Lauren Bowes Byatt: Hi, everyone. And welcome to today's Nesta Talks To. This is a series by Nesta to speak to some of the most innovative and exciting thinkers in the UK today on a various different range of topics. I'm Lauren Bowes Byatt, and I'm the Deputy Director of the Healthy Life Team at Nesta, the UK's innovation agency for social good. Nesta designs tests and scales solutions to society's biggest problems, and we have three core missions.

And today, I'm here to talk to you about our healthy life mission. Our healthy life mission is all about thinking about how people can live healthier longer lives and thrive the best way they can in society. And the main way that we're exploring this is through healthier diets. And we know that where people live, the environments that they interact with really impact their health.

This is a topic of shared interest by Tom Burgoine, who is joining me today to talk about healthier neighbourhoods and the work that he and his team do. So we're going to get on to these in a moment. Tom is a geographer based at the MRC epidemiology unit at the University of Cambridge. And his work focused on neighbourhood food environments and the impacts that these have on diets. And he's done a range of different work from using data to better understand that but also national evaluations around planning regulations.

So welcome, welcome today, Tom. It's great to have you with us. Before I start, I just want to invite all of our audience to please do put comments on the right hand side of the screen. So if there's any questions you want to ask throughout, do drop those on there. And also closed captions can be accessed also through the LinkedIn live stream, so please do join us on there if you wish as well. So Hi, Tom. Again, welcome welcome. Thank you for joining us.

Tom Burgoine: Hi, Lauren.

Lauren: So we kind of kick off a bit with a bit about telling us about your work and I think maybe why you think a focus on healthy neighbourhoods and environments is so important.

Tom: All right, the big question. Thanks a lot for having me on the podcast. It's a pleasure to be here. So yeah, hopefully, we'll have an interesting and inspiring discussion and get some good comments and questions at the end. We're looking forward to that. So as you said already, I'm interested in social and neighbourhood determinants of health with a particular focus on food access and how that shapes diet and diet inequalities, which play into health inequalities.

And when I say food access, I guess my thing, if I could call it that, is really high street food retail. So the food outlets that we encounter kind of every day as we go about our everyday day-to-day business, it's food access that affects everyone. So most people are shopping somewhere on the high street or in that kind of physical food retail space. So therefore, it's food and retail that kind of shapes what everybody buys and what everybody eats.

I think food access is important because on many high streets and in many towns, unhealthy food outlets are overwhelmingly dominant. And that makes effectively unhealthy choices, perhaps the easy choices, or the default choices. And a population, really the way I like to think about it is we're not setting consumers up for success by stacking the deck against them so strongly and making overwhelming majority of options unhealthy.

And for some, the choice to eat unhealthily is removed altogether. So we know there are a whole bunch of high streets out there where 50% of food retail is takeaway, so just takeaway is 50% of retailing. But there are some places where all of the retail is unhealthy, and the majority of that is takeaway or fast food. Now, the swamping of our neighbourhoods, I'm just going to keep going for a little bit longer, is a relatively recent phenomena, actually.

So it wasn't so long ago that we were concerned, I think, as geographers and as maybe a planning community about where's the healthy retail? Where are the supermarkets? Where are people getting fruit and veg from? But over recent years, and actually this has happened surprisingly quickly, I think, that it's really a focus on unhealthy food retail that's come to the fore. And our neighbourhoods now are more imbalanced than they ever have been and skewed towards unhealthy retailing over healthy retail.

Other types of retail haven't kept pace, right? So we know that convenience stores, restaurants, supermarkets, growth in all of those other parts of the retail environment have not boomed at the same pace as takeaway or fast food retail, for example. And that imbalance is particularly out of whack, if you like, in more deprived areas, where the density of fast food outlets is now double per head than in our more affluent towns and cities. We know that the healthiness of diet varies by deprivation. And part of that might be unequal access to food. So, yeah. Go on, go on.

Lauren: No, no, absolutely. And I was just going to mention as well that yeah, so we'll talk a bit about the food environment assessment tool in a moment as well. But I think it's also that kind of building of understanding about what's happening in our neighbourhood food environments that's really important particularly when you look at the out of home sector and that where knowledge to date has been lacking in the past in terms of knowing what's out there but also what types of food that people are consuming in these environments and how that's kind of feeding into to unhealthy diets as well.

I wonder, did you want to say a bit more about the Food Environment Assessment Tool now, or FEAT for short? I try to avoid going to abbreviation, first of all, and maybe how that's helping to better understand our local environments and how that's playing out.

Tom: Yeah, no problem. So I will do that. I guess the thing that I'd say first is that this hypothesis that neighbourhood food access is related to diet is, of course, testable. And that's what I've basically spent a decade of my career trying to resolve. So as you say, let's talk a little bit about the evidence first. We've worked in major studies across our region in the East of England, but also in London and elsewhere with samples of up to 50,000 people.

And we know what these people are eating. We know where they live. And therefore, we can kind construct neighbourhoods around them and see how healthy or unhealthy they are with regards to food retail. And in these studies, what we find time and time again, so this is UK work, is that those people who have more access to unhealthy food retail namely takeaways or where their environment is kind of out of balance, and they have an unhealthy food retailing predominance, they're generally more likely to consume unhealthy food, generally more likely to weigh more, have a BMI, have a greater risk of being obese.

