We focus on four complex health issues more prevalent in urban areas
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Children's health and food
Our response to the Department for Environment, Food and Rural Affairs
Note: Impact on Urban Health is part of Guy’s and St Thomas’ Charity.
We welcome the Government’s commitment to introducing the first National Food Strategy for 75 years and are particularly pleased to see that several departments that contribute to the food environment are involved in this strategy. If the strategy is to cover the sale and purchase of foods (for consumption in the home and out of it), we believe a cross-sector, whole systems approach is necessary to ensure everyone has access to healthy and affordable food.
We also welcome the timescales outlined in in this call for evidence. These demonstrate an understanding of the urgency with which a National Food Strategy is needed.
Our submission to the call for evidence is based on insights from our own research and on-the-ground experience from our childhood obesity. For further information, visit our children’s health and food programme.
While the relationship between income, healthy eating and access to healthy food is complex, rates of diet-related disease are far higher in areas of deprivation than wealthier areas. This gap is clearly growing. Five-year-olds from the poorest income groups are twice as likely to be obese compared to their most well-off counterparts. By age 11, they are three times more likely. A National Food Strategy should therefore emphasise coordinated initiatives that target whole populations within deprived areas.
Our 2018 report, Families and Food: How the environment influences what families eat looks at the influence of low household income on the food behaviours and habits of 44 parents and young people. It observes frequent patterns in how the burden of living under financial strain and instability relates to behaviours that lead to higher rates of childhood obesity. For example, cheap convenience food is an effective — but unhealthy solution — for stretched and time-poor parents.
Our following report – Healthy Returns, published 2018 – looked at patterns in food purchasing amongst families on low incomes. It showed that to afford The Eatwell Guide (the government’s official guidance on what constitutes a healthy diet) these families would need to spend around 60% of their disposable income. Currently they spend around 30% of their income on food.
Together, these reports build a picture of the challenges and barriers across the whole food system to families on low incomes. However, despite recent Government publications, such as ‘Advancing our health: prevention in the 2020s’, rightly highlighting the link between poor diet and deprivation, no firm commitment has been made to addressing deprivation or inequalities as factors in how we consume food.
Policies that do not acknowledge deprivation as a risk factor to childhood obesity risk exacerbating existing health inequalities. We would therefore strongly support the proposal that the National Food Strategy focus on inequalities, as the prevalence of diet-related conditions, such as childhood obesity and Type 2 diabetes, are concentrated in deprived areas.
The white paper informed by this review should set specific, measurable, achievable, realistic, and timely initiatives in relation to the food environment and fair and equitable access to healthy food so that the impact of inequality is front and centre of the food debate. Doing so will enable effective monitoring and identification of what is working, how well it is working and what more can be done to make it work.
Food environments play a vital role in how we buy and consume food. By environment we mean the places that children and families spend their time and the opportunities it provides for healthy eating and actives lives. Unfortunately, based on our evidence and research in inner-city London, the spaces where families and children spend their time, especially in inner cities, are often flooded with many cheap, unhealthy food options.
Drawing from the findings of our report – Bite Size: Breaking down the challenge of inner-city childhood obesity – we would suggest the National Food Strategy focuses on the importance of providing a healthy food environmental for all, through reducing the availability of unhealthy choices. This can be done through restricting the amount of advertising of unhealthy foods and changing the in-store environment, so unhealthy foods are less visible.
We were encouraged to see that the recent Chief Medical Officer’s report, ‘Time to Solve Childhood Obesity’, sets out a very clear framework for action around the advertising, marketing and provision of unhealthy food and drinks. We would encourage the Government to be bold in implementing the recommendations outlined in this report. The National Food Strategy should outline plans to work with the range bodies outlined in the report, including the Department of Health and Social Care, the Department of Digital, Culture, Media and Sport and Public Health England to implement these recommendations.
While ‘Advancing our health: prevention in the 2020s’ goes some way in making recommendations around infant feeding, labelling on foods and improving the nutritional content of food and drink, these should be bolder. There is a clear opportunity for the UK to become a global leader in mandating calorie reduction targets, stopping advertising by fast food outlets and limiting the sale of unhealthy food products that target children.
Our research demonstrates that practical solutions that build on existing habits and journeys rather than demanding large scale changes to people’s routines or behaviours can be more effective in changing people’s eating habits and lifestyles. Through our applied work in inner-city London, we have found that a broad range of relatively simple interventions – applied consistently at both the individual and community levels – have the most potential to tackle childhood obesity when aggregated at the population level.
Below we have listed a few projects that we are investing in that are well positioned for national replication as part of the National Food Strategy. Many of these could be funded through existing Government funds, and without the need for extra spend. We would be delighted to meet with the relevant teams to discuss these in greater depth:
Taking a community led approach – working at neighbourhood level, Healthspace, co-funded by Battersea Power Station Foundation, is running activities to help reduce levels of childhood obesity within a small geography. Led by Oasis Hub Waterloo, the scheme is producing scalable activities with local schools and businesses, helping over 800 children and their families to achieve environmental shifts and find solutions for the high rates of childhood obesity. This could be funded through an outcomes-based commissioning approach or social impact bond.
Creating healthier shopping baskets – we are currently working with The Consumer Goods Forum, collaborating with retailers like Tesco and Sainsbury’s, food manufacturers like Danone and more, to test ways to move consumers towards healthier shopping baskets through a mix of interventions in-store and online, including promotions on fruit and vegetables. Activities will be tested in Lambeth and Southwark and evaluated to inform wider roll-out. This form of localised testing has not been done on this scale before.
Investors as a lever for change – we are supporting ‘Healthy Markets’, a campaign to harness the power of the investment system to support healthier food options for consumers through responsible investment charity ShareAction and the Access to Nutrition Initiative. It will bring investors together to ask major food and drinks companies in the UK market to produce healthier, affordable products, limit marketing of sugary products to children, and provide clear and accurate food labelling.
Increasing affordable healthy food options – we are working with Big Society Capital and Grocery Accelerator to design and test support for healthy and affordable products for families living on low incomes, looking specifically at convenience stores, ready meals and school catering suppliers. Grocery Accelerator are helping us identify a small portfolio of brands and understand the support required to make these products available to families on low incomes. SME lending schemes and Government innovation funds could be directed to support this area.
Based on the points outlined above, we recommend the National Food Strategy contain the following:
We would be delighted to continue to support the development of the National Food Strategy and assist the Government in taking forward the recommendations made as part of this response.
We seek to improve the health of urban, diverse and low-income communities. Our model is to develop solutions, gain insights and share knowledge that can be used to effect change in urban areas like ours. We are therefore open to partnering with anyone who shares our ambitions to making significant changes in tackling inequalities in health. As an independent foundation, we can take risks on new approaches, partner with a wide-range of organisations, and use our assets to leverage further resources.
See more about how we intend to partner to achieve greater impact.
Guys & St Thomas’ Charity (June 2018) Families and Food: How the environment influences what families eat
Guys & St Thomas’ Charity (February 2018) Bite Size: Breaking down the challenge of inner-city childhood obesity
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.
Portfolio Manager Claire Stidston shares more on our pilot to engage wholesalers and convenience stores to drive uptake of healthier options.
Opportunities and barriers in the school food system to prioritise nutritious food for our young people
Working with Sustain, we will propose healthy, sustainable alternatives to existing local and national policy to protect children's health.