Shifting the System: Food Access and Availability in Latrobe City

Shifting the System: Food Access and Availability in Latrobe City

Shifting the System: Food Access and Availability in Latrobe City

Report prepared by: Nikki Visser1 , Julia McCartan1,2 1. Monash University 2. Healthy Together Latrobe Shifting the System: Food Access and Availability in Latrobe City December 2014 Healthy Food Connect

Shifting the System: Food Access and Availability in Latrobe City

Shifting the System: Food Access and Availability in Latrobe City December 2014

Shifting the System: Food Access and Availability in Latrobe City

Contact Julia McCartan Food System Research Officer Healthy Together Latrobe P: 1300 367 700 1300 367 700 E: latrobe@latrobe.vic.gov.au To receive this document in an accessible format phone 1300 367 700 or email latrobe@latrobe.vic.gov.au Except where otherwise indicated, the images in this publication show models and illustrative settings only, and do not necessarily depict actual services, facilities or recipients of services.

© Copyright, Healthy Together Latrobe, Nov 2014 Healthy Together Latrobe, supported by the Victorian Government and partners, is improving the health of our community.

Shifting the System: Food Access and Availability in Latrobe City

Contents Executive Summary . . 1 Background . . 3 Methods . . 6 Findings . . 8 Discussion . . 21 References . . 25 Acknowledgments . . 28 Appendices . . 29

Shifting the System: Food Access and Availability in Latrobe City

Food Access and Availability in Latrobe City 1 Executive Summary Only 7% of Latrobe City residents eat the recommended servings of fruits and vegetables each day. Research has shown that the cost and availability of fresh produce is a significant predictor of eating habits and the consumption of fruits and vegetables. Research was undertaken to assess the cost, availability and level of access to food within Latrobe City.

This project forms builds on previous food system research conducted in Latrobe City in 2013.

The price and availability of fresh produce in Latrobe was investigated by conducting the Victorian Healthy Food Basket (VHFB) survey in 28 food retailers. Access to food within Latrobe City was analysed by mapping different categories of food outlets in a Geographic Information System (GIS) mapping program. This study has identified that the Latrobe City food environment provides inequitable access to affordable, nutritious foods, particularly fruits and vegetables. Key findings of this research include: • The cost of a healthy food basket can vary significantly by up to $170 across the region.

• The satellite towns of Latrobe City are the most expensive area to purchase a healthy food basket for a family of four in Latrobe ($501.78).

• The major centre of Morwell is the cheapest area to purchase a healthy food basket for a family of four ($449.93). • The cost of a healthy food basket in Latrobe is $33.44 more expensive compared with the Victorian average. • It is $35.22 cheaper to purchase the fruit and vegetable component of a healthy food basket for a family of four from greengrocers compared to supermarket retailers. • Takeaway food outlets account for 32% of the total food outlets in Latrobe City. This is a significant share of the total number of food outlets when compared to retailers that sell fresh produce such as supermarkets (7%), greengrocers (1%), and bakery, butcher, fishmonger and poultry retailers combined (14%).

• For every one fresh food outlet in Latrobe (supermarket or greengrocer) there are 3.7 takeaway or fast food outlets. • Out of the 18 fruit and vegetable items surveyed, some satellite towns were missing up to 16 items, indicating significant gaps in access to fruits and vegetables in these towns. • There are also gaps in access to supermarket and greengrocer retailers in the major centres of Latrobe City.

Shifting the System: Food Access and Availability in Latrobe City

2 Food Access and Availability in Latrobe City • There are a significant number of food outlets selling unhealthy food items in close proximity to education centres in Latrobe City.

• Additionally, many food outlets selling discretionary food items are in close proximity to some of the most disadvantaged areas of Latrobe City. There is a clear need for strategies and initiatives that increase the supply of fresh produce in both major centres and the smaller satellite towns in Latrobe City. The findings of this research should be used to advocate for change to the local food system to key decision makers within and external to local government. Additionally, this evidence can inform and assist greater collaboration with the food retail sector in Latrobe City.

Recommendations for future action include:  Continue to emphasise the importance of considering the food system within council policies, plans, strategies, and legislation using this research as an evidence base.  Use the Latrobe Food System GIS mapping information to inform future town planning and development to ensure that there are acceptable levels of access to fresh food outlets.  Investigate the logistics of increasing the supply of fresh produce to satellite towns, ‘food deserts’ and disadvantaged areas in major centres/Encourage local greengrocers and supermarket retailers to improve delivery to these areas.

