Bellamy Road Estate
3.0 Background 3.1 Practical Considerations 3.2 Public Health Factors 3.3 Research Applicability in other Geographical Localities
3.0 Background Diagram 2: Bellamy Road Estateâ€™s position within Mansfield
Bellamy Road Estate is situated on the South Eastern periphery of Mansfield. Built to house the families of the workforce for the local coal mines, the estate is situated close to the now disused collieries. Bellamy road borders green rural land to the south and is close to the new Sherwood Oaks business park development and the area of Berry Hill.
Diagram 3: Bellamy Road Estate and Egmanton Road Shops
Bellamy Road Estate is encircled by Bellamy Road which joins Old Newark Road to the South. The surrounding road clearly delineates the estateâ€™s boundary. The Egmanton Road shops referred to in this study are displayed on the map as the block highlighted in red and have been designed to be at the centremost point inside the estate. From this map Bellamy road can be measured as being about 1.6km around, which is roughly the size of a small village.
Diagram 4: Routes; Legal and Illegal From Bellamy Road Estate to Oaktree Lane Tesco The above map demonstrates the difference in length of routes between the official pedestrian route to Oak Tree Lane Tesco from the centre of Bellamy Road Estate in contrast to an illegal shortcut across waste ground favoured by Bellamy Road residents, which cuts a significant distance off the journey time. Diagram 5: Desire Lines To Tesco This satellite image demonstrates many ‘desire lines’ or informal footpaths made by regular footfall crossing this strip of waste ground (delineated by the light blue bars) between Bellamy Road estate and Oaktree Lane Tesco. For elderly or disabled residents, this means tackling steep verges with heavy shopping. The ‘desire lines’ show that this route is preferred and quicker, but potentially hazardous.
Diagram 6: Mansfield Town Centre and Bus Station The above map shows the outline of the study area of Mansfield Town Centre (blue line). The bus station is shown in red; this is the main point of access for Bellamy Road residents using public transport.
3.1 Practical Considerations The mapping of food outlets and the location of the population that use those outlets can create a number of difficulties for researchers. This can be particularly problematic in urban areas with dense populations over large areas and high concentrations of food outlet clusters in adjacent neighbourhoods. Overcoming the potential problems outlined below was aided by drawing on the ‘Lessons learnt’ section from ‘Mapping Access to Healthy Food in Nottingham City’ as well as discussions with the researchers on that report. This ‘lessons learnt’ section noted that ‘The problems encountered during this study highlight the importance of adequate scoping to identify extent of study and allocation of sufficient resources for the fieldwork elements at the outset.’ Potential problems when choosing a target area Two geographical areas have to be defined: 1. 2.
The target population area The area that the target population will access for food shopping
The shopping area will usually be larger than the population area for two reasons. Firstly, the target population area may not have sufficient (or any) food outlets to support the basic food needs of households. This will therefore necessitate travel. Secondly, there may be sufficient outlets to support food requirements but still a preference to travel by public transport or car to other areas for food shopping. Such preferences may be based on personal taste or proximity of non-food shops to food outlets. Preferred food outlets not in the immediate locality are most likely to be the most easily accessible cluster of shops. Intuitively, this will be the nearest High Street (District Centre or Town Centre) or nearest large supermarket. Defining the area a population shops in can be problematic. In towns and cities the area will be often within a larger urban area. Any line drawn to define a shopping are will be somewhat arbitrary as there may be food outlets just beyond the defined area. This can lead to an unrealistic shopping area. It is only after qualitative consultation has taken place that the actual shopping destinations of a population are revealed. This can result in pressure on the capacity of the research project as the food outlets being investigated may change part way through the project. The potential problems described above were minimised for this report by: i) Choosing a target area that minimised adjacent borders to other residential neighbourhoods and was geographically well defined. The Bellamy Road estate in Mansfield was chosen to largely overcome this problem as the estate borders only one other residential area whilst the other 3 sides are either open countryside or industrial see Diagram 4. ii) Making intuitive common sense assumptions to minimise the need for redefining the target food outlets once the research is underway. It was considered likely that residents of this geographically well-defined estate would shop for food within the estate boundaries, travel to the nearest
27 supermarket or the most accessible shop cluster, in this case the Mansfield Town Centre. The only residential area Bellamy Road estate is adjacent to is Berry Hill a more affluent area without retail outlets of any kind. These assumptions were found to be correct once qualitative research into residents shopping habits were underway. This assumption about shopping habits did have some risks attached (residents shopping elsewhere) but allowed for more reliable planning and budgeting of the project within the limited time-scale.
3.2 Public Health Factors This study has a remit of focusing on areas of poor health outcomes particularly heart disease and obesity. Other indices of deprivation were also taken into account. Mansfield has some of the poorest health outcomes in Nottinghamshire and it is because of this NHS Nottingham County specified Mansfield as a target area for this research. The area the Bellamy Road estate is located in, the Lindhurst ward of East Mansfield, has some of the poorest health outcomes within Mansfield and therefore within Nottinghamshire. East Midlands Health Profile 2009 The health of the East Midlands population is, on the whole, similar to that of the English population though with some significant differences within the region. Life expectancy for men follows this trend but female life expectancy is worse than the national average. However, some health statistics that relate to non-communicable food related diseases are worse than the national average. Rates of diabetes are higher (second highest region in England) and levels of children’s physical activity are lower (though physical activity rates in adults are better than the national average). The East Midlands is the second worse region for adult obesity yet performs much better for childhood obesity. Older people’s health is worse than the national average. A significant non-health indicator is that GCSE achievements are lower than the national average. The East Midlands is a large, diverse county with areas of deprivation and prosperity, large urban areas and expansive rural landscapes. Nottinghamshire has it’s own distinctive identity particularly with the mining heritage in the North of the County where Mansfield is situated. There is a general increase in levels of deprivation from the South to the North of the region though the picture can be highly differentiated locally.xxiv Nottinghamshire County Joint Strategic Needs Assessment Nottinghamshire County has, in line with much of England, a rapidly growing elderly population with estimates suggesting tat by 2020 65 year olds and over will increase by 31% and 85 and older by 39%. Levels of deprivation and poverty have reduced over the last 15 years, though only marginally in Mansfield, but the patterns of deprivation remain the same suggesting no real shift in inequalities between geographical areas of the County. This is reflected in health outcomes with a large gap of 12 years in life expectancy at age 50 and over between the least and most deprived wards. There is also a significant number of the working population with a disability (21%). A quarter of the County’s population have no access to a car and this can, locally, rise to a third. Data showing fruit and vegetable consumption in both adults and children, when mapped, show very similar patterns.
29 21% of the working age population is disabled (East Midlands 19.2% and nationally 18.6%). Estimates suggest that a large proportion of Nottinghamshire residents do not consume the recommended amounts of fruit and vegetables per day. The county as a whole is estimated to have a level of obesity higher than the national average with 1 in 4 adults estimated to be obese. It is common in people aged 45 and over and is worse in deprived populations. Participation in sport and active recreation is lower in Nottinghamshireâ€™s more deprived communities e.g. Mansfield. The county average life expectancy is similar to the national average. However Ashfield and Mansfield have significantly lower life expectancy for both males and females.xxv Joint Strategic Needs Assessment Mansfield Within Nottinghamshire County Mansfield has the highest number of pupils eligible for free school meals but with the second highest and highest gap for those eligible pupils actually eating a school dinner for junior and secondary schools respectively. There is Greater incidence in Mansfield of low birth weight babies a factor associated with greater deprivation. The target of a 2% increase in breastfeeding initiation was exceeded by the County tPCT area in 2006/07 but with major differences with 86% of mothers initiating breastfeeding in Rushcliffe but only 51% in Mansfield. Mansfield has the greatest childhood obesity rates across the County at 15.4 %, a 6% differential with the lowest ward, Rushcliffe. Life expectancy varies according to levels of deprivation at local level. There is a 12 year gap between the best and worst Wards of District/Borough Councils for the 50+ across Nottinghamshire. Rushcliffe District is the best overall; Mansfield District has the worst life expectancy figures. 9.8% of people in the county felt that their general health was not good, rising to over 12% in Mansfield In terms of the overall index rankings, one of Lindhurstâ€™s three constituent Super Output Areas features within the 10% most deprived in England. There is an 8 year gap in life expectancy for men between the fifth most and least deprived areas of Mansfield. Overall, the indicators of health for people living in Mansfield are worse than average when compared with England and the East Midlands. Index of Multiple Deprivation scores in 2004-2007 showed that Mansfield only improved its relative deprivation by 2 places from 32nd to 34th out of 354 districts across the country. This means only 33 districts out of 354 across England are more deprived than Mansfield.xxvi
3.4 Applicability in other Geographical Localities History and media perceptions of the Bellamy Road Estate The Bellamy Road Estate was developed in the 1970s using the Radburn layout to house workers for the nearby mining industry, who arrived as migrant workers chiefly from the North East of England, Scotland and Wales to work in more modern coal mining facilities in Nottinghamshire. Since the pit closures from the mid-1980’s the area has suffered steady economic decline with high structural unemployment often spanning a number of generations. This type of housing can lead to a number of social problems:xxvii • • • •
lack of distinction between public and private space very little defensible space confusing house layouts remote car parking spaces
Efforts to revive the social and economic fortunes of the estate have been hampered by well documented financial mismanagement of funds. There has been local and national media interest on the estate focusing on perceived poor Local Authority involvement, lack of services and high levels of crime and anti-social behaviour. More recently a number of agencies have formed a Bellamy Road stakeholders group and have made significant progress in listening to local needs and acting quickly and decisively on solving local issues. The stakeholders group along with the older and well respected tenants and residents association have also enabled positive outcomes for the estate. Current and planned developments Two new housing schemes are underway in the area. i) Mansfield District Council is building 43 new family-sized dwellings at the Bellamy Road estate. The development is part of the Local Authority New Build programme which is funding councils to build much-needed social housing. Partners are Mansfield District Council Homes and Communities Agency (HCA) Nottingham Community Housing Association-Longhurst Group partnership. Work is expected to complete by towards the end of 2010. The council believes this development will act as a catalyst for the regeneration of the whole estate. It is hoped a masterplanner will be employed for the estate and engage with residents to identify solutions for any problems. This ongoing regeneration aims to provide numerous benefits: • • • • •
Social – creating a community hub and public space will encourage residents to interact with each other and new facilities Economic – by bringing in new investment to the area and providing access to new employment and training opportunities Demographic – by changing the housing market appeal and attracting new residents Environmental – by ensuring homes contribute to reduced carbon emissions Physical – by changing the shape and appearance of the estate and improving access.
