Impact case study database

Improving population health and reducing inequalities by empowering planning decisions to promote healthier food environments

Globally, around two billion adults and 340 million children are overweight or obese (World Health Organization statistics). In the UK, 35 million adults and three million children are affected by obesity, and the prevalence of obesity is twice as high in the most deprived areas as in the least deprived areas (NHS Digital statistics). Obesity is implicated in the development of heart disease, stroke, diabetes, some cancers, and bone and joint ailments. Ill-health related to overweight and obesity is a significant individual and societal challenge, costing the NHS over GBP6 billion annually (Public Health England statistics).

Cambridge research has highlighted the significance of the food environment, in particular identifying the role of takeaway outlets in unhealthy diets, obesity and inequalities in health. This work has directly informed national public health and planning policy guidelines, and increased media and public understanding of the problem. National guidelines and policies and local planning practices based on Cambridge evidence and tools have been important to achieving improved control of exposure to takeaway outlets across England, promoting better health.

Shaping how the mass media talks about takeaway outlets

Public awareness of Cambridge research on the food environment is high, helping to stimulate the case for change. Helped by proactive engagement, media reporting is now promoting understanding of the negative consequences of takeaways for health and inequalities, thus encouraging stronger action on the part of local decision-makers.

In 2017, for example, Cambridge researchers worked with The Guardian to mark the launch of Feat (www.feat\-tool.org.uk\), a tool now routinely used in rejections of planning applications for new takeaway food outlets across the country where likely adverse impact on health and equality are anticipated. This work resulted in a series of seven articles (#FastfoodUK) as well as features and interactive visualisations, for example highlighting associations between deprivation and fast-food retailing around schools. An episode of BBC’s The Truth About...Obesity (2018) that featured Dr Burgoine and the Cambridge research attracted 2.86 million viewers. Feat underpinned an episode of ITV’s flagship Tonight show (2017). Guided by Cambridge researchers, the Tonight journalists found, via a Freedom of Information request to local authorities, that nearly half (103/209) had tightened up policies on new takeaway outlets, or were in the process of doing so [A].

Research impacts on policy and planning guidance

Cambridge research on takeaways has influenced international policy. For example, it is cited in the World Health Organization’s Healthy prosperous lives for all (2019) report [B]. In Canada, a bespoke version of the Feat tool is under development [B].

Cambridge research has been repeatedly cited in recommendations for planners in national public health and planning policy documents in England, for example the Local Government Association’s Tipping the scales (2016), and Public Health England’s Spatial planning for health (2017) and Obesity and the environment (2016 & 17) [C]. Using the planning system to promote healthy weight environments (2020), a key Public Health England guidance document, not only cites a body of Cambridge research but also contains an evidence summary co-written by Dr Burgoine [C].

Dr Burgoine gave written and oral evidence as an invited witness to the House of Commons Health Committee Inquiry into Childhood Obesity on 8 May 2018 [D]. The subsequent report featured a focus on planning-based takeaway regulation, and recognised the need for evidence to support council planning decisions in order to make them resilient to appeals. This report informed the UK Government’s Childhood Obesity Strategy, published in June 2018 [D]. The Chief Medical Officer’s special report Time to solve childhood obesity (2019) identified the importance of takeaway outlets, citing Cambridge research in support [E]. This report also emphasised the role of local authority planning in controlling takeaway exposure, and the consequent need for specialised evidence.

Empowering local authorities with an evidence base and practical tools

Cambridge evidence and engagement has been highly influential in supporting planning decisions and other activities by local authorities to improve the food environment. For example, Manchester City Council, to support its adoption of new takeaway regulations, cited Cambridge research findings, stating that they “prove there is a link between the density of hot food takeaways per area [and] obesity” [F]. Cambridge researchers have worked in a highly engaged, hands-on way with local planning teams and grassroots groups seeking to defend decisions designed to enhance public health. For example:

In 2015, Cambridge researchers supported a Newcastle community group with a Proof of Evidence document that was considered in an appeal case against opening of a new McDonald’s opposite a major secondary school. McDonald’s subsequently withdrew its planning application [F].

In 2015, Gateshead Council used a portfolio of evidence provided by Cambridge researchers to successfully defend a challenge to their takeaway planning regulations by a prospective takeaway owner. Supported by this evidence, Gateshead’s takeaway restrictions were recognised with a national award. The Council has since been able to cap takeaway numbers at 2014 levels by refusing 100% of all takeaway planning applications and all subsequent appeals since this time – “a real impact on the number of takeaway outlets that would have otherwise been allowed to open across [the] Borough” [G].

The Feat tool has been highly successful in securing impact at local planning level**, supported by its high-quality evidence base and its facility to inform actionable decisions. It has nearly 13,000 users, including those from 573 cities and towns across England [H], attracting an average of 75 new users per week since July 2017. It was highlighted as “a comprehensive online resource” for local authorities in PHE’s 2017 Strategies for Encouraging Healthier ‘Out of Home’ Food Provision [I]. High levels of engagement from local authorities in response are evident. For example, it has been used by local authorities to identify high levels of takeaway exposure and make the case for regulatory intervention, as illustrated by the work of Wolverhampton Council, which has used data from Feat to demonstrate the spread of fast food outlets and make the case for regulatory intervention [J]. It has also been used to foster collaboration between planning and public health teams and to develop planning controls related to hot food takeaways, as illustrated by Hampshire District Council [J], where it is “part of our day-to-day business.”

Since its release, Feat data have been influential in planning decisions across England, including, for example:

Use by Coventry City Council: “if an application for a new takeaway falls in an area that has a higher than national average level of hot food takeaways per thousand population, according to Feat, the application is unlikely to be approved.” In practice, the council successfully implemented this policy for the first time in 2019 to deny planning permission to a prospective takeaway owner. Feat opened up this new regulatory possibility: “Without Feat there wouldn’t have been the evidence…and without the evidence…this policy…would likely not have come into effect” [J].

Use by Middlesbrough planning committee, who refused planning permission to a Chicken Villas takeaway outlet, because “[Feat] show[ed] that there is a saturation of fast food outlets in the area with 52 takeaways within one mile” [J].

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