Comparing local availability and accessibility to healthy foods across countries: A case study in Madrid (Spain) and Baltimore (USA)

The places where we buy food influence individual dietary behaviors, making local food environments a good example of a mass influence on population diets. Cross-cultural comparison studies, using standardized and reliable... [ view full abstract ]

The places where we buy food influence individual dietary behaviors, making local food environments a good example of a mass influence on population diets. Cross-cultural comparison studies, using standardized and reliable methods, may help understanding the relationship between food environments and diet-related health outcomes.

We aimed to make a cross-national comparison between Madrid (Spain) and Baltimore (US), systematically characterizing the retail food environment in two average neighborhoods in terms of type, and location of food stores, and accessibility and availability of healthy foods. We assessed one neighbourhood (~15,000 residents) in each city selecting median areas in terms of sociodemographic characteristics (segregation, education, ageing, and population density). Store audits were conducted with the same tool collecting data on (a) the number and types of retail food stores present, (b) their overall healthy food availability and (c) availability of fruits & vegetables. Street network analysis (200m, 400m and 800m) of food stores with high healthy food availability were mapped in each city to estimate residents' accessibility.

We found 40 stores in Madrid and 14 in Baltimore. The presence of small food stores carrying fresh foods in Madrid contrasted with the high density of corner and chain convenience stores in Baltimore. Around 80% of Madrid residents lived within less than 200m from a food store with high healthy food availability. In contrast, 95% of the residents in the Baltimore neighborhood lived at a distance of more than 400m from a food store with high availability of healthy foods.

These results may help promoting interventions from local city agencies to allocate resources to improve existing small-sized food stores, and to improve walkable urban environments. These actions may influence purchasing decisions of residents, especially for those who lack adequate access to public transportation or car ownership.