So the stable, the, what's the analogy I'm looking for? I wouldn't say it was a closed case. But I'd say that the overwhelming kind of evidence that we've been generating over the course of the past decade and others certainly indicating that there's something about the environment that's skewing unhealthy behaviour, OK. But yes, let's talk about the Food Environment Assessment Tool, definitely. So FEAT, I'll probably say FEAT tool a lot, which is tautological. I should try not to say that.

But FEAT is a tool for mapping, measuring, and monitoring food access across the United Kingdom, so all four countries, all four nations, including over time. And for us, it's something a little bit different because I'm a researcher. I do research. We don't often build online tools to share our research evidence. So FEAT is a little bit something different for us.

And we're really grateful to Nesta, who have this kind of shared vision for shaping healthier environments, who have helped us to get feedback back online after a short period of downtime, and it's back. It's on a sustainable footing. It's bigger and better, and we think better than ever. So please, do go ahead and look at that. And we're really grateful to that the web addresses feat-tool.org.uk. And we'd welcome suggestions.

But yeah, FEAT is aimed primarily at planning and public health audiences, so kind of key decision makers who shape what our food environments look like and what our food access looks like. And it's really part of our vision to make sure that the world knows about our research and engages with our research through the sharing of research-related data. Ultimately, kind of I guess I have a personal vision, but we do at a unit level as well of having impact, so doing research that matters and that can contribute to the shaping of healthier communities.

So one key thing that you can do is a take away and supermarket access from a country level but all the way down to a really small, local neighbourhood level. It's updated every month now with new data. If you go there, you'll find that there's six months of data already there, so you can look at trends over time. And the information is from local authorities.

So if you are a local authority, this is your data that you're seeing in the tool, the data that you collect to enable your environmental health checks is the data that we use and that we now use to power FEAT. So that's a little introduction. We can talk in a minute maybe about how it's used, but.

Lauren: Yeah, no, that's great. And can you say a bit more about, I guess, how have you guys found it helpful in terms of building FEAT as a tool for building that, I guess that understanding of how the UK varies in terms of its kind of picture by local authorities and that kind of, I guess, what you talked about in your opening a bit about the kind of range of different densities of fast food areas and how that varies maybe rurally or by urban locations, and maybe say a bit more about how that's kind of contributed to your understanding of the kind of UK picture more generally.

Tom: Yeah, absolutely. Actually, the one thing that we're yet to do is kind of publish a paper or publish some findings that really kind of tracks food retail change over time using this data. And we will probably do that next year. But obviously, we've been amassing a lot of information, and we can see these trends. So yeah, one thing we've seen is this growth in fast food, which in some regions of the country was as much as, sorry, nationally, was 10% growth, I think, between 2014 and 2018.

So the last time I checked, the number of takeaways went up by 10% in just four years. I mean, the population didn't increase by 10% in just four years, so it's outstripping population growth by some way I think. So that would be one example of a trend. But obviously, you've got massive regional variation, but obviously, massive regional variation maybe less obviously, sorry, variation within small areas as well.

So even within a city or even within a town, you can't generalise and say, OK, everyone. In this town has good access. We've got very, very different levels of access even across small areas and even within small cities. So that was something that really stuck out to me.

But of course, what's really interesting is what local authorities do with the data. That's what we're most interested in, right? We're putting it out there in the world to have some hopefully kind of address change. So hopefully, we can talk about that.

Lauren: Yeah. And maybe that's a seamless segue, maybe, Tom into to maybe talking a bit more about how can people use the tool? What can they find from it? How do you think it currently informs some planning decisions, or I guess how it could better inform planning decisions as well as part of that?

Tom: Yeah, OK, really good question. So we know that local authorities have used the data in a number of ways. So we as researchers, this sounds really researchy, but we weren't content in trying to have some impact. We wanted to study the impact. So we're researching our impact of our research. [LAUGHS] We have our reasons. But we know that local authorities have used the data just to start a conversation first and foremost about food retail. And we think that's important.

And if everybody on this call could go and check out FEAT, think about what the data means for them, and have a conversation with someone particularly if you're in a local authority. That's a starting point, right? And we local authorities have been doing that. And it's helping to bring planners and public health colleagues together, hoping to maybe to bring them together onto a shared agenda. We need to adopt food retail interventions because of this kind of sparking of imagination around the food environment that maybe has enabled.

But we know that also the data is being cited in local plans. We know it's been cited in supplementary and other sorts of planning documents in local authorities. So the data is there. The references are there. We know that local authorities are seeing this and thinking, hey, we've got a problem here, using it to justify intervention. And that's quite often planning intervention because the planning system can be a type of public health intervention.

And then the final way is a really applied way. So some local authorities are using the data from FEAT as a yardstick. So they'll get a new application in. They'll check what area of their city or town this application is. And if the number of takeaways is already, say, higher than the national average, their position as a starting point will be to deny this new application for a takeaway. So they're using it in a sense to actually implement the policy to provide data that will help them implement policies. So I think that's three different ways that we've seen FEAT being used. But the possibilities are endless, I think, so.

Lauren: Yeah, and it'd be great to hear. I'm sure we've got lots of people joining the chat today and do put kind of comments and questions in because I think we'd love to hear more about how local authorities have maybe used FEAT in the past and kind of as Tom said earlier, if you've got any views on how it could be better, how it could be more helpful to different local authorities who are kind of making those planning decisions as well.

