Why Do We Measure It?
Better information on the availability of healthy food and opportunities for exercise will enable communities to take action to reduce adverse health outcomes associated with a poor diet and lack of physical activity.
Although research on the food environment is still in its early stages, there is strong evidence that access to fast food restaurants and residing in a food desert correlate with a high prevalence of overweight, obesity, and premature death.[1-3] Supermarkets traditionally provide healthier options than convenience or corner stores/bodegas. Limited access to fresh fruits and vegetables is a barrier to healthy eating and is related to premature mortality.
Literature indicates that the number of calories consumed daily has increased over the past several decades. Among children, fast food restaurants are the second highest energy provider, second only to grocery stores. Environments with a large proportion of fast food restaurants have been associated with higher obesity and diabetes levels.[1,7]
Similarly, access to places for recreation is associated with higher rates of physical activity and lower rates of obesity.[1,8] The evidence for the effectiveness of improving access to recreational facilities is so strong that the Centers for Disease Control and Prevention (CDC) recommend it as one of the 24 environmental- and policy-level strategies to reduce obesity.
Researchers have used a variety of strategies for built environment measures ranging from geographic information systems to observational assessments. Studies of access to healthy foods generally look at access in terms of distance, income, and transportation. Foods such as fruits and vegetables are commonly available at grocery stores, supermarkets and farmers markets but not in convenience or small grocery stores where a large percentage of Americans purchase their food. [4,10]
Measurements to describe fast food access generally fall under four categories: coverage, proximity, density, or ratios. Coverage refers to the number and type of different fast food opportunities within a specific distance. Proximity refers to the nearest distance between an individuals’ residence, work place, or school and a fast food location. Fast food density is a measure of the amount of fast food restaurants per capita in a specific area. Ratios of fast food stores compare the number of fast food sources to the total number of restaurants in a specific area.[7,11]
Researchers have used several methods to capture important aspects of the built environment that affect physical fitness and activity levels. One approach involves sending teams of auditors to communities to measure built environment factors using specific criteria and tools. To date, this method shows strong promise for collecting reliable and objective data; however, many communities do not have detailed GIS information available and the staff and resources needed to collect and analyze such data are expensive.
What Is the County Health Rankings Measurement Strategy?
The County Health Rankings use several measures to capture the built environment:
- The percent of the population living with limited access to healthy foods is measured using the U.S. Department of Agriculture Food Environment Atlas. Individuals are defined as having low access if they do not live close to a supermarket or large grocery store and are low income.
- Based on data from the Census' County Business Patterns, the fast food restaurants measure is defined as the number of fast-food outlets over the total number of restaurants in a county.
- Also based on County Business Patterns data, access to recreational facilities is calculated as the number of recreational facilities per 100,000 population.
 Ahern M, Brown C, Dukas S. A national study of the association between food environments and county-level health outcomes. The Journal of Rural Health. 2011;27:367-379.
 Taggart K. Fast food joints bad for the neighbourhood. Medical Post. 2005;41.21:23.
 Schafft KA, Jensen EB, Hinrichs CC. Food deserts and overweight schoolchildren: Evidence from Pennsylvania. Rural Sociology. 2009;74:153-277.
 Wrigley N, Warm D, Margetts B, Whelan A. Assessing the impact of improved retail access on diet in a ‘food desert’: A preliminary report. Urban Studies. 2002;39.11:2061-2082.
 Brownson RC, Haire-Joshu D, Luke DA. Shaping the context of health: A review of environmental and policy approaches in the prevention of chronic diseases. Annu Rev Public Health 2006;27:341-70.
 Poti JM, Popkin BM. Trends in energy intake among US children by eating location and food source, 1977-2006. Journal of the American Dietetic Association. 2011;111.8:1156-1164.
 Fleischhacker SE, Evenson KR, Rodriguez DA, Ammerman AS. A systematic review of fast food access studies. Obesity Reviews. 2010;12:460-471.
 Task Force on Community Preventive Services. Recommendations to increase physical activity in communities. Am J Prev Med. 2002;22.4:67-72.
 Kahn LK, Sobush K, Keener D, et al. Recommended community strategies and measurements to prevention obesity in the United States. MMWR Recomm Rep. 2009; 58.7:1-26.
 Hallett LF, McDermott D. Quantifying the extent and cost of food deserts in Lawrence, Kansas, USA. Applied Geography. 2011;31:1210-1215.
 Sharkey JR, Johnson CM, Dean WR, Horel SA. Association between proximity to and coverage of traditional fast-food restaurants and non-traditional fast-food outlets and fast-food consumption among rural adults. International Journal of Health Geographics. 2011;10:37.
 Brownson R, Hoehner C, Day K, Forsyth A, Sallis J. Measuring the built environment for physical activity: State of science. Am J Prev Med. 2009;36.4:99-123.