The literature contains few examples examining how the opening of a grocery store in a food desert affects the experience of food security of those living in that food environment. Station 20 West (S20W) is a community enterprise centre that opened in Fall 2012 in Saskatoon’s inner city, significantly changing the foodscape of a former food desert. S20W includes the Good Food Junction grocery store (GFJ), community kitchen space, a café, community meeting space, and community organization, health region and university offices. This project investigates the experience of food security for participants in a collective kitchen (CK) at S20W. Using semi-participant observation and responsive interviews, data was collected using phenomenology to learn about participants’ food procurement experiences, their involvement in CKs, and their interaction with S20W organizations and other health-based organizations. This research illuminates the complexity of food [in]security; participants’ lived experiences of food [in]security were intertwined with their health and that of their families. Several participants came to the CK seeking socialization and friendship rather than increased food security. Most participants interviewed were not inner city residents, so their foodscapes were not changed by the opening of the GFJ. However, the S20W CK is a potential gateway to other organizations and services at S20W, and cross-promotion of programs, services, and the GFJ could increase their impact. Further research should explore the changes over time in the foodways of those who interact with S20W, to understand the longer-term effects of a food store opening in a former food desert.

Master of Public Health - MPH / Non-Communicable Diseases (NCDs) are some of the leading causes of death worldwide. Obesity results from the interactions between biology, behaviour, and environment. The current obesity epidemic is largely driven by environmental rather than biological factors, through its influence on social norms regarding food choices and lifestyle behaviours. The number of people dying from diabetes and hypertension keeps increasing because of the current obesity trend.

The prevalence of childhood obesity is escalating rapidly and it considered to be a major public health problem. Diet is a recognised precursor of fatness, and current evidence supports the premise that in Westernised countries, the dietary intakes of children are likely to be important in obesity genesis. However, we have a relatively poor understanding of the environments in which a child’s eating is learnt and maintained. Much of the existing work in this area is based on small-scale or experimental studies, or has been derived from homogeneous populations within the USA. Despite these limitations, there is evidence that aspects of the child’s family environment are likely to be important in determining obesity risk in children. This thesis examines the impact of the family food environment on a child’s eating through two related studies. The first study, titled the Children and Family Eating (CAFÉ) study comprised three phases. Phase one involved qualitative interviews with 17 parents of 5-6 year-old children to explore parental perceptions regarding those factors in a child’s environment believed to influence the development of their child’s eating habits. These interviews were used to inform the development of quantitative measures of the family food environment. The second phase involved the development of a Food Frequency Questionnaire (FFQ) to assess dietary intake in 5-6 year-olds. The FFQ was informed by analysis of 1995 Australian National Nutrition Survey data. In the final phase the relationships between dietary intakes of 5-6 year-old children, and potential predictors of dietary intake were examined in a cross-sectional study of 560 families. Predictors included measures of: parental perceptions of the adequacy of their child’s diet; food availability and accessibility; child-feeding; the opportunities for parental modelling of food intake; a child’s television exposure; maternal Body Mass Index; and maternal education. Analysis of the CAFÉ data provides unique information regarding the relationships between a child’s family food environment and their food consumption. Models developed for a range of dietary outcomes considered to be predictive of increased risk for obesity, including total energy and fat intakes, vegetable variety, vegetable consumption, and high-energy (non-dairy) fluid consumption, explained between 11 and 20 percent of the variance in dietary intake. Two aspects of the family food environment, parental perception of a child’s dietary adequacy, and the total minutes of television viewed per day, were frequently found to be predictive of dietary outcomes likely to promote fatness in these children. The second study, titled the Parent Education and Support (PEAS) Feeding Intervention Study, was a prospective pre/post non-randomised intervention trial that assessed the impact of a feeding intervention to 240 first-time mothers of one-year-old children. This intervention focused on one aspect of the family food environment, child-feeding, which has been proposed as influential in the development of obesogenic eating behaviours. In this study, Maternal and Child Health Nurses (MCHNs), using a ‘Division of Responsibility’ model of feeding, taught parents to provide nutritious food at regular intervals and to let children decide if to eat and how much to eat. Thus parents were encourages to food their child without exerting pressure, or employing coercion or rewards (controlling behaviours). The aim was to influence parental attitudes and beliefs regarding child-feeding. Through the use of these feeding techniques, this intervention also aimed to increase the variety of fruits and vegetables a child consumed by teaching parents to persist with offering these foods, over the year of the intervention, in non-emotive environments. Fruits and vegetables were chosen in this intervention because they are likely to be protective in the development of obesity. Analysis of the PEAS data suggests that this low-level feeding intervention, delivered through existing Maternal and Child Health services, was modestly effective in changing parental attitudes and beliefs regarding the feeding of young children. Further, the validity of fruits offered to intervention group children increased. This thesis expands the existing knowledge base by providing a comprehensive analysis of the relative impact of aspects of the family environment on dietary intakes of 5-6 year-olds. Further, the analysis of a feeding intervention in first-time parents provides important insights regarding the potential to influence child-feeding and the impact this may have on the promotion of eating behaviours protective against obesity.

