Segregação econômica em um grande centro urbano: disparidades no consumo e no ambiente alimentar

Abstract

INTRODUCTION: Residential economic segregation and the consequent unequal distribution of establishments that market fresh and minimally processed or ultra-processed foods may be one of the determining factors of consumer disparities and food and nutrition security of the population. However, studies on the repercussion of residential economic segregation on food consumption and the distribution of food-selling establishments are limited to high-income, less unequal countries with different cultural characteristics and food patterns from Brazil. OBJECTIVES: To examine the association between residential economic segregation and food consumption of residents around units of the Belo Horizonte-MG Academy of Health Program and to evaluate the association between economic segregation and the food environment in the City. METHODS: This work will be presented in two articles. Article 1, which was cross-designed, aimed to calculate and describe residential economic segregation in Belo Horizonte-MG and verify its association with markers of healthy and unhealthy food consumption among participants of Move-se academies. Article 2, an ecological study, aimed to analyze the distribution of different types of establishments that market food according to residential economic segregation. Residential economic segregation, categorized as low, medium and high, was calculated for each census tract sampled using Getis-Ord Local Gi* statistics from the proportion of people responsible for households with monthly income of up to three minimum wages. For Article 1, men and women, not users of the Program, aged ≥18 years and participants of the Move–se Academies (2014-2015) study were investigated. The markers of food consumption evaluated were: regular consumption of fruits, vegetables, beans, fish, meat with excess fat, soft drinks and sweets; and replacement of lunch or dinner with snacks. The distribution of food intake characteristics by segregation category was examined from the mean and analysis of the 95% confidence intervals. The binary logistic regression analyses, using the Generalized Estimating Equations (GEE) method were applied to examine the association between segregation and outcomes. In Article 2, establishments selling food were classified as: (1) predominance of the acquisition of fresh food; (2) predominance of acquisition of ultra-processed and (3) mixed. The number of establishments was categorized into: none; one; two; three or more establishments and examined by category of economic segregation. The partial proportional odds regression models were applied to analyze the association between the proportion of establishments and residential economic segregation. For both studies, a significance level of 5% was adopted. RESULTS: We analyzed 3,833 census tracts of Belo Horizonte-MG, 178 of them sampled in the Move-se Academies study. The scores of residential economic segregation in the municipality ranged from -6.64 to 3.92. Of the total sample, 18.9% were areas of high segregation, 41.1% average and 40.0% low. Article 1 found that of the 1,301 participants of the Move-se Academies investigated, 361 (18.5%) lived in areas of high segregation. Associations between high segregation and regular consumption of vegetables (OR: 0.58; CI95%: 0.36-0.94) and beans (OR: 2.01; 95% CI: 1.17-3.49) were significant. In Article 2, it was found that areas of high segregation were 54.0% and 61.0% less likely to have a high prevalence of mixed establishments and acquisition of ultra-processed foods respectively when compared to more affluent areas (p<0.001). CONCLUSION: Residential economic segregation has been associated with consumption of food markers of healthy eating and with the food environment. Highly segregated areas have a higher prevalence of regular bean consumption, lower prevalence of regular vegetable consumption, and lower chance of being areas with a high proportion of mixed establishments and food acquisition compared to more affluent areas. These results denote that both areas of high economic segregation and those of low segregation should be the target of public policies and nutritional interventions aimed at promoting adequate and healthy eating, or to reduce inequalities access to healthy foods or to protect territories from the wide range of unhealthy foods.