Evaluation of planning policy to regulate takeaway food outlets for improved health in England

Poor diet and obesity are leading causes of mortality. Takeaway food outlets (‘takeaways’) tend to sell energy-dense food, with frequent consumption linked to weight gain. There are 60,000 takeaways in England with more in deprived areas and annual growth four times that of population growth.

Physical access (‘exposure’) to takeaways is positively associated with takeaway consumption and obesity. Urban planners are unable to remove planning permission from existing takeaways, but they can refuse permission to new takeaways. The most common form of planning policy is the school-based ‘exclusion zone’ adopted by 44 of 325 LAs in England to date.

The intent of these interventions is to prevent further takeaway proliferation around schools. While appearing to target children, our previous findings suggest this is a politically acceptable means to reduce whole population takeaway exposure.

The health and other impacts of exclusion zones are unknown. If effective, this absence of evidence is a barrier to adoption and implementation and delays public health benefit.

Across seven work packages (WPs) we will exploit the natural experiment of variation in LA intervention to conduct a comprehensive evaluation. WP1: if exclusion zones impact health they must first affect retailing. We will use pre-post data from intervention and control areas to assess impacts on numbers of: takeaways; other food and non-food outlets; planning applications received, rejected, and appealed.

WP2: health impacts could only be observed in the long-term. We will model impacts to 2040 on population: takeaway exposure; obesity prevalence and related morbidity. WP3: policymakers are concerned about economic impacts.

We will model costs and benefits by 2040 to: businesses, local economy, local and national government, NHS; society. In WPs 1-3, impacts will also be explored by urban/rural and socioeconomic contexts. WP4: LAs benefit from the experiences of others.

We will conduct post-intervention stakeholder interviews to understand: implementation experiences and perceived effectiveness; implementation barriers and facilitators; how the intervention might be optimised; and with stakeholders we will produce LA guidance on how to best implement future interventions. WP5: how takeaways react to the intervention and how LAs respond is likely to affect policy content and uptake.

We will exploit public consultation data to document how: takeaways react to the intervention; LAs respond to takeaway reactions; and whether these stakeholder narratives have changed over time. WP6: policies with public support are more likely to be adopted, and perceived effectiveness increases acceptability. We will explore overall and by SES, the proportion of children and adults who: are concerned about takeaways and why; support the intervention; think the intervention will be effective. WP7: we will work with policymakers to synthesise and disseminate findings.