31 ii) A group of landowners and developers, the Lindhurst Group, have submitted a planning application for a 23-hectare 1,700 home ‘neighbourhood’ close to A60 and just South of the Bellamy Road estate. The neighbourhood on the Mansfield and Ashfield Regeneration Route (MARR), would be called Lindhurst, would include business units, shops, sports centres and a school. Developers say it could create 4,000 jobs and generate £100m a year for the local economy. If the development goes ahead it could present opportunities for the Bellamy road estate to benefit including from Section 106 (S106) of the Town and Country Planning Act 1990. This allows a local planning authority to enter into a legally-binding agreement or planning obligation with a landowner in association with the granting of planning permission. The obligation is termed a Section 106 Agreement. These agreements are a way of delivering or addressing matters that are necessary to make a development acceptable in planning terms. They are increasingly used to support the provision of services and infrastructure, such as recreational facilities, education and health. Applicability of research to other areas The Bellamy Road estate has a distinctiveness brought about by its economic, social and political history. However, this study believes there are sufficient similarities with other urban areas in Nottinghamshire and subsequently the UK for the findings and recommendations of this report to be applicable. The similarities are: • • • •
Poor health outcomes. High unemployment. High levels of indices of multiple deprivation. Negative local sentiments regarding social isolation and service provision.
Furthermore, a brief review of the findings from previous studies into access to healthy food (Section 2.3) show that areas of high deprivation tend to have poorer access to healthy food due to a combination of the issues outlined previously of accessibility, affordability, awareness and availability.
4.0 Methodology Overview 4.1 Desk Based Research 4.2 Quantative Practical Investigations: Food Mapping, Shopping Basket Survey 4.3 Qualitative Practical Investigations: Questionnaires, Focus Groups
The research team consisted of the FIG Project Officer and three research assistants. Desktop research was carried out to define the research area this was then followed by practical investigations. The practical investigations had two main objectives.
Firstly, researchers investigated the location of food outlets and the availability and pricing of certain foods.
Secondly, researchers investigated attitudes and behaviour relating to food and diet of the residents of the Bellamy Road Estate.
Data was then processed using relevant quantitative or qualitative methods, which formed the basis of the findings.
The findings were then used to inform the discussion and recommendations.
4.1 Desktop Research
Review of health and social data Scoping of public health and social deprivation data, online maps and food licensing data were all investigated to define an area that can be effectively mapped with the resources available and was in line with the commissioning public health remit. Choice of the Bellamy Road estate was then verified as acceptable through communications with the research commissioners and key local stakeholders. The rationale behind this part of the research, data analysed and resulting decision to focus on the Bellamy Road estate is explained in more detail in Section 3.0 above. Food Outlet Mapping Online maps and food licensing data were used to define an intuitive approach to the choice of food outlets to map. This the most likely preferences of food outlets for Bellamy Road estate residents based on accessibility and range of available foods most likely offered and was informed by the review of previous food mapping literature. Licensing data was obtained from Mansfield District Council’s Environmental Health Department in the form of an Excel document. This raw data shows the location and type of food outlets in Mansfield all of which must be registered by law. A sample search based on the Bellamy Road estate postcodes is shown in Table 2 below. This shows only three food outlets on the estate all located in the central and only shopping area of Egmanton Road. A similar procedure was carried out for Mansfield Town centre and areas close to the Bellamy Road estate. Table 2: Food Outlet Mapping Postcode Searched Food Outlet NG18 4NW Bellamy Discount Store Bellamy Road News Bellamy Road Fish Bar
Address 1 Egmanton Road
Outlet Type R02 Grocers
7 Egmanton Road
9 Egmanton Road
Review of previous Food Mapping A review of previous food mapping literature and guides to food mapping research was carried out to assist with methodological design. Further methodological design including adaptation of previous ‘healthy shopping baskets’ and this process is explained further in Table 3 below. Fast food takeaways were not individually mapped but analysed through licensing data to establish their prevalence.
4.2 Quantative Practical Investigations Food Mapping Location and Accessibility of food outlets The desk based research showed the most likely food outlets and areas the residents of the Bellamy road Estate would use. These were:
Egmanton Road cluster on the Bellamy Road estate (nearest shops) Tesco superstore on Oaktree Lane (nearest large supermarket) Mansfield Town centre cluster (large cluster within 20 minutes travel) Other out of town Supermarkets
These food outlets or clusters of food outlets were then investigated regarding their accessibility from Bellamy Road estate and availability of the items in the healthy and â€˜virtuousâ€™ shopping baskets. This was straightforward for the Egmanton Road shops (only 3 food outlets) and the Oaktree Lane Tesco (a single outlet). Other out of town supermarkets were excluded as Tesco provided a reasonable midway sample in terms of price and availability and was therefore used as a typical supermarket in the investigations. This required that only the Oaktree Lane Tesco need be investigated. The Mansfield Town Centre cluster was more complex to investigate with potentially dozens of food outlets. An initial scoping of the town centre by research assistants coupled with interviews with Mansfield district council and food outlet proprietors gave an overview of the types of food outlets present in the Town Centre. This was then verified and backed up by analysis of the Food Licensing data as described above. This investigation revealed a number of types of non-catering (not cafes, restaurants or takeaways) food outlets. These were:
Supermarkets Frozen Food Stores Convenience Stores Independent Outlets (Bakers, Butchers, Delis) Market Stalls
It was not within the capacity of this research to investigate all Mansfield town centre food outlets. Each sample food outlet identified was checked against one or two other similar outlets to ensure the target outlet was not an outlier in terms of price or availability, i.e. it was typical of that food outlet type. Samples of each type of food outlet were then used to conduct the accessibility and shopping basket surveys. The accessibility of the food outlets was assessed by EMPHO using GIS public transport analysis Accession software. Accession is a travel access and travel time mapping package measuring accessibility to and from any point based on current public transport availability including walk times to bus stops.
36 Shopping Basket Survey The healthy shopping basket survey form was developed from previous food access work, in particular ‘Mapping Access to Healthy Food in Nottingham City’. The following changes described in Table 3 were made to arrive at the final form. Both shopping basket forms are shown in Diagram 7: Table 3: Modifications to Shopping Basket Research Basket Items Reason for change Original fro m Previous Used in current FIG research research Specific fruit or veg Use cheapest fruit or Specifying one or two types of fruit items specified veg. or vegetables could exclude some healthy options. For example the two fresh vegetables on the original form are carrots and onions but if there were broccoli and leeks in the shop then should be recorded. Excludes potatoes, as they are part of starch group. Skimmed milk Semi-skimmed or Widening to include semi-skimmed skimmed milk as popular, more widely available and still a low fat option. Cheddar Any non-soft cheese No reason not to include other cheeses e.g. Cheshire & Lancashire. Tinned Tuna Any oily fish but not Canning process removes most of tuna Omega 3 Oils from tuna. This does not occur with other oily fish.xxviii Minced Meat Chicken Mince can be very varied in fat content and labels are often misleading or even wrong.xxix Chicken without skin is lower in fat and contains the mood food Tryptophan.
The following guidance was also given to research assistants as part of their training: If goods cannot always be matched exactly ‘like for like’ to the quantities set out in the survey a level of common sense had to be used to assign prices. FRUIT & VEG Where outlets priced fruit by the individual piece, not by the kilo, apply an ‘average number per kilo’ to generate a per kilo price. Just note down the individual price. ALL PRODUCTS Where the exact weight of pack was not available, a pro-rata pricing would not be automatically applied.
If only smaller pack sizes were sold it was assumed multiple packs were purchased to make up the correct quantity, unless the pack size was only very slightly under the weight specified. If only larger pack sizes were available this was the price recorded as it would not have been possible for a shopper to purchase a smaller quantity and as the price would not decrease in direct proportion to the weight, it would not be accurate to pro-rata the cost down. In smaller independent outlets goods should be bought then shopkeepers engaged about the research. This ‘mystery’ shopper approach overcomes the problem of engaging with shopkeepers without purchasing goods. In larger food outlets the prices were written down but not bought.
Virtuous Shopping baskets All the items in the Healthy Shopping Basket were ‘upgraded’ to a virtuous version of the same item. The ‘upgrades’ were based on a set of virtues attributed to certain foods. These were:
Local Organic Novel Food (food as medicine) Animal Welfare Protecting bio-diversity
The concept of ‘virtuous’ foods is explored further in Section 2.2. A set of labels and training in identification was given to the research assistants. Sizes and weights of items researched were kept the same as the Healthy Shopping Basket as did the advice explained above. Additional guidance given to research assistants is shown in Table 4. Table 4: Virtuous Food advice for research assistants Organic Includes organic certifications UK 1 – 5 LEAF label EU Organic Label Fairtrade Fairtrade Logo and any bananas from Windward Isles Sustainable Fish Marine Stewardship Council – tick logo – is gold standard If not MSC then note any claims to sustainability inc. in house labels, line caught etc, farmed Benecol or similar Any spread that specifically has Plant Stanol or Sterol Esters in them. Not just a claim to be good for heart or lower cholesterol. Chicken with a welfare claim Freedom Foods is the minimum above legal animal welfare standard. Round blue logo. Other standards are above this and should be counted. They include Free Range, Organic,, Compassion in World Farming. Not barn raised.
38 Diagram 7: â€˜Shopping Basketâ€™ Forms used for Quantative Practical Investigations Food outlet/cluster name: Location:
Standard Healthy Basket ITEM
Large wholemeal loaf 500g pack wholemeal pasta 1 kilo potatoes 1 k carrots (or next cheapest non-green veg) 1 k green veg (or next cheapest non carrot veg) 1 k apples (or next cheapest non banana fruit) 1k bananas (or next cheapest non apple fruit) 500g frozen peas (or next cheapest non potato veg) 1 tin tomatoes 1 litre semi-skimmed milk (or skimmed/1%) 500g cheese (not soft) 500g tub sunflower/olive oil spread 500g chicken (frozen or fresh)
185-200g tin/fresh oily fish (not tinned tuna)
Pack weight, price & Price per Kg
Virtuous Healthy Basket ITEM
Large organic wholemeal loaf 500g pack organic wholemeal pasta 1 kilo UK potatoes 1 k organic carrots (or next cheapest UK non-green veg) 1 k UK green veg (or next cheapest UK non carrot veg) 1 k UK apples (or next cheapest UK fruit) 1k Fairtrade bananas 500g organic frozen peas (or organic non potato veg) 1 tin organic tomatoes 1 litre organic semi-skimmed milk (or skimmed/1%) 500g organic cheese (not soft) 500g Benecol or similar spread 500g Freedom Foods or similar chicken (frozen or fresh)
185-200g MSC Certified tin/fresh oily fish (not tinned tuna)
Pack weight, price & Price per Kg
4.3 Qualitative Practical Investigations Food Questionnaires
Questionnaire methodology A questionnaire was used to record and then analyse information regarding access to healthy food on the Bellamy Road estate. The four broad areas the questionnaires sought to gain information about from residents were:
What food was bought, where and why?