Tom: Yeah, and you can read a couple of case studies, actually of the work that we've done with the local authorities on our website. So if you want to go and maybe be inspired about what you can do and read more about experiences in the field, then you can find that information on our website.

Lauren: Great, yeah. And we can share various links to things in the chat in a moment as well. Yeah, no, so that's, I think yeah, as you mentioned kind of that knowledge build piece is a core part of FEAT, but then it's also that kind of way in which it's then used to translate that into actual action and how it's kind of giving that tool to local authorities as well as many other tools that I'm sure they have in their hands to help them make those decisions and build that evidence up as well.

And obviously, they've kind of started to touch on, I think, about planning and the power of planning in shaping kind of healthier neighbourhoods and healthier environments and particularly the role that has on people's diets and food. So I know, Tom, you're also doing work on national evaluation on other planning elements, so I wonder maybe saying something a bit more about what you think the power of planning is for helping to shape our food environments and the kind of difference in different environments that could help them unlock in the future.

Tom: Yeah, definitely with pleasure. It is a nice segue, isn't it? I feel like this is-- it's like a recap of my academic career, kind of building the evidence, translating the evidence, and then hoping that that inspires some sort of policy action that we can evaluate, we can understand whether it works or not. And that's a different form of evidence, but an equally important form of evidence. And that's where we're at now.

So yeah, we're doing this kind of major national evaluation of one particular type of planning intervention, which I'll get to in a second. So I think it was in 2018, we surveyed, we were aware that some local authorities had started to use planning as a type of public health intervention, particularly trying to address takeaways. Because in the UK planning system, I don't want to get terribly technical, but takeaways kind of stand alone as their own class of food outlets.

So they're actually quite easily addressed using the planning system in a way that cafes and supermarkets are slightly more problematic because they're lumped in with other types of retail. So we were aware that there were some action in this space. So we kind of went to all 325 local authorities and surveyed what sort of planning regulations they were implementing to address takeaways. And we were probably surprised at the amount of action that was already taking place.

So a range of planning interventions had been adopted by local authorities from attempting to reject new applications for hot food takeaways in areas with high levels of obesity or in areas of their towns and cities that already had a high concentration of fast food outlets. They were common. But the most common by far, so this was 33 local authorities over a decade was the implementation of what many were calling exclusion zones.

We don't refer to them as exclusion zones. But I probably will for the purposes of this podcast. So these are areas around schools, commonly 400 metres, sometimes as big as 800 metres where the idea was that no new hot food takeaways would be permitted. So on the face of it, this is about protecting a vulnerable group, protecting children. This is they're anchored around schools.

But actually, because we have so many schools, you join up all of those buffer zones, essentially across a local authority. And this is potentially an intervention with population wide reach, including adults, right? Because a lot of people are moving through these spaces on a day-to-day basis. So we found that was 33 local authorities. And I think we found 50 other local authorities who had draft policies on their websites of suggesting that they might like to do a similar thing.

So this is clearly kind of a direction of travel. But there had been no evaluation of whether these policies had actually been effective in changing what the food retail environment looks like or downstream changing population health. And that's really what we sought to address. So we can talk about the findings. If you like.

Lauren: Yeah, yeah, no, I think maybe we'll go, yeah, I mean, my follow-up question would have been what kind of is the level of impact that you're seeing from that kind of policy, and kind of I guess also maybe thinking also about what more could be done, so kind of using that kind of level of impact you've seen from those policies, and maybe thinking is there other things where that similar ideas could be extended to or maybe additional ideas could be added to it to really like bolster the impact that it's already having?

Tom: Yeah, OK so it's important to know whether these things work because there is some human resource, political resource, financial, resource that's required to do anything in a local authority or a decision making space, right? So you've got to know whether this works because if it doesn't, you want to be doing something else. That's really the crux of the matter. So the question is, does it work?

Well, I think that we saw-- well, I don't think that we saw, we have seen a reduction in the number of applications for hot food takeaways. So we've got 33 implementers of these exclusion zone policies. They have led to a reduction in the number of applications. They have led to an increase in the proportion of those applications that are being rejected. And we know that in a follow-up piece of work, both of these pieces of work are under review at the moment.

But we've seen a reduction of about 50% in the number of new takeaways six years post-intervention. So it would appear that they are having some sort of impact on food retail. Whether or not that will translate into health impacts and what the economic impacts might be or the economic benefits might be in fact, we will see in the future that's kind of yet to come. So maybe I can come back and we can talk about that later.

And I say economic benefits because, of course, if you turn down a takeaway on a high street, yes, there is a cost to that for the local authority. And local authorities are rightly nervous about that, particularly those who are more deprived. But of course, then you've got a population who aren't using that takeaway to buy unhealthy food and all of the kind of health complications that come from a healthy diet and not being able to work and so on and so forth. You've got to weigh that up against the economic costs. And that's a piece of work that we're doing at the moment.

But yeah, it does appear that there have been capable of having retail impacts, definitely not a silver bullet, though, I mean, clearly, not a silver bullet. There's so much work left to be done. And you know that as well as I do. And I'm sure everyone on the call understands that this can only be one part of the puzzle. So there's a whole bunch of things. Even that planning could do better. Because why is this not 100% of outlets being protected? Why is it 54%?

