Ambiente alimentar no território de unidades básicas de saúde de uma cidade planejada do norte do Brasil

Abstract

The food environment, composed of physical, economic, political, and sociocultural contexts, influences decisions regarding the acquisition, preparation, and consumption of food. Food environments encompass the availability, accessibility, and quality of food, which are crucial for the population's eating habits. Territorial analyses help in understanding how the environment influences the risk of chronic diseases. Thus, the aim of the present study was to analyze the spatial distribution of food establishments around the Basic Health Units (UBS) in the city of Palmas, the capital of the state of Tocantins. This is an observational, descriptive, ecological study, with its methodology based on the technical study of the Interministerial Chamber of Food and Nutritional Security (CAISAN). 34 Health Units in the city were studied. Within the CAISAN classification subgroups, the establishments were grouped into 7 other types. The statistical analysis involved a descriptive analysis of the data with densities by degree of processing and by type of establishment, as well as the creation of a choropleth map according to the distribution of commercial establishments within the coverage areas of the UBS health territories. A total of 1,759 active commercial establishments in 2023 were identified and included in the study. We observed that most establishments were of the mixed food acquisition type (52.6%, n=929), followed by ultra-processed food establishments (35.4%, n=618), and, in smaller numbers, establishments of fresh or minimally processed foods (12%, n=212). Most establishments were minimarkets and others (34.16%, n=601), followed by bars and cafeterias (27.74%, n=488), and less frequently, bakeries (0.22%, n=4) and fruit and vegetable shops (2.50%, n=44). The remainder was divided among establishments of the following types: snack bars and street vendors (9.23%, n=164), restaurants (15.91%, n=280), and supermarkets (10.12%, n=178). In addition to the predominance of mixed and ultra- processed food establishments, there is an unequal spatial distribution. There is a higher concentration of mixed and ultra-processed food acquisition establishments in the central- northern region of the city, especially in the areas covered by the UBS Prof.ª Isabel Auler and Francisco Junior. The UBS Mariazinha Rodrigues da Silva has no establishments in the database and is located on the outskirts of the city. Moreover, there are areas of potential food deserts concentrated in regions farther from the city center. In conclusion, we observed the predominance of mixed and ultra-processed food acquisition establishments in Palmas concentrated in the city center, using the UBS health territories as a reference point. Thus, the study provides information for discussing the complexity of the food environment and its relationship with social determinants of health among health teams. Furthermore, this scenario suggests the need to strengthen dialogue regarding the necessity of intersectoral public policies between urban planning and health aimed at improving the accessibility and quality of food available to the entire population of the territory.