What food was eaten, how was it prepared and why?
Views on health, diet and the relationship between the two.
What barriers are there to healthy eating and how could these be overcome?
Questionnaires were used as they represent a low cost methodology with standardised answers that make it simple to compile data. Nominal-polytomous questions were used, where the respondent has more than two unordered options. Answers were mainly by â€˜tick boxâ€™ with occasional written additional information asked for. A total of 43 questions were used and the questionnaire can be seen in Appendix i. The following were applied when designing the questionnaire:
Statements interpreted similarly by members of different subpopulations.
Some use of an "open" answer category after a list of possible answers.
Use of positive statements avoiding negatives or double negatives.
Avoid assumptions about the respondent.
Use clear and comprehensible wording, understandable for all.
Minimise items that contain more than one question per item
There was a target response rate of 10% set. Design The questionnaire design was based on previous access to healthy food research, particularly previous FIG work. Questions regarding local services, virtuous foods and food growing were added. Questions were kept simple and relevant to the area. Respondents were entered into a prize draw to encourage participation.
41 Distribution Questionnaires were inserted into the winter edition of the local paper the â€˜Bellamy Bugleâ€™. This publication goes to every household on the estate, which is approximately 750. Drop off points were positioned around the estate including in the community centre and local shops. The questionnaire was publicised within the Bellamy Bugle explaining the work FIG was conducting (see Appendix ii). Focus Group participants (other than those from Berry Hill) were also asked if they wished to fill in the questionnaire. Limitations of the Research 45 out of 750 households responded which is 6%. This was less than the 10% target. After discussion with the Bellamy Road Stakeholders group and TARA it became clear this was a normal level of participation for any activity on the estate. This suggested high levels of social alienation and negative attitude towards the efficacy in statutory or other official bodies. There were comments from local groups that the Bellamy Road estate had been the target of a number of consultations without apparent positive concrete changes on the estate as a result. Questionnaires were limited by the fact that respondents must be able to read the questions and respond to them. Qualitative work with the focus groups found unexpected levels of literacy problems and this is likely to be representative of the local population as a whole. Whilst hoping to sample resident opinion from across the range of socio-demographic groups, no targets were set or required by the client in terms of specific strata, e.g. age, gender, ethnicity, employment status etc. The socio-demographic profile of the research subjects was therefore dependent willingness to complete and return questionnaires. No questionnaires were asked for or returned from young people under the age of 18 years for the Bellamy Bugle distributed forms. A young male who appeared to restrict other participants from engaging with the research assistants disrupted the young peoples focus group. This was while questionnaires were being completed and as a result all but one questionnaire was incomplete or spoiled. A decision was made not to include the under 18 questionnaires the analysis. The focus group discussion was more effective and relaxed, as the young person in question had voluntarily left for that part of the research. Data Analysis of Questionnaires Microsoft Office Access was used to analyse the data. The program is a pseudo-relational database management system. Focus Groups Focus groups were used to compliment, validate and expand the quantitative and questionnaire research. This method of research was felt to be particularly useful for access to healthy food research due to the personal nature of discussions around diet and health. Quantative research into diet is also often unreliable because of this so a number of research methods are more likely to yield useful results.xxx
‘Focus-group interviews are becoming increasingly popular in health research for exploring what individuals believe or feel as well as why they behave in the way they do. They offer a useful vehicle for involving users in care management and strategy development, needs assessment, participatory planning and evaluation of health promotion and nutrition intervention programmes. The main aim is to understand, and explain, the meanings, beliefs and cultures that influence the feelings, attitudes and behaviours of individuals. It is ideally suited for exploring the complexity surrounding food choice and dietary and other lifestyle behaviours within the context of lived experience, and in ways encourage the participants to engage positively with the process of the research’.xxxi
Cohorts Through discussions with the Bellamy Road Stakeholder and TARA groups a number of Focus group sessions were arranged. Table 5: Cohorts involved as Focus Groups Focus Group Pre-existing group Bingo Yes Bellamy Children's Centre Yes Single Men No YMCA Art Club Yes St Peter’s School Bellamy Rd Yes St Peter’s School Berry Hill Yes
Description Age 50+ Male & Female Young Mothers Group Age 18 - 65 men living alone Age 13 - 18 Male & Female Mothers Bellamy Rd Estate Mothers Berry Hill area
Numbers 8 5 7 3 2 4
All the groups met together regularly expect for the Single Men’s group, which was more difficult to arrange. There was no existing meeting place or group or men on the estate (e.g. no local pub or sports club) and this reflected potential high levels of isolation that this demographic might encounter. Research assistants were given two days training in facilitation and recording techniques and this included role-play to simulate the often chaotic nature of these types of discussion. A number of set questions were used to guide the discussions but more free ranging discussion was encouraged. The focus groups were recorded using a small digital recorder and all participants were asked for their consent. The digital recorder was not made visually obvious during the sessions. No notes were taken during the discussions as this can create a judgmental atmosphere for the participants. Food was provided at all the focus groups which acted as an ‘ice breaker’ and discussion topic. All participants were entered into a prize draw for a healthy food hamper. The research assistants recorded their initial impressions of the group. The recordings were then transcribed. An edited transcript method was used. This method records the essence of a discussion and points made. Individual speakers were not identified but some verbatim comments were transcribed to illustrate or bring to life points made during the sessions.
43 Methodology Lessons Learnt o Research regarding diet, health and food habits for under 18’s did not take into account specific difficulties with this group. No data another than through focus groups was utilised for this cohort. It is suggested future research approaches this group through a school rather than a voluntary after school club. o The instinctive ‘common sense’ method to predict where residents of an area may shop proved effective and made a good use of resources. o The GIS Mapping of travel time to shops found the unofficial route to Tesco challenging. Future research should attempt to establish any unofficial routes to shops early and relay such information to the GIS mapping organisation.
5.0 Quantative Findings: Food Outlet Mapping, Shopping Basket Surveys Findings: Questionnaires, Focus Groups
5.0 Quantative Findings Food Outlet Mapping Summary There is a reasonable physical access to all target food outlets for everyone on the Bellamy Road estate. All travel times are within the West Midlands Standard of 20 minutes except the southern half of the estate, which is within 25 minutes of travel time to the Oaktree Tesco. There is a cost to shopping outside of the estate. Shopping outside the estate would limit the amount of shopping purchased if walking or public transport was used. That limit would depend on physical health and ability. The use of a private car or taxi would increase the amount of shopping that could be purchased outside the estate but would substantially increase the journey costs particularly compared to walking. Local Food Shops (Egmanton Road) Walking Diagram very resident of the Bellamy Road estate, except possibly for those with serious mobility problems, is within 20 minutes walking time of the three food outlets on Egmanton road. This has been deduced from the size of the estate being no more than 500 metres from periphery to Egmanton Road. Oaktree Lane Tesco Public Transport The GIS Mapping in Diagram 8 shows that every resident on the Bellamy Road estate is within 20 minutes travel to the Oaktree Lane Tesco. The number 18 bus runs every 2 hours and it is assumed residents would plan their journey accordingly. The journey costs ÂŁ0.90 return without a bus pass. Walking Research assistants timed the walk to Oaktree Tesco along the main road. Walking travel time between the Bellamy Road estate and Tesco was approximately 20 minutes. This would be longer with shopping bags. The route is along a main road and not designed to ensure safe or pleasant walking. The qualitative research found no residents who used this route.
Diagram 9 shows that walking to the Oaktree Lane Tesco via the unofficial path through the industrial estate takes under 15 minutes. This is quicker than the standard walking route despite being over uneven surfaces. The route is through a gap in the fence behind Acorn Way Industrial Estate. The route appears to have been fenced off recently (and the fence quickly trampled to the ground). The route goes down a sandy bank, behind some industrial units, along Acorn Way, and through a footpath onto Jubilee Way South. Itâ€™s very informal, unsteady underfoot, badly lit, and has been vandalised. Despite this, it appears to be well used. Research assistants counted three
46 people within 15 minutes, all with Tesco carriers. Informal discussions with the walkers revealed they were returning to the Bellamy Road estate. The Oaktree Lane Tesco offers a delivery service and charges for this service (between £3.50 and £6.50 depending on delivery times). No evidence was found of this service being used on the Bellamy Road estate. This service would require a debit or credit card and an Internet connected computer. Other Supermarkets Morrison’s, Sainsbury’s and Asda are all on the periphery of Mansfield, not near the Bellamy road estate and only reasonably accessible by residents using private car or taxi. Journey times from the Bellamy Road estate by car are all under 20 minutes out of rush hours. There is free public transport to Asda but only from Mansfield Town centre. Town Centre Shopping Walking It is not reasonable to expect any residents of Bellamy Road would walk to Mansfield Town centre. A cycle journey would take approximately 25 minutes but no evidence of cycle use for food shopping was found during the research. Public Transport The GIS Mapping in Diagrams 10 and 11 show that the southern half of the estate is within 25 minutes travel time of Mansfield Town centre and the northern half within 20 minutes travel time. All residents are within 500metres of a bus stop that serves Mansfield Town centre. All Mansfield town centre food outlets are within 500 metres of the central bus station where the bus from the Bellamy Road estate terminates. Private Car Mansfield town centre by private car or taxi takes less than 20 minutes outside of rush hours. Private cars would have to pay for parking.
Quantative and qualitative travel time discrepancies There is some discrepancy between the travel times to food outlets described above and actual times reported from the questionnaires. This could be accounted for by: o Waiting for buses o Mobility problems
47 Diagram 8: Travel Time Using Public Transport to Oaktree Lane Tesco from Bellamy Road Estate
The above map shows that the average journey time using public transport to Tesco is between six and ten minutes for the entirety of the estate.