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This thesis focuses on the food environment of Masiphumelele and seeks to understand how mixed-method approaches could be employed to facilitate an advanced understanding of food access in Masiphumelele. Masiphumelele was chosen as the case study for this research project as this work is sponsored by the IDRC-funded Nourishing Spaces project, which works in Masiphumelele. Based on the food-environment framework, this thesis embarked on the valuation of food environment literature to establish the interconnections between the four pillars of food security, food environments, and food systems in the urban context. The findings of this study endorse other work on food environments that issues of access should not only be understood through the physical and socioeconomic lens but also consider related social aspects that shape, enable or constrain food choices and behaviours in urban contexts. The findings of this thesis underscore the need for the reconceptualization of food environments beyond the simplistic physical and economic access framings which dominate earlier food environment work characterized by food deserts. Following the assessment of existing literature on food security, the discourse revealed that adopting the mixed-method approach that integrates participatory and retail mapping is an applicable conceptual framework for exposing socio-spatial dynamics influencing food utilization and food accessibility in the urban context. Building on the growing scholarly and policy interest of mixed methods approaches this thesis endeavours to establish the significance of the mixed-method approach in facilitating an improved understanding of food access in Masiphumelele.

Le Sénégal est confronté au double fardeau de la malnutrition mais l’influence des politiques publiques et des environnements alimentaires dans cette crise sont peu étudiés. Or, le gouvernement est actuellement engagé à développer les premières Recommandations Alimentaires Nationales (RANS). Dans ce contexte, l’objectif principal de cette étude est d’évaluer les politiques publiques et les actions gouvernementales visant la création d’environnements alimentaires sains au Sénégal en utilisant une méthodologie basée sur l’Indice de Politique pour un Environnement Alimentaire sain (Food-EPI) du réseau INFORMAS. Cette méthodologie permet de recenser, évaluer et définir un agenda de priorités pour les politiques publiques en misant sur une approche comparative et participative. D’abord, les actions gouvernementales et les politiques publiques mises en place par le gouvernement ont été recensées et ont constitué un document de preuves basé sur 43 indicateurs qui fut validé par la Cellule de Lutte contre la Malnutrition (CLM) du gouvernement. Ensuite, un groupe d’experts indépendants (n =15) et d’experts du gouvernement (n =16) a évalué le niveau de mise en œuvre des 43 indicateurs par rapport aux meilleures pratiques internationales en utilisant une échelle Likert. La plupart des indicateurs visant la création d’environnements alimentaires sains ont été qualifiés de « faible » (31 sur 43 soit 72%). L’indice de fiabilité inter-évaluateur était de 0.75 (IC : 0.70 - 0.80). Lors d’un atelier de priorisation, les mêmes experts ont identifié 45 actions prioritaires pour améliorer les environnements alimentaires au Sénégal et réduire le double fardeau de la malnutrition. Ce faisant, le projet a permis de réaliser une recension des actions gouvernementales et d’établir un agenda d’actions prioritaires supporté par un groupe d’experts nationaux. Il a permis de regrouper et de sensibiliser les acteurs nationaux autour des questions cruciales de nutrition publique et il fournira des informations contextuelles importantes au développement des RANS. / Senegal is struggling with the double burden of malnutrition but the influence of public policies and of food environments in this crisis are poorly studied. However, the government is currently committed to develop its first National Food Based Dietary Guidelines (FBDG). In this context, the primary aim of this project is to evaluate public policies and government actions aimed at creating healthier food environments in Senegal using a methodology based on the Policy Index for a Healthy Food Environment (Food -EPI) of the INFORMAS network. This methodology allows to identify, evaluate and define an agenda of priorities for public policies using a comparative and participative approach. First, government actions and public policies set up by the government were identified and constituted a document of evidence based on 43 indicators that was validated by the Government's Malnutrition Cell (CLM).Then, a group of independent experts (n = 15) and government experts (n = 16) assessed the level of implementation of the 43 indicators against international best practices using a Likert scale. Implementation of most indicators aimed at creating healthy eating environments were rated as "low" (31 on 43, or 72%). The inter-rater reliability index was 0.75 (CI 0.70 - 0.80). In a prioritization workshop, the same experts identified forty-five priority actions to improve food environments in Senegal and reduce the double burden of malnutrition. In doing so, the project made it possible to conduct a review of government actions and to establish a priority action agenda supported by a group of national experts. It has brought together national stakeholders around critical issues of public nutrition and will provide important contextual information for the development of FBDG.

