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Over the last 2 decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization, and development. These changes have altered African food environments and, subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transition have contributed to Africa's complex burden of malnutrition—obesity and other diet-related noncommunicable diseases (DR-NCDs)—along with persistent food insecurity and undernutrition. Available evidence links unhealthy or obesogenic food environments (including those that market and offer energy-dense, nutrient-poor foods and beverages) with suboptimal diets and associated adverse health outcomes. Elsewhere, governments have responded with policies to improve food environments. However, in Africa, the necessary research and policy action have received insufficient attention. Contextual evidence to motivate, enable, and create supportive food environments in Africa for better population health is urgently needed. In November 2020, the Measurement, Evaluation, Accountability, and Leadership Support for Noncommunicable Diseases Prevention Project (MEALS4NCDs) convened the first Africa Food Environment Research Network Meeting (FERN2020). This 3-d virtual meeting brought researchers from around the world to deliberate on future directions and research priorities related to improving food environments and nutrition across the African continent. The stakeholders shared experiences, best practices, challenges, and opportunities for improving the healthfulness of food environments and related policies in low- and middle-income countries. In this article, we summarize the proceedings and research priorities identified in the meeting to advance the food environment research agenda in Africa, and thus contribute to the promotion of healthier food environments to prevent DR-NCDs, and other forms of malnutrition.

Unhealthy diets are the leading cause of mortality and morbidity globally. Simultaneously, the factors that influence diet-related ill-health also drive climate change. Acknowledging the link between health and environmental sustainability, in 2019 the EAT-Lancet Commission outlined a diet beneficial for both humans and the planet. There has since been a drive to adapt this diet for a range of settings. Thus, the Shifting Urban Diets project was initiated to support the City of Copenhagen’s move towards a planetary diet. Food environments are key to shaping dietary practices. To provide evidence on how Copenhagen residents experienced their food environments, one component of this project explored, through photo-elicitation, how residents from one neighbourhood navigated and engaged with their food environment. Ten participants attended participatory photo-elicitation workshops over three weeks in November to December 2019, photographing their food environment and discussing the implications for human and planetary health. Data from the workshops (photos, notes and captions) were analysed thematically. Participants demonstrated the myriad factors that shape food environment engagement. Beyond cost and the built environment, participants chose food outlets that allowed for socialising, that were convenient enough to make time for other activities, and that aligned with values and understandings about the role of food. Participants also naturally drew links between practices that were healthy and practices that were sustainable when considering how they would like the food environment to change. When food priorities and values align with material factors, people are more likely to purchase healthy, sustainable foods.

A changing food environment is implicated as a primary contributor to the increasing levels of non-communicable diseases (NCDs). This study aimed to generate snapshots of selected external food environments to inform intervention strategies for NCD prevention in three countries: Uganda (low income), South Africa (middle income) and Sweden (high income), with one matched pair of urban–rural sites per country. Fifty formal and informal food retail outlets were assessed, and descriptive and comparative statistical analyses were performed. We found that formal food retail outlets in these countries had both positive and negative traits, as they were the main source of basic food items but also made unhealthy food items readily available. The Ugandan setting had predominantly informal outlets, while the Swedish setting had primarily formal outlets and South Africa had both, which fits broadly into the traditional (Uganda), mixed (South Africa) and modern (Sweden) conceptualized food systems. The promotion of unhealthy food products was high in all settings. Uganda had the highest in-community advertising, followed by South Africa and Sweden with the lowest, perhaps related to dierences in regulation and implementation. The findings speak to the need to address contextual dierences in NCD-related health interventions by incorporating strategies that address the food environment, and for a critical look at regulations that tackle key environment-related factors of food on a larger scale., These authors contributed equally to this work: Mark Spires and Aravinda Berggreen-Clausen

Globally, obesity and other diet-related non-communicable diseases continue to rise. Moreover, those living in lower socioeconomic status (SES) neighborhoods in high-income countries, particularly immigrants, are more likely to suffer from negative health outcomes compared to those in more affluent neighborhoods. The high availability and marketing of unhealthy foods as well as tobacco and alcohol has been linked to unhealthy practices contributing towards negative health outcomes. Advertising has the aim of influencing practices and many studies have found that a large portion of advertisements promote unhealthy foods as well as tobacco and alcohol. We carried out a cross-sectional observational study mapping health-related food advertising in 10 low and 12 middle-income neighborhoods in Stockholm, Sweden. By using a checklist with pre-determined categories, we found that almost 60% of the noted outdoor advertisements promoted the sale of energy-dense, nutrient-poor foods and sugar sweetened beverages (i.e., “unhealthy”), compared to 20% of advertisements being food-related health promoting (i.e., “healthy”). On average, lower SES neighborhoods observed in the study had more advertising present (both unhealthy and health promoting) when compared to observed middle SES neighborhoods. In-store advertisements followed the same trend, where the majority in both neighborhoods were “unhealthy”. Furthermore, when considering store type, supermarkets had the most advertisements for both categories, compared to convenience stores and independent grocers; informal vendors had no observed advertisements at all. Exposing those living in lower SES neighborhoods to more unhealthy product advertising may play a role in furthering health and nutrition inequities which are already starkly present in the socioeconomically and ethnically segregated Swedish capital. Further research is needed to understand this nature of advertising in these neighborhoods, including outdoor and in-st, SMART2D project