48 Diagram 9: Travel Time Walking to Tesco from Bellamy Road Estate using the unofficial route
This map demonstrates that the majority of residents on Bellamy Road Estate are within six to ten minutes walk away from Tesco, with the exception of those residents living around the Redruth drive area at the most south easterly where journey times walking to Tesco can be between eleven and fifteen minutes. This map suggests that all residents are within twenty minutes of a source to purchase healthy food.
49 Diagram 10: Travel Time using Public Transport to Mansfield Town Centre 1
This map plots the travel time using public transport (bus) from Bellamy Road Estate to the Four Seasons shopping centre in Mansfield town centre on off-peak weekday mornings. This mapping demonstrates that Bellamy Road Estateâ€™s location is closer to the A617 route by road to Mansfield town centre than housing that is geographically more proximate to the town centre, allowing residents a 16-20 minute or 21-25 minute journey time to the Four Seasons shopping centre.
50 Diagram 11: Travel Time using Public Transport to Mansfield Town Centre 2
51 Shopping Basket Surveys Availability of Healthy Food Raw data from the Healthy Food shopping Basket survey of the three target areas is shown in Table 6. The target areas were:
Egmanton Road cluster on the Bellamy Road estate (2 retail food outlets) Tesco superstore on Oaktree Lane Mansfield Town centre cluster (Supermarket, Freezer Shops, Independent Shops including Market Stalls)
This data is summarised in terms of price and availability in Table 7.
Table 6: Healthy Shopping Basket Raw Data Food outlet
Basket Standard Healthy Basket Item Large Wholemeal Loaf 500g pack wholemeal pasta 1kg potatoes 1kg carrots (ONC non-green veg) 1kg green veg (ONC non-carrot veg) 1kg apples (ONC non-banana fruit) 1kg bananas (ONC non-apple fruit) 500g frozen peas 1 tin tomatoes 1litre semi-skimmed milk 500g cheese (not soft) 500g tub sunflower/olive oil spread 500g chicken (frozen or fresh) 185-200g tin/fresh oily fish (not tinned tuna) Total Red Highlight =
Bellamy Rd General Store
£1.19 none none £1.18 £1.70 none none £1.19 £0.39 £0.66 £1.83
£1.19 £1.29 £0.99 £1.00 £5.00 £1.99 £0.59 £1.19 £0.59 £0.86 £1.81 £1.00 £1.39 £1.89
£17.60 £4.98 £13.25 £11.75 single person issue (large packs only available)
£1.00 £0.75 £0.99 £1.82 £1.91 £2.20 £0.39 £0.80 £2.09 £0.58 £2.49 £2.58
none none £0.99 none none none none none £0.58 £0.89 £1.34 none none £1.18
Baby Organic Parisienne carrots, being marketed by M&S are all set to hit the British market at a whopping price of £4.83 per kilo Source: http://www.foodmall.org/entry/marks-spencers-carrot-483-per-kilo
£0.75 £0.70 £1.28 £0.68 £1.68 £0.50 £0.59 £0.79 £0.35 £0.86 £1.20 £1.24 £1.79 £0.84
none £0.73 £0.88 £0.55 £1.10 £1.65 none none none £1.10 none none
52 Table 7: Healthy Shopping Basket Findings Egmanton Road Shops Egmanton Road Shops + Oak Tree Lane Tesco supplement to complete basket Oaktree Lane Tesco Cheapest Town Centre Cheapest Independent + Town Centre
Healthy Basket £15.44 £16.89 £13.25 £12.30 £17.27
Unavailable Items 1 out of 14 None None None None
Egmanton Road Shops These are the most accessible shops and most of the healthy basket shopping items are available if using both food outlets on Egmanton Road. These shops are more expensive than the cheapest town centre and the Oaktree Tesco even without having to buy the unobtainable item (wholemeal pasta) from the Tesco. It is unrealistic to assume a resident would make that journey for a single item. Oaktree Lane Tesco All the healthy basket items are available and the supermarket is cheaper than its geographically nearest competitor, the Egmanton Road shops. It is over £2.00 cheaper than the local shops including the unobtainable item from Egmanton Road. Even with a £0.90 bus fare the Tesco would present better value for money. Mansfield Town Centre Mansfield Town centre offers the cheapest option for buying the entire healthy basket of food. It is over £1.00 cheaper than Tesco and over £3.00 cheaper than the local Egmanton Road shops. To make this saving a shopper would have to pay to get to the town centre and engage in a considerable amount of ‘shopping around’ in different outlets. This may be inconvenient for some residents either because of time or having to carry shopping bags for a long period of time. This with mobility issues or young children may also have difficulty. The low cost of the town centre shops is largely the cause of the very low cost of freezer store foods. If a resident wished to shop only using locally owned food outlets (rather than national or international chains) there would be a considerable increase in costs. It is the most expensive option and nearly £5.00 more costly than the cheapest town centre options. There would also have to be a considerable amount of ‘shopping around’ and not all items are available from independent shops. Just shopping for fresh fruit and vegetables from independent outlets represents good value largely because of the low prices in the open market. As described below, Mansfield Town centre was not a popular option for the Bellamy Road estate residents. Single Person Issue Shopping Basket items that were sold in pack sizes too large for single people to use without a possibility of unnecessary waste were most prevalent in the Egmanton Road shops and Marks & Spencer’s.
53 Availability of ‘Virtuous’ Food Raw data from the Healthy Food shopping Basket survey of the three target areas is shown in Table 8. The target areas were the same as for the Healthy Basket. This data is summarised in terms of price and availability in Table 9. Table 8: ‘Virtuous’ Shopping Basket Raw Data Bellamy Rd
500g pack organic wholemeal pasta 1kg UK potatoes 1kg organic carrots (ONC UK non-green veg) 1kg UK green veg (ONC UK non-carrot veg) 1kg UK apples (ONC UK fruit) 1kg fairtrade bananas 500g organic frozen peas 1 tin organic tomatoes 1litre organic semi-skimmed milk 500g organic cheese (not soft) 500g Benecol or similar spread 500g Freedom Foods or similar chicken (frozen or fresh) 185-200g MSC certified tin/fresh oily fish
none none none none none none none none none none none
none £0.99 none none none none none none none none none
£0.99 £0.99 £1.50 £5.00 £2.29 £1.49 none none £1.03 none none
Total KEY Red Highlight = ONC = or next cheapest
Basket Virtuous' Healthy Basket Item Large Organic Wholemeal Loaf
Bellamy Rd General Store
£0.99 £1.28 £0.96 £1.68 £1.47 £1.29 £1.69 £0.59 £0.95 £1.74 £3.46
none none none none none none £1.49 £0.49 none none none
£0.73 none £0.55 £1.10 none none none none £3.68
single person issue (large packs only available)
Table 9: ‘Virtuous’ Shopping Basket Findings Egmanton Road Shops Egmanton Road Shops + Oak Tree Lane Tesco supplement to complete basket Oaktree Lane Tesco Cheapest Town Centre Cheapest Independent + Town Centre
‘Virtuous’ Basket 0.99 22.06 22.35 18.45 20.39
Unavailable Items 13 out of 14 2 2 2 2
out out out out
of of of of
14 14 14 14
The ‘Virtuous’ Shopping Basket is almost impossible to obtain from the local Egmanton Road shops. The nearest food outlet to obtain nearly all the items is the Oaktree Tesco where it is over
54 £9.00 more expensive than the healthy basket from the same store. The cheapest option to buy all but two items from the ‘Virtuous’ Basket is to shop around in the town centre where it is nearly £6.00 more costly than the cheapest Healthy Basket from the same shopping cluster. No shopping cluster had every item in the ‘Virtuous’ Basket with wholemeal organic items and sustainably sourced fish being the least available items.
5.1 Qualitative Findings _______________________________________________________________________________________________
Demographic Composition of Bellamy Road Estate The Demographic breakdown shown in Diagram 12 demonstrates that just over half of the questionnaire respondents are not from households where any member is in employment. As detailed in the below graph â€˜Respondent Demographic by Ageâ€™ 25% of respondents were retirement age or above, meaning that 30% of respondents were below 60 years old and not economically active. This is above the National Average from April-June 2010 of around 8.0%. This shows that the Bellamy Road estate is an area of high unemployment. There will be a high percentage of households on a low income and differences in costs of any basket of food have a significant impact. About half of the Respondents do not live alone. This has implications for purchasing food and cooking duties within a household. Of the 35% of respondents which live alone, the questionnaire suggests that these individuals are responsible for cooking and purchasing food for themselves. The overwhelming demographic composition of respondents is from the White British ethnic group. This demonstrates that Bellamy road estate is largely ethnically homogenous which in turn has implications for cooking and culture. The majority of respondents live in households without children, though households with children tended to be higher than the national average.
Diagram 12: Demographic Survey of Questionnaire Respondents
57 Gender The majority of questionnaire respondents, almost two thirds, were female. This can be explained by the community group activities on Bellamy Road Estate, which were targeted by this survey, as being predominantly female in their membership e.g. Childrenâ€™s Centres and after school activities. However, questionnaire returns through the local community newspaper also showed a higher female response. An explanation might be that females are generally been more likely to participate in community consultations. This suggestion was reinforced when it was found difficult to organise and create interest for an exclusively male focus group.
Diagram 13: Gender Bias in Questionnaire Respondents Gender Bias In Questionnaire Respondents
Diagram 14: Gender Bias in Bugle Questionnaire Respondents Gender Bias In Bugle Questionnaire Respondents
Male 43% Female 57%
Diagram 15: Respondent Demographic by Age
Respondent Demographic by age 12 10 8 6
4 2 0 18-29
59 Error!Error! Health and the Bellamy Road Estate
Diagram 16: Percentage of Respondents with Health Problems
The majority of respondents have self identified as having health issues. Diagram 17: Respondents with Self Identified Health Issues Respondents With Self Identified Health Issues 18 16 14 12 10 8 6 4 2 0 Diabetes
Amongst the self identified health issues, eight respondents suffered from diabetes, seven respondents heart disease, but a total of nine respondents suffered from two or more health concerns. These health issues ranged across all study groups and were not exclusive to one group.
60 Three of the respondents identified themselves as having mental health problems. This graph depicts individual health issues from across the sample of 42 responses including those who indicated more than one response to the question. The two single health problems with the highest responses, diabetes and heart disease, can be both caused and exacerbated by poor diet. Diagram 18: Do Your Think Your Diet Is Healthy?