Addressing complex global health challenges, including the burden of noncommunicable diseases (NCDs), will require change in sectors outside of traditional public health. Contemporary regional trade and investment agreements (RTAs) like the Trans-Pacific Partnership (TPP) continue to move further ‘behind-the-border’ into domestic policy space introducing new challenges in the regulation of health risk factors. This dissertation aimed to clarify the pathways through which RTAs influence NCDs, and to explore points along those pathways with the intent of improving the existing evidence base and supporting policy development. This work develops a critical theoretical framework exploring the ideas, institutions, and interests behind trade and investment policy; it also develops a conceptual framework specifying how trade and investment treaty provisions influence NCD rates through the effects of trade and investment on tobacco, alcohol, and ultra-processed food and beverage products, as well as access to medicines and the social determinants of health. Using health impact assessment methodology, three analytical components were designed to examine pathways of influence from RTAs to health outcomes as mediated by the interests of transnational corporations (TNCs). The first component explored the influence of industry during the TPP negotiations and how its health-related interests were reflected in the final TPP text. The second component examined the role of trade and investment liberalisation in health-harmful commodity markets, finding a rise in TNC sales after a period of liberalisation. The third component demonstrated how investor rights and investor-state dispute can challenge the state’s right to regulate if it damages the profits of TNCs, which may threaten effective health regulation, and provides opportunities to strengthen the right to regulate. The work in this dissertation provides support for the thesis that trade and investment policies are a fundamental structural determinant of health and well-being, which are highly influenced by TNCs that guide such policies in the interest of maximising their profits and protections, often to the detriment of public policy and population health. This work identifies the need for more robust health impact assessments of RTAs before future agreements are ratified, as well as an imperative to challenge vested interests that entrench neoliberal policy preferences that have hindered sustainable and equitable development.

Thesis (M. Sc. (Dietetics)) -- University of Limpopo, 2021 / Background: Most school food environments in low socioeconomic countries offer cheaper unhealthy snacks of low nutritional value. Generally, these defeat the aims and goals of the National School Nutrition Programmes that offers nutritionally balanced meals to enhance concentration and learning. These unhealthy snacks that are available in school food environments have the ability to promote food choices that may lead to early onset of obesity and diseases of the lifestyle. The creation of healthy school food environments should be observed as a fundamental priority and a responsibility to all stakeholders with the necessary powers. Objectives: The study explored the perspective of school vendors, learners and school governing bodies on snack sale in selected primary schools of Dimamo circuit, Limpopo Province, South Africa. Design and Methods: A cross-sectional, exploratory descriptive study was conducted on the perspectives of vendors, learners and school governing bodies on the sale of snacks in selected primary schools of Dimamo circuit, Limpopo Province, South Africa. Data were collected with 69 participants using a semi-structured questionnaire in one-on-one interviews and focus group discussions at three public schools in the Dimamo circuit. Criteria for trustworthiness were adhered to throughout the study. Ethical principles were adhered to in order to ensure the ethical standards of the study. Findings: A negative perception regarding the sale of snacks was found by both the learners and school governing bodies. However, the vendors were reluctant to raise their views with regard to the snacks sold in schools despite them being aware of the diseases experienced, such as ringworms, rash and vomiting. Improved hygiene practices and sale of healthy snacks was suggested by learners while drawing of a school food policy was seen as a last resort to improve the school food environment. Conclusion: A negative perception towards unhealthy snacks exists among the learners and teachers as they have been disruption in teaching and learning; due to random absenteeism associated with ailments allegedly caused by consumption of unhealthy snacks. However, the vendors reported learners’ preference for the sale of unhealthy snacks viii over the healthy ones due to cost. Furthermore,the vendors reported that the provision of free fruits by the NSNP in school was a challenge. Lack of cooperation, accountability and responsibility amongst the School Governing Bodies (SGB) and vendors were a barrier to facilitating a healthy food environment.