The changing landscape of food deserts and swamps in Flanders, Belgium

Abstract Introduction For decades, people's body weight has been increasing at alarming rates, leading to a worldwide obesity epidemic. One of the main causes of this obesity epidemic is poor diet quality. The food environment has been suspected to be one of the principal drivers of poor diet quality. Older people and families with a poor socioeconomic background can be disproportionately affected. Methods This study maps the food environment in Flanders between 2008 and 2020 by using the concepts of food deserts and food swamps. Food deserts have been defined as neighborhoods that lack access to some or all foods that are required for a balanced, nutritionally adequate diet. Food swamps refer to places where there is an abundance of unhealthy food options relative to healthy food options. A spatial analysis using population- and retail density datasets yielded the change in food deserts and swamps between 2008 and 2020. Results Food deserts in Flanders are found to be small in area and very localized. While food deserts in areas with the two highest deciles of people older than 65 years increased from 1.3% to 1.6% of total surface area in Flanders between 2008 and 2020, the food deserts in areas with the two lowest deciles of low income families decreased from 4% to 2.4%. Food swamps in Flanders on the other hand, are ubiquitous. In 2020, 42.9% of the residential area examined contained no healthy food retailers and 77.7% of the area can be considered a severe food swamp. Areas with a high number of vulnerable groups are healthier than Flanders as a whole because these areas are mostly found in dense urban centers where the ratio of healthy food retailers to all retailers is higher. Conclusions Food deserts are a relatively small problem in Flanders in comparison to the widespread occurrence of food swamps. These food swamps exacerbates the obesity epidemic in Flanders and lead to a shorter health span of the affected individuals and to increased medical costs for society. Key messages • The food environment in Flanders is generally unhealthy, making it easy for individuals to buy unhealthy foods. • Food swamps are a major problem in Flanders, where unhealthy retailers drown out healthy retailers.

The majority of emerging infectious diseases are zoonoses, most of which are classified as ''neglected''. By affecting both humans and animals, zoonoses pose a dual burden. The disability-adjusted life year (DALY) metric quantifies human health burden using mortality and morbidity. This review aims to describe and analyze the current state of evidence on the burden of neglected zoonotic diseases (NZDs) and start a discussion on the current understanding of the global burden of NZDs. We identified 26 priority NZDs through consulting the CDC One Health Zoonotic Disease Prioritization Exercise, the Joint External Evaluation reports, and the WHO roadmap for NTDs. A systematic review of global and national burden of disease (BoD) studies for these priority NZDs was conducted using pre-selected databases. Data on diseases, location and DALYs were extracted for each eligible study. A total of 1887 records were screened, resulting in 72 eligible studies (58 national or sub-national, 12 global, and 2 regional studies). The highest number of BoD studies was found for non-typhoidal salmonellosis (23), whereas no estimates were found for West Nile, Marburg and Lassa fever. Geographically, the highest number of studies were found in the Netherlands (11), China (5) and Iran (4). The number of BoD studies retrieved mismatched the perceived importance in national prioritization exercises. For example, anthrax was considered a priority NZD in 73 countries, but only one national estimate was retrieved. By summing the available global estimates, these diseases would cause at least 10 million DALYs in total. The burden of NZDs at the global level remains scattered, and trends were challenging to identify. There are several priority NZDs for which no burden estimates exist, and the number of BoD studies does not reflect national disease priorities. To have complete and consistent estimates of the global burden of NZDs, these diseases should be integrated into larger global BoD initiatives.

Key messages:
There is a mismatched between the estimated retrieved in the search and the perception of the importance of these disease. This amplify the need for a comprehensive program.

Introduction:
For decades, people's body weight has been increasing at alarming rates, leading to a worldwide obesity epidemic. One of the main causes of this obesity epidemic is poor diet quality. The food environment has been suspected to be one of the principal drivers of poor diet quality. Older people and families with a poor socioeconomic background can be disproportionately affected.

Methods:
This study maps the food environment in Flanders between 2008 and 2020 by using the concepts of food deserts and food swamps. Food deserts have been defined as neighborhoods that lack access to some or all foods that are required for a balanced, nutritionally adequate diet. Food swamps refer to places where there is an abundance of unhealthy food options relative to healthy food options. A spatial analysis using population-and retail density datasets yielded the change in food deserts and swamps between 2008 and 2020.