 Encourage and support takeaway food and dining outlets to offer healthier menu options that include fruits and vegetables.  Encourage the development of more community gardens and local food hubs, particularly in smaller towns of Latrobe and outskirts of major centres  Support mixed businesses e.g. petrol stations, milk bars and convenience stores to increase their supply of fresh produce.

Shifting the System: Food Access and Availability in Latrobe City

Food Access and Availability in Latrobe City 3 Background The Problem According to preliminary survey findings from the Victorian Population Health Survey Report 2011- 12, rates of overweight and obesity in Latrobe are 10% higher than the Victorian average.

1 60.6% of Latrobe residents are considered overweight or obese compared with the Victorian average of 49.8%. 1 Additionally, only 7% of adults in Latrobe meet the recommended daily intake of two serves of fruit and five serves of vegetables a day. 1 This figure exceeded the Victorian average of 5.2%, however these rates are still considerably low.

1 Fruit and vegetable consumption is particularly important as a nutritious diet high in fibre, vegetables and fruit protects against chronic diseases such as heart disease, cancer, diabetes and obesity. 2, 3 A nutritious diet is recognised as important in maintaining and improving health and wellbeing. 4, 5 Additionally, the cost and availability of nutritious food is a recognised as an important determinant of health. 5 Factors influencing healthy eating The factors influencing healthy eating habits are complex. However, the availability and cost of nutritious foods are widely accepted as factors which influence eating habits.

4, 6 Physical access to nutritious foods is an important determinant of health. 4, 7 Research has shown that individuals who have access to good nutritious food are more likely to consume a healthy diet and are less likely to be obese than those who do not have the same level of access. 8 Additionally, access to good, affordable food makes more difference to what people eat than health education, therefore it is important to ensure that individuals have access to a nutritious food supply and are not just educated on the ‘right’ way to eat. 6 Cost is also a large predictor of healthy eating habits as studies have shown that diets high in fruit and vegetables are more expensive than diets which are high in sugar, salt and saturated fat.

2 This means that for low income or welfare dependant individuals and families it can cost a significant proportion of their income to purchase the foods required for a healthy and nutritious diet. Studies in Australia have shown that low income households are less likely to buy and eat healthy food, with income shown to be

Shifting the System: Food Access and Availability in Latrobe City

4 Food Access and Availability in Latrobe City the biggest predictor of food purchasing behaviour, compared to education and occupation. 9 Furthermore, it should be noted that Latrobe City has lower rates of median total weekly family income than Victoria with $1236 the average in Latrobe compared to $1460 in Victoria. 10 This is a difference of $224. The lower rates of total family income for families in Latrobe may be a factor contributing to the lower rates of fruit and vegetable consumption occurring in the region. However, there is currently little understanding of the level of access, cost and availability of food across all regions within Latrobe City.

The purpose of this report  To present a visual representation of food access and availability within Latrobe City by conducting Geographic Information System (GIS) mapping.

 To report on the findings of the Victorian Healthy Food Basket (VHFB) survey regarding the cost of and access to food within Latrobe City.  To provide evidence-informed strategies to relevant stakeholders to improve Latrobe residents’ access to healthy and affordable food. This project will address the first two steps of the Victorian Government’s Healthy Food Connect framework: ‘Undertake a local food needs assessment’ and ‘Identify and prioritise actions’ and builds on previous food system research conducted in Latrobe City in 2013.

11, 12 Healthy Together Victoria Healthy Together Victoria is a state wide systems-based initiative that aims to improve the health of people where they live, learn, work and play.

13 The Healthy Together Victoria initiative focuses on the underlying causes of poor health in workplaces, communities and children’s settings by encouraging healthy eating and physical activity, and reducing smoking and harmful alcohol use. 13 Twelve locally led Healthy Together Communities operate throughout Victoria, including within Latrobe City. 13 Latrobe City Council and Latrobe Community Health Service together form Healthy Together Latrobe. Previous Research Research was previously conducted on Latrobe City’s food system by Monash Nutrition and Dietetics students in 2013.

12 A situational analysis of the natural, socio-cultural, economic and built environments within the Latrobe food system was conducted and identified a number of potential opportunities for future action. This research also identified that in recent years, two local fruit and vegetable wholesalers and four sole fruit and vegetable retailers had closed, which has implications for fruit and vegetable access and consumption rates in Latrobe City over the past few years. 12 This report acknowledges and builds on this previous research conducted in 2013.

Shifting the System: Food Access and Availability in Latrobe City

Food Access and Availability in Latrobe City 5 Context The City of Latrobe is located approximately 150kms east of Melbourne and contains the four major centres of Traralgon, Morwell, Moe/Newborough and Churchill.

