Assessing the Foodscape of Small Island Developing State: The Case of Barbados

Project: Assessing the Foodscape of Small Island Developing State: The Case of Barbados

PhD Supervisors: Professor Ian Hambleton and Dr. Christina Howitt

Program: PhD Epidemiology (UWI Faculty of Medical Sciences and the George Alleyne Chronic Disease Research Centre)

The overall aim of this project to assess the local food environment in Barbados and its impact on individuals living with obesity and chronic non-communicable diseases such as diabetes and cardiovascular disease within the country. This project will also examine how the food environment impacts individual dietary behaviours. On the completion of this project it is hoped that recommendations can be made to inform policy to create a healthy food environment in Barbados and expand the research to the other Caribbean islands. This project is designed in three phases (See Table 1). The first phase will examine the community nutrition environment. This will be done at the national level to assess the number, types, location, density and proximity of food venues in a defined geographical area. The second phase will examine the consumer nutrition environment. This includes assessment of the foods available in stores and restaurants, the pricing and placement of foods and the nutrition information or marketing material within stores and restaurants. The third phase will examine individual level dietary behaviours, including dietary diversity and purchasing habits. All three phases are interdependent and are based on the social-ecological model. This project is aimed to be completed within the next 3 years.

Hypertension and obesity are two major health issues that impact the Caribbean. More than half of the Caribbean population is overweight and over a quarter is obese while the prevalence of high blood pressure ranges from 20-50% across the region. In Barbados, it is estimated that two-thirds of Barbadian adults are either overweight or obese and one-third of adults were hypertensive. These are known to be downstream determinants for cardiovascular diseases and diabetes. This means that there is a direct link between these risk factors and chronic non-communicable diseases (NCDs). The relationship between downstream determinants have well been explored, however there has been less research that examine the potential impact of upstream determinants which are the factors that contribute, cause or create an environment for the downstream determinants. One such upstream determinant is the food environment.

Unhealthy diets including for example energy dense food that is high in salt, sugar or fats, are regularly reported as the main contributor to obesity and NCDs . More recently, researchers have begun to explore the relationship between the food environment in terms of food availability and accessibility and its subsequent development of an obesogenic environment. Food outlet availability and accessibility as it regards to identifying potential food deserts (presence of limited healthy food accessibility) and food swamps (an overabundance of unhealthy foods despite having healthy food options) along with the customer experience within food outlets lead to the creation of obesogenic environments and laying the foundation for the development of NCDs.

Currently there are no known studies in the Caribbean nor Barbados that have examined the food environment to this level of detail at the national level. Similarity, there is no data within Barbados that maps out the location of all food outlets in Barbados, therefore there is no formal way of knowing if one area is saturated with food places or not. This is a new and upcoming area of research that is just beginning in the Caribbean, particularly in Jamaica and Haiti, which evaluates the linkages between the macroscale and microscale features of the foodscapes at the individual level. It is however a new area of work for Barbados, a high-income country, whose economy has marked differences compared to low/middle-income country that may have an effect on the foodscape environment. Given the exponentially high rates of obesity, cardiovascular disease and diabetes in Barbados and the relatively low success rates with current national-level diet change public health program, it is time to step back, revisit and reset the whiteboard, to understand the entire food system and foodscape to then pinpoint where exactly in the Barbados food system is the most impactful to implement a public health policy. This is exactly what this project is aiming to do.

Assessing the Foodscape of Small Island Developing State: The Case of Barbados – Table 1 Outline of PhD thesis phases

Phase 1

• Macroscale features of food outlets influencing diet.
• National data collection – The community nutrition environment will be assessed using GIS and administrative data in Barbados. A near comprehensive listing food outlets (inclusive of restaurants and food stores) will also be mapped.

Phase 2

• Microscale features of food outlets influencing diet.
• Sampled data collection – A more detailed assessment of a sample of food outlets examining food availability, quality, price, marketing etc will be done using an adapted version of the Nutrition Environment Measurement Survey (NEMS). This will examine the aspects of the consumer nutrition environment.

Phase 3

• Individual level measurement of dietary and food source behavior
• Sampled data collection
  A) 24hr food-recall interviews
  B) Survey of household larder content.
  C) Survey using a pre-developed Caribbean food source questionnaire