The environment in which we live impacts on our health. The food available to us in our environment is likely to influence what we eat and subsequently our weight. The use of planning policy can be one way for both local and national government to help shape a healthy environment. In England there are three main types of planning policy used to promote a healthy food environment: 1) restricting new fast-food outlets near schools; 2) restricting new fast-food outlets if the density of existing outlets has surpassed a certain threshold of all retail outlets, 3) restricting new fast-food outlets if childhood obesity rates are above a certain threshold. In 2015, Gateshead council, a local authority in the North East of England implemented all three types of guidance. We utilise a longitudinal administrative dataset, the Food Standards Agency Food Hygiene Rating Scheme Data, covering the period 2012-2019 on all premises selling or preparing food in Great Britain. To analyse the impact of employing all three types of planning guidance on the density, proportion, and number of fast-food outlets in Gateshead, we employ a propensity score matching difference-in-difference approach. We match small geographical areas in Gateshead (lower super output areas) to other local authorities in the North East with similar demographic characteristics that did not implement planning guidance. Results show a reduction in density of fast-food outlets by 12.45 per 100,000 of the population and a 13.88% decrease in the proportion of fast-food outlets in Gateshead compared to other similar local authorities in the North East. There was a marginally significant reduction in the number of restaurants which became insignificant after controlling for population density. These results suggest that a multi-pronged planning approach significantly changed the proportion and density of fast-food outlets in the food environment in the short term (4 years).

In October 2016, Public Health England was initially notified of four cases of cryptosporidiosis among users of two swimming pools. We investigated to identify further cases, the outbreak source, and ensure the implementation of appropriate control measures. Probable primary cases had diarrhoea and reported swimming in the pools 1–12 days prior to illness; confirmed cases were verified by the reference laboratory. Secondary cases had contact with primary cases 1–12 days prior to illness. We identified twenty-two cases: eleven were primary (eight confirmed) and eleven were secondary (five confirmed). Four cases were infected with C. parvum (different gp60 subtypes); all were primary and swam at two pools. Seven primary and secondary cases were infected with C. hominis gp60 subtype IdA16, and all were associated one pool. Failings in pool water treatment and management were identified that likely contributed to the load on the filters and their efficiency. Our investigation identified a complex outbreak, with secondary transmission, involving exposures to two swimming pools. C. hominis IdA16 is rare; it has been isolated from only three previous UK cases. We hypothesize that C. hominis cases arose from a common exposure, and the C. parvum cases were likely sporadic. This investigation highlights the value of integrating epidemiology and microbiology to investigate clusters of Cryptosporidium cases, defining the extent of the outbreak and the likely transmission pathways.