14 Smaller townships located within Latrobe City include: Boolarra, Glengarry, Toongabbie, Tyers, Traralgon South, Yallourn North and Yinnar. 14 There were over 73,788 residents living in Latrobe in 2011, with that population expected to increase to 78,215 in 2021. 15 The Socio-Economic Indexes for Areas (SEIFA) ranking is a measure of the relative level of advantage and disadvantage in an area. The lower the ranking the more disadvantage in an area. Conversely, the higher the ranking the less disadvantage in an area. Latrobe City has a SEIFA ranking of 940 and is ranked 133 out of 564 in all local government areas in Australia.

16 Furthermore, Morwell and Moe are ranked in the top 10 percent of the most disadvantaged towns in Australia, and are also ranked as the fourth and sixth most disadvantaged towns in Victoria respectively. 17 There are also considerably higher levels of unemployment in persons aged 15 years and over in Latrobe compared to Victoria, 7.9% and 5.4% respectively.

10

Shifting the System: Food Access and Availability in Latrobe City

6 Food Access and Availability in Latrobe City Methods Victorian Healthy Food Basket Survey The Victorian Healthy Food Basket (VHFB) is a tool developed by Monash University to measure the cost of a ‘healthy food basket’ for four different family types: a family of four (two adults and two children), a single mother with two children, a single male, and an elderly woman. 18 During this study, VHFB surveys were conducted in Latrobe City and data was collected from food retailers including supermarkets, greengrocers, convenience stores and mixed businesses (n = 28) using the VHFB tool.

See Appendix 1 for a list of stores where surveys were conducted. VHFB data was collected over a one month time frame from late August to end of September 2014, with the majority of stores surveyed within a three week timeframe to reduce the variability of price in seasonal produce. The price was recorded for each cheapest, non-generic product, with promotional or special prices ignored as per VHFB protocols. All supermarkets and green grocers within Latrobe City were surveyed except for one supermarket where management refused. Although greengrocers typically do not stock all the items included in the survey, they were included in the data collection so that comparisons could be made between the cost of fresh fruit and vegetables in greengrocer retailers compared with supermarket retailers.

Data analysis was conducted on only the fruit and vegetable component of both baskets. Several convenience stores and mixed businesses were included in the data collection as these can be the only or nearest food access point for many Latrobe residents, particularly those living in some of the smaller satellite towns. Whilst many of these businesses were missing items from the VHFB survey it was important to include these in the data collection as each of these businesses have the potential to stock all items contained in a healthy food basket.

All stores were grouped into four area codes as seen in Figure 1. Major centres were each given their own area code and the smaller satellite towns of Latrobe City were combined into one area code so that no individual businesses could be identified in the data analysis, as per VHFB protocols. Comparisons could then be made in the cost of a healthy food basket between the major centres (area codes 1, 3 and 4) and the satellite towns of the region (area code 3). Analysis was conducted on the mean, median, standard deviation, minimum and maximum values for each of the four area codes as well as for Latrobe City as a whole.

Averages were also calculated for the percentage of income that a healthy food basket would cost a family of four (two adults and two children) receiving Centrelink benefits. An analysis of the availability of fruit and vegetables was also conducted in the satellite towns. This was done to better understand the level of fruit and vegetable access away from Latrobe’s major centres as often there was only one food access point for residents in these towns.

Food Access and Availability in Latrobe City 7 Figure 1: Area codes for VHFB analysis Area Code Township/s 1 Moe, Newborough 2 Morwell 3 Churchill, Boolarra, Yinnar, Yallourn North, Glengarry, Toongabbie, Tyers, Traralgon South 4 Traralgon, Traralgon East Significance tests were conducted on the following data comparisons: satellite versus major centres, and greengrocers versus supermarkets (fruit and vegetables only). These non parametric data sets were analysed using SPSS (version 21.0). A Mann-Whitney U-test was conducted and a significance limit of p=0.05 was set. Where the p-value was less than 0.05 the results were deemed to be statistically significant.

Where p-value equalled greater than 0.05 the results were deemed to be not statistically significant.

GIS Mapping Geographic Information System [GIS] mapping was undertaken for all food access points within Latrobe City. GIS mapping is a tool that assists in the collection and display of data in relation to its place and is a useful public health tool. 19 GIS data can be mapped in relation to other key infrastructure and public health information including transport routes, schools, hospitals, and other amenities. GIS mapping was used in this project to gain a better understanding of geographical distributions of different types of outlets throughout Latrobe City, the density of different types of food outlets, and to identify any ‘food deserts’ that may exist within Latrobe where there is limited access to fresh food and produce.