So I think that we could talk about that for a second. So we treat all takeaways the same, right? So it doesn't matter. You can come and say I'm a healthy takeaway. We might argue that sushi takeaways are healthier than pizza takeaways, for example. And an owner of a prospective business might try to make that case. We could factor that in when planning decisions are made.

There is one local authority that I know of in the country at the moment that's asking new owners to submit a menu. And the menu is assessed by nutritionists within the council. And then the planning decision is made factoring into account the healthiness of the prospective new outlet, which I think is kind of interesting. I think it might have legs. There might be some questions around enforcement.

Lauren: Yeah. And that also kind of relates back I guess to the point I mentioned earlier on as well, which is I think the growth of the out-of-home sector or the growth of fast food outlets and other things, there still feels like there's kind of knowledge gaps that are catching up to that. So although we kind of know the prevalence, knowing what is or isn't healthy in those outlets, that kind of knowledge that perhaps we have for a better sense in a retail or an in-home environment is still kind of catching up.

And I'm going to use this as like a shameless time to plug some work we're also doing it Nesta as well, which is we're doing some work that should be published in the early next year, which is really digging into what people consume in out-of-home settings, so kind of across a broad range of restaurants, pubs, fast food outlets, but also bakeries, cafes, anything that kind sits in that space and really trying to dig into what are people eating in those settings?

What's consumption looking like? How is that comparing to what people are consuming in the home to really kind dig into the potential rise and increase that that is potentially having on diets as well and how that might lead to the doubling rates that we've seen in obesity and kind of the past 30 years as well. So yeah, so that's my shameless plug for this session as well on that. So that should be out in the early, early new year if people are interested in that as well.

Tom: I'm pleased to be the only one with shameless plugs. Because coming up, we have a piece of work actually by somebody who's led by someone who's doing their PhD with me that aims to effectively be able to take in a menu and then spit out a score for how healthy it is. So that takes away some of the subjectivity of a nutritionist in the local authority deciding, hey this takeaway is healthy. This one's not.

If we could have an objective way of scoring a menu, then I think you could have a system in place that's a bit less easy to argue with if you're a new business being turned down. So I think there's some legs in that, and that can make the planning system a more effective lever. But we should also, I think, I think as a non-planner, I think we should be thinking about making planning permission personal.

So I do not blame if any of your listeners did not realise that when a takeaway closes down, it can open up again as another takeaway without the need for planning permission. So that means that there's no scope for our exclusion zones to apply. Because they don't need to apply for planning permission. They can't be denied planning permission. If, when a takeaway, and that's and that's because it's the unit that has the planning permission, not the business.

If every time a business closed down, they had to apply for permission to open again, even if it's the same type of business, this policy or policies like it could be much more effective. And I think that's another way that we could reform the planning system if we really wanted to make it more about health and centre health in planning is one option.

Lauren: No, that's-- yeah, that sounds like a great idea, and also I guess, getting that kind of better, as we've just talked about before another kind of thing is like getting that kind of better sense of what is always unhealthy in the out-of-home sector or kind of in neighbourhoods and getting into that granularity as well feeding into that. I was going to ask as well because kind of I guess, staying on the planning element of it, there was the Times article, I think it was last week about KFC pushing back on trying to put pressure on local areas around their planning and decisions made around planning.

And I wonder if you had any reflections on best tactics for local authorities to use or any guidance or help on how they might counter some of those pushes.

Tom: Yeah, that was really interesting and timely. One of my collaborators messaged me and said somebody should do some research around that. And we have. So that was a piece, wasn't it, about KFC? So it was KFC who had routinely pushed back against these policies over the last decade. So we've actually been doing some work that has taken all of the responses to the consultation process.

So every time a policy is going to come into place, there's a public consultation. Food businesses are welcome to respond to that public consultation. And we've captured all of that consultation material and analysed it. So this work is again currently under review, so much left, so much under review at the moment. But it doesn't surprise me that the KFC have done the kinds of things that the food industry and other commodity industries have done.

For example, shifting the responsibility for choices to individuals, right, this is all about individual choice. What people eat is all about what individuals choose to eat. See the previous part of our conversation. I think if you stack the deck against individuals, it's perhaps unfair to say that these are even choices. They're just kind of behaviours in a context that is not in their favour.

And then a lot of these businesses also try to deflect the blame elsewhere, right? So this isn't about fast food. This isn't about what we sell. It's about sweets at checkouts in supermarkets. It's about convenience stores. It's about provision of green space. All kids need to do is get more active, and then they can eat what they want. These are common arguments that come out from KFC and others.

My main reflection, I think your audience might be interested in this is that most KFCs are not take aways in the planning system. So they are responding to consultations about policies that, for the large part, don't affect them because they're not takeaways. They're actually restaurants. They have enough seating that they're classed mostly as restaurants in the UK. So yeah, they're the ones. We didn't actually find any evidence that independents are responding.

It's the large chains who aren't actually subject to intervention. And I guess our thinking is that they see the writing as being on the wall. And in the future, if they allow it to affect independents now, in the future, it will affect their chains and their business. So they're making it their business now. But for us, that just seemed like a really interesting disconnect.

Lauren: Yeah, yeah, no, it's yeah, an interesting one to see play out. We've obviously saw-- we've talked loads about planning and kind of ways in which that can be used and be helped as well. But we've also saw, I guess, a kind of use of outdoor advertising and kind of restrictions and bans on outdoor advertising. There's the Transport for London example that's out there. There was again, this weekend about Brighton and Hove putting some additional restrictions in around junk food advertising in their local areas.

