We focus on four complex health issues more prevalent in urban areas
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Children's health and food
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Our response to part two of the National Food Strategy authored by Henry Dimbleby.
In Part 2 of his National Food Strategy, Henry Dimbleby makes the case that our food system is having a negative impact on population health, through a decades-long – and reinforcing – cycle of supply and demand for food that is high in salt, fat and sugar and low in other nutrients.
This chimes with our evidence which shows childhood obesity is an issue of unhealthy and unequal food environments. For the past five years we have been focused on changing the food available to children and families in the places they live, go to school, and shop.
The Government has committed to addressing inequalities through its Levelling Up agenda and its obesity strategy aims to reverse rising obesity trends. But these commitments only become meaningful when matched with equally bold policy implementation. The National Food Strategy gives a clear picture of what this looks like in practice.
Changing the ‘junk food’ cycle needs a seriously disruptive force, which can only come from government intervention. It is impossible for individual people and individual companies to shift the entire direction of food environments. To be sure, this is a collective problem that needs government intervention.
Food retailers make decisions on the products placed in shops, and how they are priced and promoted. With 80% of household food spend happening in supermarkets, these decisions influence – potentially more than any other factor – what people buy, and ultimately eat. Our work with the Consumer Goods Forum showed how practical in-store changes to pricing and promotion lead to healthier baskets, without a negative impact on sales.
The food industry has huge research, development, and innovation expertise. This can be put towards producing healthy products that also meet people’s needs around affordability, convenience, and taste. Our pilot Good Food Fund demonstrates this. This is supporting healthier challenger brands to scale and replace popular High Fat Sugar Salt products.
However, these industry interventions must happen fast and at scale to make a difference to population health. For this pace to be achieved, the commercial risk of undertaking them needs to be reduced. Only government has the levers to make this happen.
“ It is impossible for individual people and individual companies to shift the entire direction of food environments – this is a collective problem that needs government intervention
It is impossible for individual people and individual companies to shift the entire direction of food environments – this is a collective problem that needs government intervention
The levy on sugary drinks demonstrated exactly how this works in practice; leading many companies to reformulate products, removing over 30,000 tonnes of sugar from customers’ baskets. Extending this type of fiscal measure – as the proposed Sugar and Salt tax does – across food product categories, would give it the coverage it needs to make a serious impact across people’s food purchasing.
More broadly, government needs to stop viewing commercial markets as something in opposition to or wholly separate from public health intervention. For example, the Healthy Markets campaign that we have funded through ShareAction demonstrates through investor dialogue that company action on health is linked to their bottom line. Longer-term trends suggest that demand for responsible industry behaviour is only set to increase. So the campaign calls for companies to disclose (and improve on) the percentage of their sales from healthy vs unhealthy food products.
Tesco is the first company to take this challenge on, because of investor pressure. To further this success, we support the recommendation in the National Food Strategy to mandate big food companies to report on the source of their sales. Creating a standardised metric, and forcing disclosure against this, will create a level playing field. Within this, companies can create environments that are good for both health and business.
The school food market has some similar competing incentives. This leads to food on pupil plates often falling below School Food Standards regulation. When we researched this in our London boroughs, we saw that innovative practice by schools and school food caterers to deliver nutritious school food was happening despite, not thanks to, the complex procurement structures around them. Therefore, we support the National Food Strategy recommendation to strengthen public procurement rules, to drive focus towards nutritional quality.
We need policies like this that tackle the root causes of dietary inequalities. Initiatives that assume people are low on money, time, and headspace – thereby demanding the least additional efforts from people as possible – are the only ones with any evidence of working at scale to change diets, whilst also reducing inequalities. Government health interventions tend to ignore these real-world and commercial aspects – either through an overemphasis on individual education and weight management support or by viewing commercial markets as something in opposition to public health intervention.
Complementary food subsidy policy adds to the focus on tackling obesity as an issue of inequality. We have spoken before about how effective food subsidy policy needs to have an eye on both accessibility and quality. The National Food Strategy points to this in their recommendations to extend eligibility to Healthy Start and Free School Meals. We would go further and apply the same principle of scale as the industry recommendations.
Universal provision is the easiest way to reach those in need and allow food subsidy programmes to focus on nutritional quality rather than complex and costly administration. More broadly, government can take lessons from the charity sector in innovative and user-focused delivery. For example, the Rose Vouchers scheme achieves the aims of Healthy Start, with higher take-up and additional benefits to local economies through its placement in local food markets.
Today, as part of Guy’s & St Thomas’ Foundation, we are calling on the government to demonstrate clear leadership. We also want to see ambition in its response to National Food Strategy. The focus should be on creating a food system that promotes health and wellbeing for the entire population.
Looking ahead to the next 6 months we stand ready to support the Government in shaping its response based on our experience and evidence of what works well for companies, investors, schools, and citizens.
Where children grow up is a big predictor of their chances of becoming overweight or obese. We think the strategy can go further to tackle childhood obesity.
Our response to the Department for Environment, Food and Rural Affairs
The evidence we've gathered on childhood obesity, alongside others from the sector, is supporting changes in policy.
For food programmes to have a meaningful impact on health inequities, they need a persistent eye on two things: access and quality.