Improving local food environments: Stakeholders’ perceptions and systemic efforts to transition towards healthy and sustainable local food environments

Contemporary food environments encourage the consumption of unhealthy and unsustainable food, with negative consequences for human and planetary health. The food environment consists of political, physical, economic, and socio-cultural factors shaping food choices. While (local) governments are responsible for the public health of their citizens, there are insufficient governmental policies targeting food environments. Because of this lack of policies, municipalities have limited (legal) instruments to shape local food environments. Some Dutch municipalities have called on the national government to develop policies giving them the leverage to take action. In addition, municipalities (in the Netherlands and worldwide) are exploring ways to improve local food environments despite the lack of legal instruments. However, there is insufficient evidence regarding the (perceived) healthiness and sustainability of local food environments, and limited understanding of the factors influencing these environments. Moreover, insights into the process and impact of systemic efforts to improve local food environments are needed to support municipalities in implementing efforts to improve local food environments. Therefore, the main aims of this thesis were: 1. To gain insight into the (perceived) healthiness and sustainability of local food environments, as well as the perceived factors and mechanisms shaping these food environments and 2. To gain insight into two systemic efforts to structurally improve local food environments with stakeholders and identify challenges encountered. This thesis showed that most citizens acknowledged that the local food environment was largely unsupportive of healthy and sustainable food choices, for instance due to the presence of unhealthy food advertisements. Still, they mostly considered this unhealthy food environment to be normal and acceptable. At a public music festival setting, citizens thought that other visitors would not consider it normal and acceptable to eat healthy and vegetarian food on site. The results of an interview study from this thesis indicated that most participants seemed open to the possibility of a governmental ban on unhealthy food cues (anything visual that reminds you of food, e.g. food advertisements or the presence of a supermarket) in outdoor public spaces, but believed this to be a complex issue. On the other hand, when asked about their opinion on the same type of governmental ban through a mobile survey, most citizens were opposed to it. This thesis also identified dynamic factors that shape the local food environment, highlighting the need to consider this complexity when improving the food environment. Findings demonstrated that policy makers may engage citizens in the policy-making process to generate effective, long-lasting responses that are likely to receive public support. However, findings also showed the challenges that arise when private stakeholders are involved in policymaking processes addressing the food environment, as their interests do often not align with public health goals.