Results:
Food deserts in Flanders are found to be small in area and very localized. While food deserts in areas with the two highest deciles of people older than 65 years increased from 1.3% to 1.6% of total surface area in Flanders between 2008 and 2020, the food deserts in areas with the two lowest deciles of low income families decreased from 4% to 2.4%. Food swamps in Flanders on the other hand, are ubiquitous. In 2020, 42.9% of the residential area examined contained no healthy food retailers and 77.7% of the area can be considered a severe food swamp. Areas with a high number of vulnerable groups are healthier than Flanders as a whole because these areas are mostly found in dense urban centers where the ratio of healthy food retailers to all retailers is higher.

Conclusions:
Food deserts are a relatively small problem in Flanders in comparison to the widespread occurrence of food swamps. These food swamps exacerbates the obesity epidemic in Flanders and lead to a shorter health span of the affected individuals and to increased medical costs for society. Key messages: The food environment in Flanders is generally unhealthy, making it easy for individuals to buy unhealthy foods. Food swamps are a major problem in Flanders, where unhealthy retailers drown out healthy retailers.
In 2015 the German Prevention Act was implemented. The National Prevention Conference published the first National Prevention Report in 2019 to evaluate the health promotion activities. The second National Prevention Report is planned for 2023. Development of a harmonized prevention reporting system for the German Federal States is needed to form the basis for the contribution of the Federal States to the next National Prevention Report. A working group mandated from the sub-national health authorities has developed a harmonized prevention reporting system for the German Federal States since 2018. The Robert Koch Institute collaborated as representative of the national level during the process. Subject areas for indicators were selected based on a survey in which all 16 State Ministries of Health participated. Indicator subgroups developed indicators for each subject area based on predefined indicator selection criteria. Final set of indicators was adopted by indicator rating and majority voting process. The German Health Ministers Conference acknowledged the indicator system in June 2021. The conceptual framework is adapted from the health determinants model of Dahlgren and Whitehead. The indicator system is divided into 14 subject areas categorized into upstream, midstream and downstream level of prevention indicators. Seventy-three prevention indicators were included as a whole. The indicator short list consists of 32 Core indicators. An overview of the prevention indicator system will be given. First results of a pilot data collection will be shown. Health promotion and prevention reporting tools are needed to monitor prevention policies and evaluate health promotion measures. The prevention indicator system of the German Federal States will be used for the National Prevention Strategy in Germany of which one component is the next National Prevention Report 2023. Key messages: The prevention indicator system of the German Federal States is a useful tool to monitor prevention policies.
The indicator system will form the basis for the German Federal States' contribution to the National Prevention Report 2023.

Background:
The Scottish Burden of Disease (SBoD) Study monitors the contribution of over 100 diseases and injuries to the population health in Scotland, in the context of disabilityadjusted life years (DALYs). Providing robust estimates of burden is the first step in identifying areas of prevention which could have the biggest impact on health; including identification of modifiable risk factors and changes in the underlying risk factor prevalence. Our aim was to estimate DALYs for 2019, to describe the current burden in Scotland and as a baseline for future burden scenarios.

Methods:
The SBoD 2016 study estimated the burden using routine data and patient-level record linkage. For this update, years lived with disability were estimated using 2016 age-sex-deprivation specific rates, assuming no change in disease prevalence from 2016, but taking account of changes to the population structure. Years of life lost were calculated from 2019 observed deaths and the application of the Global Burden of Disease (GBD) aspirational life table. Population attributable fractions (PAFs) were sourced from the GBD 2019 and risk factor prevalence from the Scottish Health Survey.

Results:
In 2019 the leading causes of burden were ischaemic heart disease (IHD), Alzheimer's/other dementias, lung cancer, druguse disorders and cerebrovascular disease, representing over a quarter (27%) of the total DALYs in Scotland. Application of PAFs shows that a proportion of the burden for each of these causes can be attributed to modifiable risk factors.

Conclusions:
IHD continues to be the leading cause of health burden in Scotland in 2019. However recent years show an increase in burden of social causes and diseases affecting the ageing population. Application of PAFs demonstrate the importance of continuing to monitor both the burden of disease in Scotland and the prevalence of risk factors, to provide robust evidence for planning of local and national services. Key messages: The Scottish Burden of Disease continues to monitor the population health landscape of Scotland. Ischaemic heart disease continues to be the leading cause of burden in Scotland.