Most people considered their diets to be ‘Fairly Healthy’. This response appears to conflict with the high levels of poor health in the area and amongst the respondents. Tables 10 show that there is a good understanding of the links between health and diet and what constitutes a healthy diet. Given the rates of non-communicable food related diseases this is surprising. This subjective view of healthy food shows that education may still be a factor in supporting healthy diets. Nearly a quarter of respondents thought they ate unhealthy diets or didn’t know. This suggests support is need but shows an awareness of their situation an important precursor to changing behaviour. Table 10: Identifying A Healthy Diet Mansfield Access to Healthy Food- FIG Questionnaire How would you briefly describe a healthy diet
How would you briefly describe an unhealthy diet?
Lots of pasta, fibre, fruit and veg
Lots of fatty, sweet stuff, chips
Lots of pasta, fibre, fruit and veg
Lots of fatty, sweet stuff, chips
A mix of everything
A lot of takeaways, chocolate
Fruit, veg, daily intake
Fruit, veg, pasta
Too many curries and other takeaways
Salads and veg
Chips and chocolate
Fresh veg, also some fruit
Chips and takeaways
Fruit and veg
Sweet meals Fats
Porridge, Jacket Potato, Meat, Veg & Potato, Fruit
Fresh fruit, veg, salads
Chocolate, Burgers, Crisps
Fresh local veg, nice hearty meals
Bingeing on snacks and fatty foods with no exercise
Eating fish, veg and fruit
eating fatty foods - like chips, crisps etc
Low fat, low sugar, fresh ingredients
High fat, sugar, salt
less salt and sugar
loads of fat
Plenty fruit, veg Pasta and Dishes
Stodgy foods, cakes crisps biscuits
61 Mansfield Access to Healthy Food- FIG Questionnaire How would you briefly describe a healthy diet
How would you briefly describe an unhealthy diet?
Combination of fruit & veg, meat/fish/dairy/pasta/dry ingredients
Lack of fruit/veg, takeaways, processed food, prepared meals
Eating Fresh Fruit and Veg everyday, home cooked food, limiting fatty and sugary food/drink
Too much Fat, Salt, Sugar- ready meals/convenience foods
Fresh Fruit & Veg, Fish
Low Fat, Low Calorie
High Fat, Calorie, Sugar
Fresh foods, good range of food
Ready Meals, regular takeaway
Balanced, Low Fat, Fresh Food, Low sugar
Current Diet and Lifestyle
Fresh Fruit, Veg, Meat
Takeaways, Ready Meals
Protein, Carbs, Veg
Takeaways, Lazy food
Fruit & Veg
Chocolate, Fast Food
Fruit & Veg, Meat
Alcohol, Fat, Sugar, Carbs
Fruit, Low Fat
Takeaways, snacks fizzy drinks, Alcohol
Too much processed food
Balanced, Home Cooked
Too much Salt, Fat Sugar etc.
Mixed Food, Pulses, Fruit, Veg, Meat, Fish
Junk food, fatty food, lack of variety
62 Household Providers: Who Shops? Who Cooks? Diagrams 19 and 20 illustrate that the overall majority of respondents are both the sole shoppers and cooks for the household. This exceeds the 35% who live in single person households by almost double, suggesting it is more characteristic for Bellamy Road estate residents to have a designated household provider who is responsible for both shopping for food and preparing food as opposed to households who share these duties in some way. This validates the responses in the questionnaire as the vast majority of respondents have a significant degree of input into the duties of shopping and preparing food. There were no instances where the respondentsâ€™ partners took on the role of primary provider. This validates the responses in the questionnaire as respondents Diagram 19: Household Providers who Shops Who Cooks?
63 Diagram 20: Primary Provider or Shared Duty Shopping and Cooking
Primary Provider or Shared Duty: Shopping and Cooking
Primary Provider 69%
64 Error!Error! Food Shopping
Diagram 21: Where do you mostly shop? Where Do You Mostly Shop? 35 30 25 20 15 10 5 0 Local Egmanton Road Shops
Oak Tree Tesco
Other Town Centre Freezer Store Open Market Supermarket
By a significant margin, the Oaktree Lane Tesco is the primary location residents on Bellamy Road estate buy their food. Other supermarkets and the local Egmanton Road shops are also popular. Few respondents use Mansfield Town centre other than to shop at the occasional open market. Diagrams 22 and 23 show the majority of respondents to this survey do not require or have access to a private vehicle when going food shopping. Private vehicles are the single most common form of travel to the shops. Not one respondent primarily used taxis as a mode of transport, and only used taxis in conjunction with walking or using public transport.
65 Diagram 22: How do you usually get to the shops? How Do You Get To The Shops?
Public Transport, Walk, Other 68%
Diagram 23: How Do You Get To The Shops? How Do You Get To The Shops? 20 18 16 14 12 10 8 6 4 2 0 Car
Combination of non-car Transport
66 Diagram 24: How long does it take you to get to the shops? Travel Time to Shops 60 minutes plus 4% 19% 20 - 60 minutes
Under 20 minutes
As shown in the EMPHO Mapping, it should take residents of Bellamy Road Estate no more than 20 minutes to any of the food outlets described in this research except for public transport to the Mansfield town centre which may take up to 25 minutes for half the estate. A significant number of respondents take more than 20 minutes to travel to their desired food outlet. Some of this may be the longer time it takes for some if the estate to get to the town centre though a small percentage of respondents takes more than an hour. These results suggest the GIS data does not wholly represent the experiential realities for day-to-day food purchasing of the questionnaire respondents. This may be due to mobility problems or unreliable public transport services.
67 Diagrams 25 and 26 show the vast majority of respondents do not find it difficult getting to the shops. However a significant 13% did find it difficult to access a food retailer. This could be explained by health problems or travelling with young children. A greater percentage of respondents found it difficult returning from the shops. 5% of respondents found it harder to return with shopping than to access the food retailer, the reasons for this largely centred on the difficulty of carrying heavy shopping. One respondent also cited health problems as reason for increased difficulty. Diagram 25: Is Accessing or Using A Preferred Food Retailer a problem?
Is Getting To Or Using The Shops A Problem?
68 Diagram 26: Is Getting Back From The Shops A Problem? Is Getting Back From The Shops A Problem?
69 Diagrams 27 and 28 show that value for money is the primary rationale behind respondentâ€™s desired food retailer. Quality is the least common factor. There is no major over-riding factor as most respondents picked two or more criteria for their desired food retailer. This showed shoppers were balancing economic and quality choices when foods shopping. Other responses included loyalty points and quietness of the supermarket as desirable factors. The majority of respondents supplement their food purchasing with food sourced from local shops, however about a third do not utilise local shops to top up food from. Diagram 27: Why do you shop where you shop?
Rationale behind Desired Food Retailer 20 18 16 14 12 10 8 6 4 2 0 Quality
Value For Money
Diagram 28: Do you top up food from local shops? Do You Top Up From Local Shops?
Rarely or Never 33%
70 Diagram 29 shows the reasons respondents were reluctant to use Bellamy Road Shops. Price is the most evident. Choice and Quality also feature as factors deterring potential customers. Distance and access also had a significant response, which was surprising considering the location of the shops. Diagram 30 explains what would encourage residents of the estate to purchase more fresh fruit and vegetables locally. Price, range and quantity were key reasons which corresponds with replies shown in Diagram 29 describing why these shops were not used. Diagram 29: If You Never Use Egmanton Road Shops on Bellamy Road Estate, Why Not?
If You Never Use Bellamy Road Shops, Why Not 10 9 8 7 6 5 4 3 2 1 0
Fear of Crime
Distance & Access
71 Diagram 30: What would help you buy more fruit and Veg from Egmanton Road Shops? What Would Help You Buy More Fruit & Veg From Local Egmanton Road Shops on Bellamy Road Estate? 18 16 14 12 10 8 6 4 2 0 More To Buy
Not Interested in buying Fruit and Veg
Diagram 31 shows a strong desire for ‘Better Local Shops’ and a lesser but significant desire for ‘Better Public Transport Access’.
Diagram 31: What Would Make Shopping Easier? What Would Make Shopping Easier? 35 30 25 20 15 10 5 0 Better Local Shops
Better Public Transport Access
Help with Access
72 Diagram 32: Are You Able To Purchase The Food You Want?
Overall, the respondents had access to a desired range, quantity and quality of purchased food items. Between five and ten respondents per question were unhappy with the range, quantity and quality of purchased food.
73 Diagram 33: Would You Buy Different Foods If You Had More Money To Spend on Shopping? Would You Buy Different Foods If You Had More Money To Spend on Shopping?
Two thirds of the respondents would agree that given the economic opportunity they would have differing food purchasing norms. This appears to contradict the largely positive response to the question â€˜Are You Able To Purchase The Food You Want?â€™ above.
74 Error!Error! Cooking
Diagram 34: What type of cooking do you do?
What Type Of Cooking Do You Do? 35 30 25 20 15 10 5 0 Sandwiches, snacks and other cold food
Heating up ready meals, tins etc
Food Assembly-tins, microwave,premade
Food from scratch with fresh ingredients
Don't really cook
Respondents could offer more than one answer to this question. Over 70% of respondents agreed that they cooked food from scratch with fresh and around 30% were unable to prepare food in this way.
Diagram 35 explains that the nine respondents that stated that no-one in their household cooked from scratch using fresh ingredients, the reasons given were a combination of lifestyle choice and a general feeling in single person households that cooking for one was perhaps a waste of ingredients and energy. This was often described as â€˜no point cooking for oneâ€™. This question illustrates that single person households are more likely to rely on food that is not prepared from fresh ingredients and may rely on fast or convenience foods more. Lack of confidence and cooking skills taken together show that education can play a major role in encouraging healthier eating from fresh foods. Time is also a significant factor in not cooking from scratch and it is assumed those who responded in this way will already have some cooking skills.
Diagram 35: If You Do Not Cook Using Fresh Ingredients, Why Not?
Diagram 36: Where are Most of Your Meals Prepared?
o o o
83% of all meals prepared for the consumption of respondents are prepared at home. 10% of respondents eat meals from outside the home in their dietary routine. However, the second largest singular group were those that skipped one of the three meals (breakfast, lunch, and evening meal).
The vast majority of respondents prepared food at home for their evening meal whether from scratch or otherwise. Only one respondent stated that they most likely purchased food from a takeaway. Two respondents stated that they rarely eat evening meals.
