Mapping the availability and accessibility of healthy food in rural and urban New Zealand--Te Wai o Rona: Diabetes Prevention Strategy.
OBJECTIVE
Uptake of advice for lifestyle change for obesity and diabetes prevention requires access to affordable 'healthy' foods (high in fibre/low in sugar and fat). The present study aimed to examine the availability and accessibility of 'healthy' foods in rural and urban New Zealand.


METHODS
We identified and visited ('mapped') 1230 food outlets (473 urban, 757 rural) across the Waikato/Lakes areas (162 census areas within twelve regions) in New Zealand, where the Te Wai O Rona: Diabetes Prevention Strategy was underway. At each site, we assessed the availability of 'healthy' foods (e.g. wholemeal bread) and compared their cost with those of comparable 'regular' foods (e.g. white bread).


RESULTS
Healthy foods were generally more available in urban than rural areas. In both urban and rural areas, 'healthy' foods were more expensive than 'regular' foods after adjusting for the population and income level of each area. For instance, there was an increasing price difference across bread, meat, poultry, with the highest difference for sugar substitutes. The weekly family cost of a 'healthy' food basket (without sugar) was 29.1% more expensive than the 'regular' basket ($NZ 176.72 v. $NZ 136.84). The difference between the 'healthy' and 'regular' basket was greater in urban ($NZ 49.18) than rural areas ($NZ 36.27) in adjusted analysis.


CONCLUSIONS
'Healthy' foods were more expensive than 'regular' choices in both urban and rural areas. Although urban areas had higher availability of 'healthy' foods, the cost of changing to a healthy diet in urban areas was also greater. Improvement in the food environment is needed to support people in adopting healthy food choices.
Medical Research Council Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK.
Jing
J
Wang
Margaret
M
Williams
Elaine
E
Rush
Nic
N
Crook
Nita G
NG
Forouhi
David
D
Simmons
D003132:Commerce / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control; D005523:Food Supply / Q000191:economics* / Q000706:statistics & numerical data*; D058870:Food, Organic / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D009520:New Zealand; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population