Using data obtained from both the Latrobe City Council’s Health Services and Economic Sustainability teams, the Prime Safe online database and desktop research, a database of all the food outlets and food access points within the Latrobe City was developed. Each food outlet was allocated to one of 15 categories, which can be seen in Appendix 2. Pubs, clubs, hotels and motels where meals may be served were excluded from this analysis. This data was then uploaded to the Intramaps database. Data was then analysed through the development of a series of GIS maps that could analyse the placement and distribution of different food outlet categories throughout the entire Latrobe City municipality.

8 Food Access and Availability in Latrobe City Findings Victorian Healthy Food Basket Survey The following are the findings of the VHFB data analysis for Latrobe City. Note that all analyses are based on the cost of a healthy food basket for a family of four (two adults and two children).  The cost of a healthy food basket for a family of four in Latrobe City ranged from $415.70 to $586.18 (see Appendix 3). This is a difference of $170.48 from the cheapest to the most expensive basket.  The average price of a healthy food basket for a family of four was $480.84 in Latrobe City. Based on this price a healthy food basket would cost 35% of a family of four’s total fortnightly government assistance from Centrelink (see Appendix 3).

 The Victorian average price of a healthy food basket for a family of four is $447.40. Therefore the healthy food basket is $33.44 more expensive in Latrobe City compared with the Victorian average.  The cheapest area to purchase food was within Morwell, with an average cost of $449.93 (see Appendix 3).  The most expensive area to purchase foods was area 3, which contains the satellite towns of the region, with an average cost in of $501.78. It should be noted that the cost in area code 3 ranged from $458.79 to $586.18, a difference of $127.39 (see Appendix 3).

 The average cost for major centres combined (area codes 1, 2 and 4) was $469.67 (see Appendix 3).

This was $32.09 less expensive than the cost in area code 3, the satellite towns of Latrobe City. The cost of healthy food basket for major centres ranged from $415.70 to $532.23, a difference of $116.53 (see appendix 3). Additionally, the difference in the range between satellite towns and major centres can be seen in Appendix 4, a box plot analysis of the cost of a healthy food basket of major centres versus satellite towns, which differences in the range between these two groups. The statistical significance of the cost difference between major centres and satellite towns was tested with a Mann-Whitney U-test with this test indicating that these results were not statistically significant (p=0.93).

However, the results can be classed as clinically significant since $32.09 is still a substantial amount of money for a low-income family.

 When comparing the cost of fruits and vegetables in greengrocers versus supermarkets it was found that the average cost of fruit and vegetables was $127.67 at supermarket retailers and $92.45 at greengrocer retailers (see Appendix 5). This shows that on average it is $35.22 cheaper to purchase

Food Access and Availability in Latrobe City 9 the fruit and vegetable component of healthy food basket for a family of four from a greengrocer than from a supermarket in Latrobe City. See Appendix 6 for a box plot analysis of the cost of fruit and vegetables in supermarkets versus greengrocers that shows a clear difference in the range of costs between these two categories.

For the supermarket and greengrocer fruit and vegetable cost comparison a Mann-Whitney U-test indicated that these results were statistically significant (p=0.002).

Availability of fruit and vegetables When analysing the availability of fruit and vegetables within the satellite towns of Latrobe City (area 3), it was found that out of 18 items of fresh, tinned and frozen fruits and vegetables, some towns had up to 16 missing items. Therefore residents in these towns only had access to two fruit and/or vegetable items if they were unable to travel to another location where there was greater access. Additionally, it was reported by retailers in satellite towns that stocking fresh produce such as fruits and vegetables was often inconsistent and sporadic, which has further implications for the level of access that residents have to fresh produce in these areas.

Food outlet database The food outlet database developed for the purpose of providing data for GIS mapping assisted in discovering the following findings:  As of October 2014, there were 89 takeaway food outlets, 82 cafés and restaurants, 20 supermarkets and 4 greengrocers in Latrobe City (see Appendix 2).  The takeaway outlets represent 32% percent of the total number of food outlets in Latrobe City, whilst supermarkets represented 7%, greengrocers 1%, and fresh retailers such as butchers, and bakery combined represented 14%, see figure 2 below.

 There is a disproportionate number of fresh food outlets compared with outlets which provide discretionary choices.

For every one fresh food outlet in Latrobe (supermarket or greengrocer) there are 3.7 takeaway or fast food outlets.