77 Diagrams 37, 38 and 39 describe how skilled respondents were at cooking and the desire to learn cooking skills. The majority of respondents are very confident to prepare a meal from scratch from fresh ingredients. The overall majority of respondents had a desire to learn better cooking skills. The largest singular group were those who had confidence in cooking but wanted to learn better skills. There was a lack of desire to learn cooking skills from those with few or no confidence already and this may be an issue regarding more general confidence. Learning skills in preparing world cuisine was often mentioned in responses for those with existing cooking confidence but willingness to learn. In response to “If a cooking course was offered locally would you go?” 74% of respondents answered ‘Yes’ or ‘Yes if Free’, 20% were disinterested and the remainder were undecided or not sure. This data shows a greater desire of respondents to learn cooking skills than from previous questions. This shows that when presented with the choice of attending a free cooking class respondents were more inclined to reassess their own desire to learn new skills.
Diagram 37: Acquiring Cooking Skills: Respondents who want to learn new cooking skills
Diagram 38: Respondents attitude toward learning better cooking skills
Diagram 39: Acquiring Cooking Skills: cooking course attitude
79 Error!Error! Food Safety
20% of respondents state they never check food safety labels. Diagram 40: Do You Check Safety Labels on Food? Do You Check Safety Labels on Food?
80 Error!Error! Local Food Initiatives
Diagram 41: Would You Use a Good Quality, Healthy, Affordable Local CafĂŠ?
Diagram 42: Would You Be Interested In Using a Local Community Allotment?
58 Would you be interested in using a local community Allotment
No Series1 Yes
There was ambivalence about the desire for the two food initiatives mentioned above. A previous community cafe and allotment had proved popular in the past in the estate.
82 ‘Virtuous’ Food Diagram 43 focuses on a strand of investigation detailing opinion of what we can deem ‘virtuous food’ which is foodstuffs with some wider benefit to the environment, society or personal health. The categories were: Virtuous 1. Organic Produce 2. Free Range Produce 3. Fair-trade Products Healthy 4. Products containing Benecol/Plant Esters 5. Products containing Omega 3 Oils For those who didn’t buy any of the above ‘virtuous’ food products, expense was a major factor.
Diagram 43: Purchasing Virtuous Food
Focus Groups Summary Below is an overview of all Bellamy Road Focus Group observations excluding the St Peter’s School Berry Hill, which is used for comparator purposes only. All the groups are described above in Table 5. Any themes, similarities, differences or comments of interest have been noted. This helps us understand attitudes and behaviours regarding food on the estate. The analysis has been interspersed with verbatim quotations to illustrate observations. The observations have been arranged under the following groupings: o All Bellamy Road Estate focus groups o Individual Bellamy Road Estate focus groups o Bellamy Road Estate and St Peter’s School Berry Hill focus groups Within each grouping observations have been arranged under the following headings: • • • •
Favourite Foods/Best Food Memory Cooking Ability and Cookery Lessons Availability of Healthy Food Barriers to healthy food
Key observations All the groups are critical of the healthy food on offer from the local Egmanton Road shops i.e. too expensive and poor quality. Favourite foods, and best food memories, are similar across all groups. Traditional British meals such as stews and casseroles are most often mentioned. The notable exception is in the (more affluent) St Peter’s School Berry Hill group, which add international foods. Participants seem aware of the issues around eating healthily, although there is confusion about how to effectively address these in their own eating habits. Each group was unsure of exactly what they should be eating reflecting confusion about current health messages. Cooking ability varies within the groups. Older residents tend to be the most confident and active. Single men very rarely cook for a variety of reasons, not always due to lack of skills. Berry Hill residents are very confident in their cooking ability and were the most keen to express this. There is a general view that cooking skills are being lost and that is a negative development. Most of the participants use supermarkets to get their food but are aware that this can be inconvenient without a car.
84 Most groups also mention at least one less usual source of food including farm shops & food from allotments. Some recall a mobile shop going round the estate selling farm produce. Aspirations and knowledge regarding healthy eating were similar with the Berry Hill and Bellamy Road groups but barriers (economic and physical access) for the Bellamy Rd group prevented these aspirations being realised. Price and physical access Time was an issue with regard to shopping and cooking regardless of employment status or family size. Food as culture (sharing, cooking for pleasure) was not mentioned except as a memory All Bellamy Road Estate focus groups Favourite Foods/Best Food Memory. All five Bellamy Road estate focus groups gave similar answers to this question: the vast majority of respondents listed traditional foods as the favourites, such as stews, casseroles and roast dinners. The participants identified these types of meals as 'old-fashioned' and they represented between 62% and 80% of favourite foods/best food memory. Favourite foods were often linked, to food cooked by mothers and grandmothers: 'All the things my Mum made' Bellamy Children's Centre 'Mum cooking in the oven by the fire, can almost taste it now', Bingo group
'Rice pudding, Grandma's rice pudding - I don't know how to make it - can remember the taste, the skin on top was glorious. Tinned is not the same'.
One respondent, in the Single Men's group, commented that they remembered 'cooking as a family tradition - all the family got involved, and made everything, rather than A minority in each group (normally just one person) listed fast food as a favourite: chips, pizza or curries. In the Bingo group, some participants also listed yoghurt, melon and chocolate as favourites. Cooking Ability and Cookery Lessons Responses, and levels of confidence, differed between groups, with the older focus group the most confident. The source of cookery skills, where they existed, was consistent, however, mostly
85 coming from people’s mothers, grandmothers and occasionally school. There was general consensus that school cookery tuition was patchy for the generations interviewed, and very poor for current pupils. 'I think cooking lessons at school can be unrealistic - my son was asked to make a salad. I didn't send the ingredients, as this is preparation, not cooking, and not what families would eat'. Availability of Healthy Food All the focus groups consistently agreed that the Egmanton Road shops are poor for fresh food. 'I avoid estate shops if possible as I’m very critical of freshness'. Bellamy Children's Centre
'Don't buy veg on Bellamy Road estate - I cut through the middle of an onion, and it was all black'
'The shop on the estate is not good, have to got to Tesco' Bingo Group
There's also the feeling that the estate shops are more expensive than supermarkets: ‘It's expensive, 70p for a can of garden peas, 24p in Tesco.' Bellamy Children's Centre
Most people get their food from the big supermarkets such as the Oaktree Tesco and generally do one shop a week, to save time. Two of the focus groups (the Bingo group and the Bellamy Children's Centre group) also mention the availability of farm shops: at Clipstone, and at Edingley, which are seen as stocking: 'Lovely fresh veg, much cheaper'… But which the respondents admit require a car to get there. All focus groups also mention the market, but with varying attitudes, which will be discussed in the next section. Barriers to healthy food Again, all groups listed the paucity of local shops as a major stumbling block. 'The local shop is hopeless - got to go away from Bellamy Road if you want fresh vegetables' Bingo 'Fruit and veg in shop is horrible.' Single Men
86 Bingo Group Participants seemed to have a high level of confidence in their cooking ability and emphasised that they mainly learnt from relatives 'School cooking lessons were not good'. They also mentioned that, for their generation, during periods of austerity and rationing, cooking was a key skill so they didn't like to waste food. 'We were brought up learning cookery when food was on ration' In terms of getting healthy food, most of the group tended to use the supermarkets. Some of the group tended to shop every day, for freshness and efficiency (not throwing away waste food) while others stated that this is an expensive way to shop. Some participants had access to food grown on allotments, which they praised for freshness and taste. Other respondents stated a preference for food from the market, though the quality of the market was disputed, with some stating that it has gone downhill due to a lack of competition. 'Mansfield market has gone downhill - not same competition' 'The indoor market had rows of fishmongers and butchers, closed to renovate, and then never re-opened. Now a car park'. The group had some interesting views about changing food standards. Many people stated that animals didn't taste the same as in their youth: 'Things aren't reared the same way' 'Chickens were out in a field, not cooped up'
This generation is able to remember smaller, localised food distribution methods including a van that used to come round the estate every week from the local farms. This group also brought up some interesting thoughts about organic food generally believing it to be a ‘con’ or faddish: 'Wouldn't touch organic - it's overpriced, all from fields, it's not supposed to have pesticides, but you need pesticides to kill off the bugs. If you don't kill them, they eat what you've got'. This may seem to clash somewhat with the group’s suspicions of modern, industrially farmed meat, and their nostalgia for more self-sufficient childhoods despite the era of large scale pesticide use starting in the 1940’s.
87 Bellamy Children's Centre Some of the Surestart participants expressed confidence in their ability to cook healthily: 'I was taught by Mum, pick up recipes from friends...Will always have a go, even if it doesn't always turn out perfectly'. However, others were less confident, listing themselves as self-taught, or reliant on school tuition, which they pointed out was 'patchy'. Time was given as a barrier to eating healthily. Respondents were aware of how they and their children should be eating, but felt they hadnâ€™t the time to enable this: 'It's time - kids have a good meal every night, but mine's grab a packet of crisps or a sandwich. I eat on the go, I haven't got time'. Another barrier to healthy eating is freshness of food. Time usually limited shopping at the supermarket to once a week, so keeping food fresh was considered a big problem. The group identified a number of other sources of fresh food, other than the supermarkets including relying on relatives. 'Father in law lives in Lincoln, so gets a sack of potatoes when he comes to visit'.
Single Menâ€™s Group The Single Men Group seemed much less confident in their cooking skills and were aware that their diets were unhealthy. Many stated that they didn't cook at all: instead, ate soup, microwave meals and takeaways. One respondent revealed that he only ate a proper meal twice a week, Thursdays and Sundays at the community centre. Most of the time, he ate toast at lunch and soup in the evening. A few seemed more confident, and prepared fresh food at weekends, enough to last a few days reheated. Time was the main reason given despite some of the group not being in paid work (though some were heavily involved in non-paid activities). 'My cat eats better meals than I do, he gets chicken everyday'. In this group the majority used supermarkets to find healthy food usually Tesco. However, price was a bigger issue than freshness: 'I shop around for the cheapest food'
88 There was repeated and forceful comment on the frustrations of cooking for one. Oversized packets and portion sizes as well as the frustration of having to walk all the way to Tesco for a small amount of fresh veg: 'Packet sizes are wrong for single people, and Buy One Get One Free are no use at all'
'Don't want large quantities - embarrassing to ask for one carrot' They found waste frustrating: 'I hate waste; I was brought up that way. Now it's a throwaway society. I'm forced to waste food'. Time for eating also seemed to be an issue for this group. One participant summed it up: 'Sometimes sandwiches or something quick. Binge eat, eat junk food and rubbish because I don't have time - when I get home from work, I just want to relax'.
