Study Explores Whether an Area’s Density of ‘Healthy’ Food Retail Outlets Affects Foodborne Illness Risk
Foodborne illnesses remain a significant global public health concern, with an estimated 600 million cases annually worldwide and approximately 4 million cases each year in Canada. Retail food establishments have been identified as a common setting for exposure to foodborne pathogens, and inspection results have been associated with illness risk.
In this context, researchers from the University of Guelph examined whether characteristics of the local retail food environment are associated with food safety infractions, used as a proxy for potential exposure to foodborne hazards.
Study Design and Scope
Published in Environmental Health Review, the study analyzed 12,432 food safety inspections conducted between 2015 and 2019 in the Wellington-Dufferin-Guelph Public Health (WDGPH) unit in Ontario, Canada. Inspections spanned 226 dissemination areas and included high-, medium-, and low-risk facilities (determined based on the Risk Categorization of Food Premises Template, where risk rating corresponds to the likelihood of a foodborne illness outbreak).
In total, 9,500 infractions were identified, of which 2,484 (26 percent) were classified as critical, meaning they posed an immediate public health risk or could lead to foodborne illness.
Researchers applied general linear mixed effects models to assess whether the relative density of "healthier" food outlets or fast food outlets in a given area was associated with the odds of observing any infractions or critical infractions. Analyses controlled for covariates, including measures of marginalization, seasonality, and inspector variability, and were stratified by facility risk rating.
Associations with "Healthy" Food Outlet Density
The researchers reported that the odds of at least one infraction increased in areas with low-to-moderate relative density of healthy food outlets compared to areas with low density. Among moderate-risk facilities, the odds of at least one infraction were 30 percent higher in areas with moderate-to-high density of healthy food outlets.
For critical infractions, the odds tended to increase as the relative density of healthier food outlets increased; however, these findings were not statistically significant. The direction of association was generally consistent for moderate- and high-risk facilities but not for low-risk facilities.
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The authors suggested that these findings may reflect increased access to foods such as raw fruits, vegetables, and leafy greens, which are often consumed without cooking and may carry a higher risk of contamination.
Associations with Fast Food Outlet Density
In contrast, lower access to fast food outlets was generally associated with lower odds of infractions. Areas with no access to fast food outlets showed decreased odds of any infractions and critical infractions compared to areas with the highest density of fast food outlets, with statistically significant results observed for high-risk facilities.
Similarly, low and low-to-moderate densities of fast food outlets were associated with reduced odds of infractions, particularly in high-risk establishments. However, some associations were not statistically significant, and trends varied for moderate-risk facilities.
Interpretation of Results
The researchers reported that the findings supported the hypothesis that the local retail food environment may be associated with risk of exposure to foodborne hazards. Notably, lower access to fast food outlets and unhealthier options was associated with reduced odds of infractions, aligning with prior hypotheses that limited access to healthier foods and greater reliance on certain food establishments may increase the risk of contracting foodborne illness.
At the same time, the observation of increased infractions in some areas with greater access to healthier food outlets indicated that the relationship is complex and may be influenced by the types of foods available and their handling requirements.
The authors emphasized that the analysis was exploratory and that no clear overall trend emerged. They noted that further research is needed to confirm these associations and identify additional factors that may explain the observed patterns.
Public Health and Policy Considerations
The study’s findings suggested that the local retail food environment could be an important factor in understanding and reducing exposure to foodborne hazards. The authors indicated that, if confirmed, these associations could inform targeted outreach to food establishments in higher-risk areas, as well as local policy and inspection strategies.
They also highlighted limitations, including the exclusion of unregistered food operators and the potential lack of generalizability beyond the study region.
Overall, the researchers concluded that these results represent some of the first evidence linking measures of the retail food environment, including the density of healthy and fast food outlets, with food safety infractions as a proxy for foodborne illness risk.
