Company practices and socio-economic inequalities in the food environment: A scoping review

Background

Worldwide, over the last decades, the availability, accessibility, and marketing of unhealthy foods increased and individuals living in socio-economically disadvantaged circumstances are disproportionately exposed to these unhealthy products. The Commercial Determinants of Health (CDoH) capture the pathways through which corporate actors influence health and health inequities. This scoping review aimed to summarize the existing literature on how company practices on food environments impact inequalities in access to healthy food and the mechanisms enabling this.

Methods

Four databases - SCOPUS, MEDLINE, Web of Science, and Embase - were systematically searched for peer-reviewed English-language studies addressing the intersections between the food environment, equity, and the CDoH. The review covered studies published from 2000 to 2024. ASReview and Rayyan software were used for screening.

Results

A total of 320 studies were included, most conducted in high-income countries, particularly the United States (46%). The majority of studies examined retail food environment practices (71%), followed by marketing (6%) and pricing practices (4%), while few studies assessed product composition or labelling (<1%). Respectively, in the retail and marketing domains, 78% and 84% of studies found that disadvantaged populations were exposed to less favourable food environments. Evidence for pricing was mixed (57% indicating disadvantage), while evidence for labelling and composition was scarce.

Conclusions

Company practices shaping food environments are consistently associated with socio-economic inequalities in access to healthy food, particularly through retail availability and targeted marketing. Evidence remains limited for product composition, labelling, and digital food environments. Comprehensive policy action addressing different food environment dimensions is essential to improve equity in access to healthy food and reduce diet-related health inequalities.

Key messages

• Company practices shaping food environments are consistently associated with socio-economic inequalities in access to healthy food, particularly through retail availability and targeted marketing.

• Comprehensive policy action addressing different food environment dimensions is essential to improve equity in access to healthy food and reduce diet-related health inequalities.