Cooking food wasn’t perceived as a relaxing or creative activity for this group.
YMCA Art Club
The young people in the group were split in their favourite food. Half favoured traditional foods, such as Sunday dinner, stew and dumplings and bacon sandwiches and the other half listed chocolate, McDonald’s and desserts. The group had varying experiences of learning to cook at school. Some had specialist lessons, working towards qualifications like BTECS. Others had less satisfying experiences of school cookery, and had been taught at their hostel accommodation or at home. The group seemed aware of healthy food. Some stated they were interested in eating healthy because of being interested in sport. However, the awareness of healthy eating didn’t always translate into reality for others: 'I have 10 packets of crisps and biscuits, but I do eat healthily because I have lots of fruit'. In terms of access, the group states that they get most of their food, including healthy options, from Tesco. They feel that local shops are too expensive. They had no issues with availability on the Egmanton Road shops, just cost.
89 Contrasting Bellamy Road Estate and Berry Hill focus groups St Peterâ€™s School - Berry Hill
Favourite Foods In terms of favourite foods and food memories, the Berry Hill parents also list traditional foods 'As a family, the meal we all enjoy is a chicken roast dinner'
'When I first started work, I used to go to my grandma's house for lunch and we had a set cooked meal for each day'
However, participants supplement these traditional meals with more cosmopolitan, ethnic cuisines: 'Spicy food, chilli-con-carne, homemade curries, Italian pastas'
Cookery Skills Participants in this group also were much more confident in their cookery skills than in the Bellamy Road focus groups. Most claim to be self-taught, and seem to be very proud of this fact. The consensus is that their school cookery lessons were very positive. 'Very confident cooking, love it, trying new things, nothing from books, sometimes follow a recipe and then improve it'
'I'm self taught, I like to push boundaries with what you can do, and cook everything from scratch'
'My mum worked evenings and my Dad only cooked beans on toast and omelettes...so I started cooking from there. I did A level Home Economics and entered Junior Masterchef Interest in Healthy Food Members of the group all agree that they try to eat healthily. There was a high awareness of healthy eating issues here, and a pride in the eating habits of their children, to the point of worrying about the impact of eating healthily:
90 'Our kids eat as healthy as they possibly can: not much chocolate, no added sugar, don't eat sweets, eat plenty of fruit. And then, when my son went to the dentist, he had cavities caused by fruit acid!'
'My two children have what they want more or less when they want it, and always eat their meals, never had any problems. They tend to choose fruit and vegetables, never been an issue with just the occasional lapse.' Access to Healthy Food In terms of access mainly use supermarkets, as these are convenient often on the way home from work. However, they differ from the Bellamy Road participants in the positive view they have of the open market. Other focus groups had been ambivalent or critical of the Mansfield Town centre open market. 'Mansfield town centre market is fantastic. Quality at market is better, it's fresher'.
A marked difference is this groups preference for farm and independent shops over the convenience of supermarkets:
'There has been a call for better local shops over the last few years. A while ago supermarkets were taking over the world, local shops were non-existent, and you certainly couldn't buy fresh food. Now that has changed.'
This group views the buying and cooking of food as an aspirational, enjoyable activity. St Peterâ€™s School - Bellamy Rd Issues of Concern This group found more barriers to healthy food. Cost was often a significant barrier: 'The Healthy Start vouchers just stopped without warning when my daughter was 4 and that ÂŁ12.40 per month makes a difference to me. I just can't afford the fruit and vegetables that I used to buy.'
Healthy Start is a government scheme that provides free milk, fresh fruit and vegetables, infant formula, and vitamins to certain low-income women who are pregnant or have children under for
91 years old. Favourite Foods/Food Memories Ideal foods were similar to the Berry Hill group. with a high emphasis on family cooking sometimes supplemented with more international cuisine. 'Mum's Sunday Roast. My Mum was a fantastic cook , I do miss it, roasts, stews, soupsâ€™
'The smell of bacon sandwich. Italian - pasta or pizza. Pork Pie with mustard, olives, hummus'. Cooking and Confidence This group was critical of school cookery lessons: 'We had good lessons at school. I don't think food technology lessons are very good now. They are asked to take ingredients in ready prepared, eg for a pasta salad they had to take in cooked pasta and prepared vegetables. I worry that that's not actually teaching children how to cook. If parents can't cook, they won't learn how to do it.'
Access to Healthy Food Like most participants in all the Bellamy Road estate groups, this group confirms that most of their shopping is done at supermarkets: 'Best places are Tesco, Morrisonâ€™s and Asda, usually shop at Tesco usually walk there sometimes walk back if not too much shopping. ' However, they also state that transport is an issue if you haven't got a car.
'I've got a car, tend to go to Tesco, but do use other supermarkets. I do not use the shops on Bellamy Road at all, it's more convenient to shop at supermarket with a car.'
'The buses are not very good; one per hour to Tesco and 2 per hour to town.'
92 Respondents recall a time when some food was grown in the local area. 'The allotments have gone, there used to be a shop for produce. A local farmer used to bring a van around but he stopped.' In contrast to the Berry Hill group, this group is critical of the market, criticising the amount of stalls selling fresh food. The open market in the town centre was not seen as a place to engage in regular food shopping.
6 Discussion The Bellamy Road estate is both geographically, architecturally and socially isolated. The desire for a GP practice on the estate was mentioned frequently and along with other services, employment and social facilities came up unprompted in discussions. These issues were considered contributing to and often more important than issues regarding diet and health. This isolation has also become apparent in its’ residents access to healthy foods. Current housing plans as well as social and economic initiatives to relieve this isolation present an ideal opportunity to address these issues of poor access to healthy foods. This poor access is best summed up by using the four ‘A’s’ used to describe food access of Accessibility, Availability, Affordability and Awareness. This study has resulted in findings that suggest that another category, related to awareness should be added. That is Motivation or Attitude Accessibility Everyone on the Bellamy road estate is within the 20 minute (West Midlands standard) travel to an outlet that sells fresh fruit and vegetables. However, the price, range and quality of the produce on offer means residents never, rarely or reluctantly use outlets on the estate. These local shops stock most of the healthy food basket but price is a major barrier. Any resident with a car has good accessibility to reasonably priced healthy foods either from supermarkets or Mansfield Town centre. Those relying on public transport or walking have greater access problems due to infrequency of public transport or the problem of walking to, and especially back from, the local Tesco. The town centre is less used and the local Tesco is the preferred option so much so that residents have created an informal, even illegal, route to the supermarket. Availability The Egmanton Road shops have most of the items in the healthy basket though it is clear that the fresh fruit and vegetables are of unacceptable quality and of a range so limited as to stop utilisation of those outlets. The local Tesco has all the items in the healthy food basket as does the Mansfield Town centre cluster. The local Tesco is still preferred regarding availability but the Town Centre is preferred for fresh produce from the open market. This suggests that local, fresh produce is desirable and residents are willing to travel or otherwise bear some cost to buy it. Tesco and the town centre are the only reasonable places to buy ‘virtuous’ foods. Affordability Shopping for healthy food at the local shops is considerably more expensive than the local Tesco even accounting for travel costs. The cheapest option is Mansfield town centre using a variety of outlets including freezer shops and the open market. Many residents still use the Egmanton Road shops suggesting accessibility often overrides affordability. This will be particularly true for those not wishing to walk long distances with shopping bags. Deciding to ‘upgrade’ to buy arrange of virtuous foods is very expensive to the point of unobtainable. It is likely, however, that residents wishing to buy ‘virtuous’ foods will choose one or
94 two items rather than a whole basket. Tesco is the most affordable outlet for all foods when combined with accessibility and this is reflected in its popularity as a preferred outlet. Awareness Residents seem largely aware of what constitutes a healthy diet and the consequences of following or not following such eating habits. This is no different to the more affluent residents of Berry Hill. However, price is the main barrier followed by time and motivation. Attitude/Motivation Most residents shop to cook at home even if not necessarily from scratch and would welcome better quality, more affordable and a wider range of healthy foods available on the estate. Cooking skills vary and those with some skills are most likely to take up lessons suggesting that to reach those without skills would require explaining the benefits, including cultural, of cooking. Food culture was rarely mentioned except in the context of good food memories and favourite foods. Many skilled cooks didn’t use their skills because they felt there was little point and this was particularly evident in men who lived alone. In contrast the Berry Hill group discussed food as culture. Time was the main barrier to cooking for mothers. This suggests cooking advice that is offers quick and easy recipes would be welcome. It may be worth exploring the cultural and communal aspects of food as a way to promote healthy diets as this may help counteract low motivation towards cooking and diet. Other issues The concept of virtuous foods is of interest to residents and some attempt to apply this ethical or health stance to their shopping behaviour but the costs are often prohibitive. This along with mentions of confusing health messages may create anxiety around issues of food about eating ‘well’ and not having the resources to do so. There is small but significant numbers of respondents, who skip meals, aren’t interested in healthy eating and have no desire to do so. This hard to reach group, within hard to reach groups, will require any project to improve diet to partner with local stakeholders and services to be successful in creating behaviour change. Skipping meals is common. This may be due to having other priorities or limitations of time and money. Education on the importance of regular meals coupled with easy quick preparation of healthy snacks would be useful. This is particularly relevant in a population with a high prevalence of diabetes. After the main research was completed on the estate FIG took part in an event as part of the Big Lunch celebration. At the event the Bellamy Road community allotment and other allotment holders, with help from the YMCA, set up a fresh fruit and veg stall with produce from the allotments. Donations were asked for, in exchange for produce. It was remarkable how quickly this fresh produce was taken up and there were frequent requests for something similar to happen weekly. There appeared to be a strong market for reasonably priced fresh produce.
95 Strategy and Policy for the Bellamy Rd Estate The remit of this study is Access to Healthy food. However, while undertaking the research it has become clear that a number of interrelated structural factors have a powerful influence on the health and diets of the Bellamy Road estate residents. These are economic, social and local service provisions related factors and are described below: Economic Unemployment and low incomes restrict the range, quantity and quality of healthy foods available to residents. Whilst increasing economic prosperity in the area is an inappropriate and unrealistic recommendation for this report to make it can be recommended that any local or nation al government strategy or lobbying to increase employment in the area can use the findings of this report to demonstrate the link between low income, poor diet and poor health. Social Despite knowledgeable and lengthy engagement of residents with the invaluable help of local community groups and social services the Bellamy Road estate continued to be a â€˜hard to reachâ€™ population. This was particularly evident with men who lived on their own. The introduction of informal and accessible social spaces for residents, particularly men is recommended before engagement regarding diet and health can begin. Local Service Provision There is no GP practice for the estate and the nearest is an inconvenient walk close to the Oaktree Tesco. Residents mentioned this lack of provision unprompted when asked about food provision on the estate. A feasibility study for a GP practice for the estate is recommended. This would make information dissemination about diet and health more effective and would create a point of contact for hard to reach groups.
7 Recommendations Recommendations to Increase Access to Healthy Food i) Existing Community Nutrition teams should engage with Bellamy Road Stakeholders Group and input into their Action Plan to ensure food related health issues are included in local strategies. ii) Lobby for free public transport provision to local supermarket with bus operators, Tesco and Mansfield District Council. iii) Existing service provision should consider the range of cook and eat classes. Classes should be based around healthy traditional meals with a take home meal included. Food culture rather than the more medicalised ‘healthy food’ approach may prove a more suitable method of behaviour change. Support for healthy eating should be focused in practical help that can alleviate barriers of time and financial resources for the residents. Use of a variety of venues tailored to the needs of specific client groups including:
For mothers at Children’s centres or schools based on low cost, quick meals. Crèche facilities essential to ensure good take-up of classes.
For men living alone. Inclusion of non-food social activities and allowing walk-in clients would increase uptake.
Intergenerational ‘food memories’ cook and eat classes would build on the positive cultural food memories that are mostly based on childhood or family meals.
iv) The new housing on the Bellamy Road estate, the appointment of a Master Planner and the potential new village to the south of the estate, all represent unique opportunities to include access to healthy food in local and regional strategies as well as opportunities raise funds in to support such initiatives. This should include a more outward facing, attractive and accessible shopping centre. v) Increase local provision of a wide range of affordable, good quality fresh fruit and vegetables through one or combination of the following initiatives: o Engagement with Egmanton Road shops to better source, display and promote fresh fruit and vegetables. The Change4Life Convenience Store Scheme is a useful and successful model. The profitability of fresh produce should be promoted through recent hard economic evidence. o Increased use of the Bellamy Road Community Allotment. Discussion Mansfield district council regarding informal sales or distribution of excess allotment produce on the estate. It is recommended that any allotment project should seek support from the Federation of City Farms and Community gardens. o Feasibility of a food co-op for the estate. There is national support and successful local
97 models to draw best practice from. o Feasibility of the Egmanton Road cafe as a â€˜food hubâ€™ for fresh produce sales, cook and eat classes and low cost healthy food provision. Discussion with current leaseholders (YMCA) and local shops so as not to negatively impact local business is essential. These recommendations require support and most would require further funding. A small part of the budget for this research has been allocated to seed fund a project subject to approval by the Ashfield and Mansfield Health Partnership. FIG will be able to signpost to other funding sources and support for any project approved.
9 Appendices Appendix i
99 FIG Food Questionnaire
Please fill in this form and get a chance to win one of three Christmas Hampers! FIG is part of the charity Groundwork and all information will be treated as Confidential and under no circumstances will be passed on to anyone else or used for marketing purpose. If you don’t want to supply your address please still fill in the form. These forms can be returned to the boxes around the area e.g. local shops, Tuxford Court, old community cafe or can be sent to FIG at Groundwork, Denman St East, Nottingham, NG7 3GX. If you would like an online version to return by e-mail please email BELLAMY FOOD to firstname.lastname@example.org. Name Address Post Code
Which other adults live with you? Partner None Family member Friend Child1 Age M F
Child 2 Age M F
Child 3Age M F
Child 4 Age M F
Anyone in household working? Yes No
In further education? Yes No
Note other health problems
Other (please state) 1. Do you think that your diet is fairly healthy? Yes No Don’t Know 2. How would you describe a healthy diet? ______________________________________________________________________________ 3. How would you describe an unhealthy diet? ______________________________________________________________________________ 4. Who does the main food shopping in your family? You Your Partner Share Don’t really do food shops Other __________________________________________________________________
100 5. Who does the cooking in your household? You Your Partner Share Don’t really cook in household Other __________________________________________________________________ 6. Where do you mostly shop? (you can choose more than 1) Egmanton Road (Bellamy) Shops Local Oak Tree Lane Tesco Other supermarket (name) _________________________________________________ Town centre Freezer stores Open Market Other _______________________________________________________________________ 7. How do you usually get to the shops? Car Bus Cycle
8. How long does it take you to get to your food shops? Less than 5 - 10 mins 10 – 20 mins 20 mins – 1 hr
more than 1 hr
9. Is getting to or using the shops a problem? No Yes If yes why is this? _________________________________________________________________ 10. Is getting the shopping back from the shops a problem? No Yes If yes why is this? _________________________________________________________________ 11. Why do you shop where you shop? Quality Choice Value for Money Convenient Other ___________________________________________________________________________ 12. Do you top up with food from local shops? Yes Rarely or never If rarely or never why is this? ______________________________________________________ 13. If you never or rarely use Egmanton Rd shops, why? Choice Quality Price Fear of crime Distance and access Other ___________________________________________________________________________ 14. What would help you buy more fruit and veg from Egmanton Road shops? More fresh fruit and veg Wider range of fresh fruit and veg Cheaper fresh fruit and veg Not interested in buying fruit and veg Other ____________________________________________________________________________ 15. What would make your shopping easier for you? Better Local Shops Better Public Transport Access 16. Are you able to get the food you want? Range Y N Quantity Y N
More Help Whilst Shopping
17. Would you buy different foods if you had more money to spend? Yes No If yes, what sort of foods? _____________________________________ 18. What sort of cooking do you do?
101 Sandwiches, snacks and other cold food Heating up ready meals, tins etc. From scratch with raw ingredients Don’t really cook Other ______________________________________________________________________ 19. If you don’t cook food regularly from raw ingredients in your household, what is the main reason? Time Cooking skills. Cooking equipment Confidence No point cooking for one Not interested in cooking Other ______________________________________________________________________ 20. Where do you get most of your breakfasts? Prepared at home Cafe Takeaway Snacks Rarely eat breakfast Other __________________________________________________________________ 21. Where do you get most of your lunches? Cooked at home Cafe Takeaway Snacks Rarely eat lunch Other __________________________________________________________________ 22. Where do you get most of your evening meals? Cooked at home Cafe Takeaway Snacks Rarely eat evening meal Other __________________________________________________________________ 23. Would you like to learn better cooking skills? Yes No If answer No, why is this? __________________________________________ 24. If a cooking course was offered locally would you go? Yes Yes, if free No If No, why is this? ______________________________________ 25. Do you check ‘use by’ labels on the food you eat? Always Never Sometimes 26. Would you use a good quality, healthy, reasonably priced local cafe? Yes No 27. Would you be interested in using a local community food growing allotment? Y N 28. Do you intentionally look for and buy any of the following types of food: Organic, local, sustainable fish, Fairtrade, Benecol or similar, Free Range or other high welfare meat or eggs? Y
10 References i
Flaherty, J. Understanding Food Poverty. EMPHO, 2009 FAO. Practical Guide: Basic Concepts of Food Security. EC - FAO Food Security Programme, 2008 iii See http://www.nhs.uk/aboutNHSChoices/aboutnhschoices/Aboutus/Pages/Introduction.aspx iv World Health Report 2002. World Health Organisation, 2003 v Food Matters Towards a Strategy for the 21st Century. The Strategy Unit , 2008 vi Choosing a Better Diet: A Food and Health Action Plan. Department of Health, 2005 vii Flaherty, J. Understanding Food Poverty. EMPHO, 2009 viii Local Action on Food Archive at http://www.sustainweb.org/page.php?id=234 ix Developing a physical accessibility standard for healthy food in the West Midlands. Department for Health West Midlands, 2009 x Family Food in 2007. Office for National Statistics/Defra, 2007 xi Brief on policy affecting food and drink - Quarterly Report see http://www ec.europa.eu/environment/enveco/RealWorld_Briefing2Food.pdf xii Soil Association Organic Market Report 2010 see http://www.soilassociation.org/Businesses/Marketinformation/tabid/116/Default.aspx ii
The Validity of Food Miles as an Indicator of Sustainable Development. DEFRA/AE Technologies, 2005 Marine Stewardship Council Annual Report 20098/9. http://www.msc.org/search?SearchableText=annual+report&path=/MSC/documents xvi Law M. Plant sterol and Stanol margarines and health. British Medical Journal. 2000; 320: 861-864. xvii The Fairtrade Foundation – five key Fairtrade Benefits – standards and practice behind Fairtrade Labelling, 2008 xviii Leather, S. The Making of Modern Malnutrition: An Overview of Food Poverty in the UK. London: Caroline Walker Society, 1996 xix Previous FIG research on healthy food access can be obtained by contacting Groundwork Greater Nottingham xx Derbyshire Food and Health Needs Assessment. EMPHO, 2009 xxi Caraher et al. Shopping for Food: Accessing healthy affordable food in three areas of Hackney, London Borough of Hackney, 2006 xxii Dowler, Blair et al. Mapping the Availability of Healthy Food in Sandwell. University of Warwick, 2001 xxiii Making the Connections: Final Report on Transport and Social Exclusion. Social Exclusion Unit, 2003 xxiv East Midlands health Profile, 2009. APHO and Department of Health, 2010 xxv Nottinghamshire County Joint Strategic Needs Assessment 2009. Nottinghamshire tPCT, Bassetlaw PCT, Nottinghamshire County Council, 2009 xxvi Joint Strategic Needs Assessment Mansfield. www.nottinghamshire.gov.uk/jsna-chapter4.pdf xxvii Radburn and the American Planning Movement. Journal of the American Planning Association, Volume 46, Issue 4, 1980, pages 424-431. xv
FSA http://www.eatwell.gov.uk/asksam /healthydiet/fiasandshellfishq/#A221144 Shoppers being misled by minced meat labelling. Food Standards Agency, Ref: 2004/0529, 2004.
Murcott, A (Editor). The Nation's Diet: The Social Science of Food Choice. Longman, 1998
Rabiee, F. Focus-group interview and data analysis, Proceedings of the Nutrition Society (2004), 63, 655–660
Published on Jul 5, 2011
Access to Healthy Food Bellamy Road Estate, Mansfield 01 Introduction 1.0 Commissioning p5 1.1 Partners p6 1.2 Aims, Objectives & Output...