We focus on four complex health issues more prevalent in urban areas
With the Social Progress Imperative, we've developed the first neighbourhood level, health-focused social progress index of its kind.
With Wellcome Trust
Sign up to our newsletter
Our response to the House of Commons' Education Select Committee
Note: Impact on Urban Health is part of Guy’s and St Thomas’ Charity.
Guy’s and St Thomas’ Charity is an urban health foundation, exploring how living in cities impacts on people’s health. We take an applied approach, testing whole-system solutions to complex health issues. We focus our efforts in inner-city London and work in areas that experience the widest health inequalities.
We have an ambitious 10-year programme aimed at tackling childhood obesity. Our goal is to close the ‘childhood obesity inequality gap’: to reduce childhood obesity rates in lower income areas to closer to those in wealthier areas. To achieve this, food options available to children and families in inner cities need to fundamentally change. Nutritious food needs to displace the huge prevalence of unhealthy food as options that meet families’ need for food that is affordable, convenient, tasty and healthy. We work with partners in the private, statutory and third sectors to achieve this mission.
The World Health Organisation has said that childhood obesity is one of the most serious public health challenges this century1. The impacts of obesity in childhood are lifelong: overweight or obese children are more likely to be overweight or obese as adults, are more likely develop health conditions such as diabetes, heart disease and cancer, and are more likely to die earlier2.
Tackling childhood obesity should not just be viewed as a matter for health services. Childhood obesity is strongly linked to some of the main social determinants of health, including living in an urban environment, financial deprivation and ethnicity, and so requires a whole systems approach. Education and early years settings have an important role to play in ensuring children have access to affordable, nutritious food.
We know that the environments children spend their time – their home, school and streets – are key drivers of eating and physical activity3. COVID-19 has already had unprecedented impact on all three of these environments, reducing household incomes, temporarily closing schools and affecting food supply and local retailers, including destabilising school food catering provision in many areas. The consequences of these increases in inequality have potential to be long-term and severe, such as rising rates of childhood obesity.
Our submission to the Education Select Committee inquiry on Food Supply during the COVID-19 pandemic is founded in our expertise in childhood obesity, and our lens as an urban health foundation working to tackle health inequalities. The submission draws on existing evidence, as well as new research we are undertaking to understand the current and likely future impact of COVID-19 on food and diet.
In this submission, we draw the Committee’s attention to the significant impact that COVID-19 and school closures have had on access to healthy, affordable food for families on low incomes in particular. This has exacerbated avoidable challenges — like the poor design of voucher schemes. Targeted and timely action from Government, working closely with schools, businesses and communities themselves, will be essential to ensure the pandemic does not widen even further the childhood obesity gap between the richest and poorest families.
Our submission focusses on the following questions in the inquiry’s terms of reference:
We draw the Committee’s attention to the following pressing issues:
For over 1.3million children from the most deprived backgrounds, Free School Meals (FSM) are an essential guarantee of a regular, nutritious hot lunch4. As FSM currently don’t cover breakfast, many schools also offer breakfast as part of their extended hours childcare provision. The impact on school closures on children’s diets has therefore been significant. It is encouraging that national Government has continued funding for FSM in England through schools and supermarket channels during school closures, and has committed to the COVID Summer Food Fund5.
However there remain some pressing issues to be addressed. At an overarching level, it is vital that initiatives such as the FSM voucher scheme don’t solely address food insecurity, but also ensure that families on low incomes have access to nutritious food during this period and as the longer-term, economic impacts of the pandemic are felt.
Guy’s and St Thomas’ Charity have funded an emergency schools COVID-19 response project in Lambeth and Southwark. By week eight of the project, breakfast boxes had been delivered to families at 101 different schools, with enough food for 236,730 healthy breakfasts. Hampers had been delivered across eight schools providing 25,200 lunches.
The scale of the demand for this support has far outstripped the official numbers of families eligible for FSM. A major driver of this is the increase in families experiencing financial hardship and food insecurity due to COVID-19: evidence shows that families on low income have been hit hardest by job insecurity and unemployment due to COVID-19. This increase in eligible families raises urgent challenges:
As we enter the summer holiday period, the COVID Summer Food Fund needs to address these challenges to ensure as many families as possible are benefitting from this support. Guy’s and St Thomas’ Charity would be delighted to support this work, for example by convening retailers and other interested stakeholders to model solutions. Actions should include:
Healthy Start vouchers do provide welcome support for families with pre-school aged children (and pregnant women) in England, Northern Ireland and Wales, enabling access to dairy or formula milk, and fresh fruit and vegetables for those who are eligible for other benefits. The scheme is due to be digitalised in October 2020, but at present uses printed vouchers. Extended periods of social distancing mean that families without access to a printer may not be able to continue accessing this scheme.
We recommend that the digitalisation of the Healthy Start scheme is brought forward.
COVID-19 and school closures have highlighted the fragility of the school food catering market in many areas. As school food caterers have struggled with financial uncertainty and workforce shortages due to COVID-19, early evidence indicates that the nutritional quality of school food has taken back seat. For example, many schools have been reliant on packed lunches as opposed to hot meals as they re-open to pupils, due to social distancing guidelines. Our own engagement with schools indicates that this may continue as schools fully re-open in September.
It is vital that schools and caterers are supported to prioritise the provision of hot, nutritious meals – shown to be healthier than packed lunches in most cases11 – for as many children as possible in the Autumn Term.
3 Impact on Urban Health & Behavioural Insights Team, ‘Bitesize: Breaking down the challenge of inner-city childhood obesity’ (2018)
6 Food Foundation survey ‘The Impact of Coronavirus on Food’ (April 2020).
8 School Food Matters (14 April 2020).
We're partnering and collaborating with food retailers and manufacturers to improve local food retail environments.
Sharing how we're working across sectors to address obesogenic streets and what our next steps are through our ‘streets’ strand.
The evidence we've gathered on childhood obesity, alongside others from the sector, is supporting changes in policy.
Ten ambitions for London to give every child nutritious food options, plenty of water to drink, and opportunities to run and play.