And I wonder if there's yeah, it's kind of as you started to allude to, it's not just the planning that is responsible for this. It's those other interactions, those wider systems on how we all get together, how all those things come together to create healthier environments. So yeah, I was wondering, is there any kind of reflections on how the advertising piece kind of sits with this and the wider planning restrictions as well and maybe speaking to your point before that it's not a silver bullet. And it needs some other complementary policies that are occurring and happening together.

Tom: Yeah, so that's the start of the answer to my question. It's not just one thing, and we have to do lots of things across our whole system, lots of different points of intervention are required. So the work that I have been part of, which has been led by colleagues at the London School of Hygiene and Tropical Medicine looked at restriction of advertisements for HFSS foods on the TFL network implemented a couple of years ago.

And that ban on advertising in that system was associated with a reduction in weekly HFSS product purchasing to the tune of about 1,000 calories per household per week and 320 calories per household a week from chocolates and confectionery alone. And that was compared to an area of the North of England as a control group whose diets didn't change and who didn't receive that intervention. So you've got a control group there over time in the same place.

Because obviously, lots of things could have shifted diet in London. But whatever it was shifted diet differently in London compared to the north. So yeah, I think that that's another part of our environment, right? And there are different levers. I don't think it's a planning concern outdoor advertising. But we just need to be thinking in a more joined up way what can we done. How can we use-- how can we be creative, actually, because for a long time, we thought about poor health as being something that could be just fixed with the health service, right?

It's OK. The health service will fix this. But actually, the things that are population level we can address and not are things that planners could help us intervene with, are things that environmental health, that public health colleagues and local authorities can help intervene with to shape kind of diets of everybody before people get sick. So we just need to be creative.

Lauren: Yeah. And I think it's really interesting as well, isn't it, that interplay between local level powers and control and what kind of local authorities can do. And then obviously, there's the national agenda and how that's set as well and having both of those things connecting and interplaying together is obviously very, very important as well.

I was going to ask, because I think what we've talked about a lot as well today is predominantly our physical environment, so our neighbourhoods, where we live, where we work, and those kind of places that we are, but obviously, lots of our lives are also online and in digital spaces these days as well. So I was wondering yeah, have you looked into how that interlinks and how has the increased use of digital and online spaces started to impact the ways in which our diets are or our access to healthier food as well?

Tom: Yes, absolutely. So there's some really good emerging research evidence on this, including from colleagues and somebody, again who was doing their PhD with me in Cambridge and some excellent work in this area. And we can probably link to some papers or something somewhere so your audience can find this work. But yeah, we know that we're all obviously online more than ever. We're all using online sources of food. You're just eating your deliveries, if I can mention names. I presume I can.

We're using more of that as a population. So yes, we're doing more of our food shopping at home. And that includes prepared food. And we know that we've kind studied in a similar way to the physical environment, the effects of the online environment. So we've taken data on who is on Just Eat and where are they delivering. We've taken people, and we've said, who will bring food to this location?

So we've got an individual level of how many options somebody has online, so we've got our measure of online food access. And we've linked that to online food consumption. And the two things were quite pretty strongly linked, right? So those people who had more access were consuming more takeaway food from online sources. So yes, there does appear to be some sort of link there.

The key question probably is how the physical and the online are interlinked. And that's what we haven't really been able to bottom out yet. So does having more online mean that we're eating more overall, and we keep eating food from the physical high street in addition to food that we've sourced online? Or does one eat into the other, so kind of net consumption of takeaway food just remains the same and that we're not quite to the bottom of yet, but we will do.

Of course, it's important. It's still important, even if the net consumption remains the same because the levers for change might look different. The planning system has not that much to do with online exposure, just with physical exposure.

Lauren: Yeah, and we're hoping as well the work I mentioned earlier, which is predominantly on the out-of-home sector. But we'll look into what's the interaction from online versus in person, so how many people are purchasing things physically in the store versus via delivery app or ringing the phone and kind of accessing it via that way as well. So it'll be able to dig in a bit into that detail and understand as well.

Tom: Yeah, and we've also done some work. Because I think there's also something interesting like how people might interact differently in these spaces as well. So there might be differences in terms of how someone might interact physically in a space or kind of how that informs their purchasing from a kind of behavioural perspective than when you're in an online space in your own home as well.

Lauren: So yeah, we did a bit of work on that before looking at delivery apps and simulated delivery apps and testing out how we can tweak how a delivery app might appear in order to see if it can prompt some healthier choices. And we found there are ways to do it and that you can make those changes. So understanding that, knowing what the solutions are and then bringing that all together is really important.

Tom: Well, that sounds really, really interesting and really, really good to hear, and we should talk more about that. I think there are opportunities here, right? And the reason why I think it's interesting because there are opportunities. So if you've got one platform with 30,000 takeaways listed on it, 30,000 food outlets, 30,000 restaurants, whatever it is, you can start to make change. You can insist that change is made on menus.

You can have healthier options promoted more highly up these online menus. And the implementation would be so much easier than trying to persuade or cajole or mandate 30,000 outlets on the high street to change their menus. So I think there are actually some opportunities here just when we start to understand the science a little bit more.

Lauren: Yeah, definitely. We've had a pretty good chat, haven't we? We've covered lots of ground. And I think we've got lots of questions and comments coming in over the chat. So I wonder, unless there's anything else you want to say, Tom, before we switch to comments or questions, Tom, on--

Tom: I would just like to bring in one more thing because it just relates to what you said a minute ago, which was about this link between national and local level policy making. Because we have talked today a lot about local policy. And its local authorities who are responsibility for a lot of what goes on at local authorities. But clearly, they don't operate in a vacuum. And there's a national context, a national planning policy.

And a whole bunch of other guidance documents at a national level do encourage local authorities to act locally, including using the planning system to address food environments. But I think they could probably do more. They could be stronger. And that's perhaps part of the reason why we see 33 exclusion zones policies and not 325 exclusion zone policies. And to some extent, they're actually undermining local decision making.

So if you're a prospective takeaway, and you don't like the decision that's made, if your outlet is rejected by your local authority, you can appeal. So you appeal all the way up to the National Planning Inspector. And then they make the decision. So the decision is taken out of the local authority's hands and made nationally. And more often than not, maybe certainly, a decent proportion of the time, significant proportion of the time, appeals are overturned and against the will effectively of the local authority and national level the planning inspector is undermining what they're trying to achieve.

So I think that there is some role, perhaps, for training in that kind of national planning role some increased awareness of health, some increased awareness of the evidence around health and fast food and other types of retail just so you don't have that contrast of national direction versus local priorities. So I just wanted to say that, but yeah.

Lauren: Yeah, I know. And I'm sure that probably plays into the pressure that local authorities feel as well. So if they're getting you know we mentioned earlier lobbied from different organisations, that kind of national level versus a local level must just feel quite tricky to navigate as well when perhaps you're making those decisions more locally rather than having the guidance set from a more national footing.

Tom: Yeah, absolutely. And it sets a negative precedent, right? And then perhaps if you're in a local authority, and you're trying to implement a policy that you know if it goes to appeal, maybe you've had experience of it going to appeal and it being undermined, maybe you'll just stop trying to implement it in the first place. I mean, that's just my own personal opinion. I'd be interested to hear other people's reflections. But I think the whole thing can kind of spiral quite negatively, so it's an important topic.

Lauren: Yeah. Definitely. And there's probably lots of-- there'll be multiple considerations that local authorities have to make in terms of their local areas kind of whether it's economic, health focused, and all of those things. So it's kind of-- some of the-- I guess, the national policy enabling them to make those decisions towards health as well is kind of core to it all.

And we've got quite a lot of questions, so I'm going to make sure we've got a bit of time to run through some of those. So the first one I was going to go to was about has FEAT been mapped against IDM, which I think, I'm assuming, is Indices of Multiple Deprivation, I'm going to assume.

Tom: I would presume similarly. Yeah. Yeah.

Lauren: Yeah, so I don't know, Tom, if you want to come in on that one.

Tom: The answer to that is no, not personally, but the relationship between-- certainly between fast food and takeaway retail and deprivation is so well established in the UK and elsewhere around the world, that almost, it doesn't seem worth doing. And in fact, the same data was analysed by the Food Standards Agency, I think, in 2018. So even with the same data, it's very, very closely linked. It's almost a linear relationship more deprived, more fast food. It's almost perfect.

Lauren: And there's probably some quick checks you can do on it as well, even though it's not integrated into the Feat tool, but once you've kind of done the mapping and saw where the density is to then quickly reference that to how the indices of multiple deprivation plays out from different local areas and kind of-- I guess, looking at those data side by side. And you'll see those known correlations appear.

Tom: Absolutely. And now I think about it. Actually, we've worked with the food foundation now, I think, for the last four years on their broken plate report, which is an annual statement of the nation's food and food-related issues effectively. And we've, for them, linked fast food and deprivation over that four-year period. And I think if anything, that relationship is growing stronger over time. So it's not going in the right direction.

Lauren: Yeah. Cool. I'm going to move to another question. So I see one from Tom Maplethorpe, which is about the main gap in the evidence base is being about linking fast food outlet density directly to overweight and obesity prevalence and a question about whether that situation has changed at all or not.

Tom: OK. Great question. I suppose it depends how in the past we're talking. I mean, my work, some of my work feels quite old now, which makes me feel old.

So it was 2013 when we published in the BMJ this first relationship between fast food access, consumption of fast food, and obesity in the East of England in 12,000 individuals, maybe in 10,000 individuals. I'm not sure. Since then, we've been following up with previous papers that have looked at how that relationship differs, depending on how deprived you are as what sort of deprivation level, and what sort of area you live in, and how deprived that is, what personal income you have, what household income you have.

And then I think it was 2016 when we looked at 50,000 participants of Biobank in London and found the same thing. So if you know that stuff, that's probably still the cutting edge, although, there is some work by others that's gone on in the meantime.

Lauren: Tom, I'd love to communicate via with you via email. And that goes to anyone on here. If you want to reach out and you've got further questions, please do, and we can work out the details.

I think we'll drop various emails in the chat section afterwards as well, so people can make sure they can reach out to us on any of that as well. As I mentioned, we did some work. I think it was-- was it last year I think that we did a little bit of work on looking at childhood obesity levels and how those mapped alongside local environments and the kind of access to different food outlets and local environments and found your expected correlation, basically, your expected findings that you would assume, which is higher levels of childhood obesity tended to be in the areas where there were increased amounts of food outlets as well.

So yeah, we found similar things. And it does seem that that kind of assumption stands up when you do various bits of evidence and work on it. I'm going to move to a question from Fran now, which is about, I guess, going back to the story earlier on KFC and hot food takeaway planning restrictions. And I think we kind of touched on this a little bit in the conversation as well. But I wonder if there's anything further to say on how those local policies could be strengthened to kind of help them deal with the pressure and lobbying that they might face from industry.

Tom: Yeah. So I don't want to straddle the line. I need to be careful here because obviously, I'm a researcher, not a policymaker and I'm working local. I don't work in any sort of government.

So these are just my personal opinions. I think what we've heard from local authorities is that they will value the work that I spoke about, which was a systematic survey and capturing of everything that fast food retailer has said in response to the idea of these policies, so that they can-- they've got a head start. They can already write, and plan, and shape their policies in a way that gets ahead of the criticism, gets ahead of most of the things or all of the things that they're likely to hear in response to the consultation.

So rather than saying, here's what you should do, it's here's the questions that you should be prepared to encounter over to you guys to write the policy in a way that you think will be robust against those criticisms. Yeah, so I think I might have dodged that one. But what we're doing is sharing with you, here's what you need to be prepared for, rather than here's how you need to respond.

Lauren: Yeah. And I think in my mind, there's probably two things from my perspective that I probably draw on, which I think we've already kind of discussed before. But I think a lot of what you've been talking, Tom, about is about having the evidence, the evidence both that these policies can have an impact and that these policies are required. And kind of having that evidence piece, I would assume, is probably really helpful in terms of giving local authorities that means of being able to push back and say, these are shaping how people are interacting with their environments.

These are having an impact, going back to the Transport for London piece as well, so being able to stack that up. And then I think the other reflection I would add is what we talked about before, which is that national local interaction, and I guess, making sure that there is that, at a national level, that ability to connect what's happening across the whole country and understand how planning decisions made at a much kind of centralised level might be able to help and impact that, and I guess, avoiding-- and I don't know if this is currently happening, but avoiding that sense of currently, I guess, industry might be able to reach out to different local authorities and approach them in a way that feels, I guess, a bit more disjointed than if it's coming to that pressure at a centralised level. So I think there's probably something in both of those things. That's my off the top of my head reflections.

Tom: Yeah. We've heard anecdotally, at least, that that's exactly what's happening. Particularly, in London in the past, a local authority has a policy. They turn someone down, and it pops up in the borough next door.

And in London, because it's so dense, that can be the street next door, right? What we need is a more national frontier, so we don't have that possibility for displacement, and something like the London Plan. The London Plan, which is implemented across all 33 boroughs in greater London, I think, says that actually, exclusion zones are a thing across that whole patch.

And they will be more than the sum of their parts if they're joined up like that. So imagine that scaled up nationwide. Perhaps, that's the direction for the future.

Lauren: Yeah, definitely. And I'm pulling out another question from Charlie Blandy, which I think we also kind of touched on a little bit. But I guess, it's-- the question is, is there data or evidence regarding the increase in delivery services?

So your various different delivery apps and the service and skill that they provide. We kind of touched upon that to begin with. And I think the evidence is kind of emerging and getting there, but I don't know if there's any reflections on that that you have, Tom.

Tom: Yeah. So as I've said, we've tried to capture that from an individual perspective, what will come to me, because that's really what's most important. What's important is what's there when you log on. And that's a function of everything that's there and how far they're willing to deliver to get to me, right?

And we know that's linked to consumption. There is another piece of work, actually, by another one of my colleagues here at the unit that has looked across seven countries in Europe, I think, including the UK at access to food on Just Eat and Deliveroo, I think. And I think that she has looked at the range of that access.

So it had a more outlet-centred analysis where it's about this outlet and how far they are looking to deliver. And she's done that for the UK and across Europe, many countries in Europe. So I'd give that work a bit of a look. That might be quite informative. That just came out a matter of weeks ago, maybe a month ago tops.

Lauren: Yeah. No, that sounds really interesting. And we'll try and do our best to share various links after this as well and make sure people can reach the things that we've mentioned. I was going to go to another question that's from Ben Arnold, which is asking the question of, would a local authority have the ability to stipulate what a takeaway sells, even if they have been given the menu? So I think Tom speaks to the kind of point that you mentioned earlier about the colleague that's doing some work on how you classify helpfulness in takeaways or out-of-home settings. So yeah, I don't know if you want to add to that any more.

Tom: It's a great question, Ben. I thought that, naively until this year, perhaps, that the planning system was too big and too unwieldy and would never change or could never change. But it feels like from the conversations I've had with some local authorities, that there's some tinkering around the edges that can happen.

So I think that they do have the ability-- no, I'm sure they do-- to say your menu is not healthy enough, or your menu could be improved. And they're linking up with expert nutritionists in the house to make those judgments and make those decisions. I think you're right.

The question about enforcement comes. Well, what if they change the menu after six months, how do you keep on top of that? And what if they change to a completely different business-- going back to the conversation we had about you can change businesses and there's no planning permission required. But I think that's where this idea of planning permission being personal has to come into effect.

So I think you have to say then, well, if it's the business that changes, then we look at the menu of the new business. So one probably comes with the other to make that work. There's some big challenges that I'm not 100% convinced it would work or can work in practise. I'd love to do some research into that, definitely.

Lauren: Actually, we haven't touched on yet is the food data transparency partnership that's being led out of government at the moment, central government, which I mentioned because I think it's interesting in this context of out-of-home settings, where-- so I'd say the data is pretty good in terms of retail and knowing what retailers are selling and how that's planning out. But part of the food data transparency partnership is about, how do we better understand the healthiness or the healthful offer that's available across the country? And I think depending on where that policy goes and depending on how it's developed, but if done right and if done in a way that enables us to understand how healthy different out-of-home providers are or how healthy those bigger providers, at least, your big multinationals are, then that would start to help us see what's playing out in local areas. Is there kind of a balance of healthiness or unhealthiness? And how is that shaping up. So I think having that data to unlock that would be a big first step in it.

Tom: It would be because I think-- maybe I disagree. I'm not sure we do have good data on what food outlets are selling across the country. I mean, we have pretty good data for the large businesses with over 250 employees who now have to put calorie counts on their menus. But even they don't have to put a more detailed description of the nutrient content of each menu item.

And then for everything else, that's 20% of the sector. The other 80% of the hot food out-of-home sector, we don't really an awful lot about what they're selling, say, for a few that have bought some food and analysed it nutritionally. It's honestly a bit of a black hole. I think there's a lot more we could do for surveillance in that area.

Lauren: And I completely agree with that. And when I said we have a better understanding, I mean specifically on the retail setting, so predominantly the kind of supermarket sector where I think the data is in a better shape than-- I think, yeah, the whole reason we're doing the bit of work that I've mentioned already on out-of-home is because it feels like a bit of a black box. It feels like if there's lots of-- you might have data on the menu itself, but you don't know sales. So even if a portfolio has healthier options on it, it's really difficult to know, are people actually buying that, or does it feel like a kind of tokenistic addition to the menu that doesn't actually translate into sales?

Tom: Absolutely. Absolutely. And that's one thing about this-- McDonald's will say they have healthy things on their menu, right? But who's buying them? I'm not going to McDonald's to buy fruits and vegetables. But sales data is what we need, 100%.

Lauren: Yeah. Yeah.

Yeah. Well, we're going to try and fill that gap a bit. I'm looking at some sales data that we've got and analysing the out-of-home. So hopefully, we should be able to plug some of that gap a bit. I'm just kind of going back going back to the questions.

I've got another question in again about whether menus could be inspected alongside environmental health inspections, so thinking of the role FSA play and others in that and how they're assessed. I think it seems like a thing that's possible. I guess, the question is whether it's probable or not. But yeah, I don't know if you've got any thoughts on that.

Tom: It seems like a no-brainer. But I mean, environmental health colleagues are busy. As far as I understand, they have challenge enough keeping up with the environmental health inspections that they need to do.

So quite often, when we've heard they've been tasked with monitoring of healthy catering commitments-- so these-- things that businesses can sign up to in some local authorities that say, we're frying our fish in healthy oil. We get a score out of five for your door. These are things that are quite commonly done.

And sometimes environmental health are expected to help with the enforcement of those. And quite often, we hear that's a challenge because they've got some environmental health inspecting to do. So to add an extra thing to the workload might be a challenge. In theory, it seems like an easy answer, though. Yeah. But in practise, it might be more challenging.

Lauren: Yeah. And what we've been thinking about as well at Nesta is it links to the Food Data Transparency Act that I mentioned before. But if you were to have nationally collected data and a better understanding of health across the country and how that's playing out in retailers, then maybe then you could push to have that publicly reported. And then if that's publicly reported, we have a better knowledge of that. And then you could build on that again. And if that's out there, then you could push industry to have different targets attached to that, so a push towards improving the helpfulness of their sales, not their portfolios in a really meaningful way as well.

Tom: Yeah, absolutely.

Lauren: Cool. I'm conscious of the time and that we're kind of almost at the end of it. And I always like to give someone any time for any final reflections that you wanted to share on this, Tom. It's been a really, really, really great really great conversation. And yeah, I was wondering before I go to close if there was anything final you wanted to say before we did that.

Tom: Only that my virtual door, email, Twitter, preferably email, is always open, so let's connect if you want to talk about anything, if anybody on this call wants to talk about anything. Set myself up for a new year full of presentations at local authorities. But if I can come and talk to you about our work and how it might impact your work, then please do get in touch. Always happy to speak.

Lauren: Yeah. And equally from our side at Nesta, if there's anyone who's on this call and wants to hear any more about what we're working with or equally has a great idea for something that we should be doing or exploring, we can really help anyone on the call with, then we'd be very happy to do that as well. So I'm just going to do some final closing bits, but I think firstly, just to say a massive thank you, Tom, for joining us and having this chat.

And it's been great working with you for the past few months as well getting feedback up line. It was a really interesting discussion. And I hope others enjoyed it as well.

Yeah. So thanks to everybody as well online who's joined and those who asked questions. We really appreciate all of those. And Monique in the chat has also just dropped in a short survey to fill in.

So there's a prize for that if you fill it in. So that might tempt people a bit more to do it. And also we'll be sharing various links, so you can make sure that you can reach out to us both and our healthy life team at Nesta email, but also the Feat email, so you can reach Tom and clog up his inbox pre-Christmas.

So yeah, very much love to hearing from you. And yeah, we hope you all have a great rest of your day. So thank you, everyone.