A Food Security Indicator Framework for British Columbia, Canada.

Food security is a determinant of health and increasingly recognized as a focus for health promotion. Led by the Population and Public Health Program, British Columbia Centre for Disease Control, this article outlines the process of development and the evidence-based conceptual framework that guides the systematic selection of food security indicators in the Province. A phased, iterative approach to develop the food security framework was adopted. Phase 1 consisted of a literature search of food security indicator models, and key informant discussions. Phase 2 consisted of modification of the model based on stakeholder consultation. The framework development occurred between January 2016 and April 2019. A structured scan of the literature found no existing conceptual frameworks specific to food security indicators in the Global North. The most relevant and frequently used frameworks for indicator reporting identified were environmental health indicator frameworks. This article presents a matrix framework based on existing environmental health indicator frameworks. It integrates environmental health causal networks (e.g., determinants-current state-impact-response) with food security elements identified as (a) individual and household food insecurity, (b) food systems, and (c) capacity. This framework contributes to food security performance monitoring in the Global North and fills an important gap in evaluating the impact of the public health response to food security. Use of this comprehensive framework can enable program planners and policy makers to be clear about where and how they are attempting to assess, influence and monitor food security, and illustrate the interconnectedness between indicators.

Retail Food Environment Intervention Planning: Interviews With Owners and Managers of Small- and Medium-Sized Rural Food Stores.

Retail food environments are an important setting for promoting healthier diets and reducing the global burden of diet-related disease. The purpose of this 2-year community-university partnership was to develop a health promotion intervention for stores in a rural and remote region of British Columbia, Canada. This article reports on the qualitative interviews that were conducted with retail operators as part of an intervention planning process. Seven in-depth, semistructured interviews were conducted with store owners and managers of small- and medium-sized stores in a rural and remote region. Interviews were analyzed using thematic analysis to identify business operations and practices relevant to intervention planning and implementation. Relevant considerations for health promotion planners included the unique business models of rural stores; the prominence of regional travel and "outshopping" in rural and remote regions; challenges balancing between choice, value, and profitability; relationships with suppliers; and using local products to attract and retain customers. Involving retailers in settings-based approaches to improve population nutrition may help to mobilize existing practices and ensure that interventions are responsive to local context.

Entrepreneurialism and health-promoting retail food environments in Canadian city-regions.

The retail sector is a dynamic and challenging component of contemporary food systems with an important influence on population health and nutrition. Global consensus is clear that policy and environmental changes in retail food environments are essential to promote healthier diets and reduce the burden of obesity and non-communicable diseases. In this article, we explore entrepreneurialism as a form of social change-making within retail food environments, focusing on small food businesses. Small businesses face structural barriers within food systems. However, conceptual work in multiple disciplines and evidence from promising health interventions tested in small stores suggest that these retail places may have a dual role in health promotion: settings to strengthen regional economies and social networks, and consumer environments to support healthier diets. We will discuss empirical examples of health-promoting entrepreneurialism based on two sets of in-depth interviews we conducted with public health intervention actors in Toronto, Canada, and food entrepreneurs and city-region policy actors in St. John's, Canada. We will explore the practices of entrepreneurialism in the retail food environment and examine the implications for population health interventions. We contend that entrepreneurialism is important to understand on its own and also as a dimension of population health intervention context. A growing social scientific literature offers a multifaceted lens through which we might consider entrepreneurialism not only as a set of personal characteristics but also as a practice in networked and intersectoral cooperation for public and population health.

A Systematic Review of the Effect of Retail Food Environment Interventions on Diet and Health with a Focus on the Enabling Role of Public Policies.

PURPOSE OF REVIEW: Update the state of evidence on the effectiveness of retail food environment interventions in influencing diet and explore the underlying role of public policy, through a systematic review of population-level interventions to promote health in the retail food environment, including community and consumer environments. Diet-related outcomes included purchasing, dietary intakes, diet quality, and health including weight. We coded studies for enabling public policy levers underpinning the intervention, using two widely used conceptual frameworks. RECENT FINDINGS: Of 86 articles (1974-2018), the majority (58 articles, 67%) showed at least one positive effect on diet. Thirteen articles (15%) discussed natural experiments, 27 articles (31%) used a design involving comparison groups including 23 articles (27%) specifically describing randomized controlled trials, and 46 (53%) were quasi-experimental (cross-sectional) evaluations. Across the "4Ps" of marketing (product, promotion, placement, and price), promotion comprised the greatest proportion of intervention strategies, especially in earlier literature (pre-2008). Few studies combined geographic access interventions with 4P strategies, and few used robust dietary intake assessments. Behavior change communication remains an intervention mainstay, but recent work has also incorporated environmental and social planning, and fiscal strategies. More recent interventions were multi-component. The retail food environment intervention literature continues to grow and has become more robust overall, with clearer evidence of the effect of interventions on diet-related outcomes, including consumer purchasing, dietary intakes, and health. There is still much scope for development in the field. Attention to enabling public policy could help to strengthen intervention implementation and evaluation in the retail food environment.