Food environments in socioeconomically disadvantaged and immigrant populations through a non-communicable disease lens

Background: Globally, non-communicable diseases are increasing. With an evidenced link to the social determinants of health, this highlights a social gradient, whereby socioeconomic status, ethnicity and other factors influence poorer health outcomes. They are also linked to food environments, the interface of interaction between the food system and consumers. Aim: The aim of this thesis is to improve understanding of the food environment and its interactions with a focus on socioeconomic disadvantage and immigrant populations through a non-communicable disease lens. Methods: In Study I-III, the external food environment was mapped using a modified version of the Environmental Profile of a Community’s Health observation tool. Study I included under-resourced and socioeconomically disadvantaged sites, one urban and one rural, in a low- (Uganda), middle- (South Africa) and high-income (Sweden) country. Further, twenty-two lower and middle socioeconomic status neighborhoods of Stockholm were mapped in Study II and III. Descriptive and inferential statistical analyses were carried out. Study IV, a scoping review, used the Analysis Grid for Environments Linked to Obesity (ANGELO) framework to analyze and interpret the data on the interaction between personal and external food environments. Results: Across countries, food environments differed in the number of informal outlets present, the most found in Uganda and the least in Sweden. Primarily supermarkets, as well as other stores, were a source of both unhealthy and healthy food items, while advertising unhealthy items in store. Overall, outdoor advertisements of unhealthy foods were the most common and more prevalent in areas of higher socioeconomic disadvantage. Fruits and vegetables had similar prices across countries, though in the Swedish context, these cost less with lower neighborhood socioeconomic status. Structural and social factors like income, time, mobility and children’s preferences influenced the healthiness of foods acquired by immigrants from low-and middle-income countries living in high-income countries. Conclusion: Unhealthy items were both widely prevalent, as well as advertised across settings, at a higher rate in areas of higher disadvantage. Combined with structural and social factors that push consumers towards unhealthy practices, this could exacerbate existing health and nutrition inequities. Further research to better understand the food environment and its interactions with consumers are needed to facilitate healthier choices and improve health