Title: Evaluation of planning policy to regulate takeaway food outlets for improved health in England
Funder: Department of Health and Social Care

Abstract: About 60,000 shops in England sell hot food to take away. Takeaway food tends to be high in salt, fat and calories. People who live and work in areas with the most takeaways eat more takeaway food and are more likely to live with obesity than those who live and work elsewhere. Online food ordering ‘apps’ make it easier to access takeaway food, but this still mostly comes from local takeaways._x000D_ _x000D_ Local Authorities (LAs) are increasingly worried about the impact of takeaways on health. Existing takeaways cannot be shut down, but a quarter of LAs have applied planning rules to new takeaways in this typically fast growing sector. The most common approach is 400-800m (0.25-0.5 mile) ‘exclusion zones’ around schools where planning permission is denied to new takeaways. Forty-four LAs have zones and 70 more are considering them. In previous research, our interviews with planners suggest that the focus on schools is a strategy to make zones more politically acceptable. These policies are intended to target whole communities. There is very little research on the impacts of preventing new takeaways from opening._x000D_ _x000D_ Our main research question is: “What is the impact of exclusion zones on the number of takeaways?” Using a dataset of all food outlets in England, we will compare takeaway numbers in areas with and without exclusion zones, two years before and after zones are introduced. We will also study areas just outside zones in case takeaways are displaced there. Any health impacts of zones are likely to be small and take a long time to occur. We will use statistical modelling to estimate the impact of zones on obesity and health. Policymakers are concerned that exclusion zones may harm local economies. We will conduct an economic analysis to explore the costs and benefits of these zones across the whole of society. Exclusion zone policies vary between LAs and may not be implemented as intended. We will interview 30 LA officials to understand what, if any, problems they had with implementation, and how these were addressed. We will work with participants to design exclusion zone policies that address these problems and share these with LAs who have not yet implemented zones. Exclusion zones are more likely to be adopted and effective if they are acceptable to local residents and business people. We will use written responses to statutory local consultations on exclusion zones to see how food businesses react. In ‘go along’ interviews with 32 local residents, we will explore views on takeaways and exclusion zones in depth. We will use a survey of 4000 people to understand any concerns more widely. _x000D_ _x000D_ The need for planning permission for new takeaways was recently relaxed for 24 months in response to coronavirus. Our study will use data from before the rules were relaxed and the results will be relevant after the rules are tightened up. The main audience for our findings is local and national policymakers and practitioners. Dissemination activities will include workshops, evidence briefs, blogs and presentations at relevant conferences.

Lay abstract: Poor diet and obesity are leading causes of mortality. Takeaway food outlets (‘takeaways’) tend to sell energy-dense food, with frequent consumption linked to weight gain. There are 60,000 takeaways in England with more in deprived areas and annual growth four times that of population growth. Physical access (‘exposure’) to takeaways is positively associated with takeaway consumption and obesity. Urban planners are unable to remove planning permission from existing takeaways, but they can refuse permission to new takeaways. The most common form of planning policy is the school-based ‘exclusion zone’ adopted by 44 of 325 LAs in England to date. The intent of these interventions is to prevent further takeaway proliferation around schools. While appearing to target children, our previous findings suggest this is a politically acceptable means to reduce whole population takeaway exposure._x000D_ _x000D_ The health and other impacts of exclusion zones are unknown. If effective, this absence of evidence is a barrier to adoption and implementation and delays public health benefit._x000D_ _x000D_ Across seven work packages (WPs) we will exploit the natural experiment of variation in LA intervention to conduct a comprehensive evaluation. WP1: if exclusion zones impact health they must first affect retailing. We will use pre-post data from intervention and control areas to assess impacts on numbers of: takeaways; other food and non-food outlets; planning applications received, rejected, and appealed. WP2: health impacts could only be observed in the long-term. We will model impacts to 2040 on population: takeaway exposure; obesity prevalence and related morbidity. WP3: policymakers are concerned about economic impacts. We will model costs and benefits by 2040 to: businesses, local economy, local and national government, NHS; society. In WPs 1-3, impacts will also be explored by urban/rural and socioeconomic contexts. WP4: LAs benefit from the experiences of others. We will conduct post-intervention stakeholder interviews to understand: implementation experiences and perceived effectiveness; implementation barriers and facilitators; how the intervention might be optimised; and with stakeholders we will produce LA guidance on how to best implement future interventions. WP5: how takeaways react to the intervention and how LAs respond is likely to affect policy content and uptake. We will exploit public consultation data to document how: takeaways react to the intervention; LAs respond to takeaway reactions; and whether these stakeholder narratives have changed over time. WP6: policies with public support are more likely to be adopted, and perceived effectiveness increases acceptability. We will explore overall and by SES, the proportion of children and adults who: are concerned about takeaways and why; support the intervention; think the intervention will be effective. WP7: we will work with policymakers to synthesise and disseminate findings.

Research activity codes: 3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE