1) What are the key causes of food insecurity in the UK? Can you outline any significant trends in food insecurity in the UK? To what extent (and why) have these challenges persisted over a number of years?
1.1. Changes and cuts to the benefits system including the introduction of universal credit has led to increases in food insecurity. Research by the Trussell Trust has shown that in areas that have introduced universal credit foodbank use increased by 52% compared with an increase of 13% in areas where it is not yet introduced. The problem is exacerbated by the five week wait people are often faced with when moving onto universal credit. People with disabilities who have been placed in the Employment Support Allowance work-related activity group often by being incorrectly classified as being “fit to work” are also more likely to need to visit a foodbank. Oxford University has conducted research on the reasons households and individuals need to use foodbank use https://www.trusselltrust.org/wp-content/uploads/sites/2/2017/07/OU_Report_final_01_08_online2.pdf
1.2. In addition to changes to benefits, freeze on benefits, benefits sanctions, rising costs of housing and food prices, unstable incomes, disability, mental ill-health and debt were all associated with foodbank use.
1.3. Hunger is a particular problem during school holidays when children are unable to get at least one meal a day at school.
1.4. The latest data from Blackburn Foodbank shows that between April 2018 and end March 2019 4,351 vouchers which provide three meals a day for three days for all members of a family were distributed covering 9,842 people. This is an increase of 21% since 2015 when 3,583 vouchers were distributed. 40% of the vouchers are going to children under the age of 16. There is a strong association between foodbank provision and deprivation, unemployment and child poverty.
1.5. Brexit and in particular a No-deal Brexit is also likely to impact on food insecurity as food prices are predicted to rise. A large proportion of fruit and vegetables are imported in the UK and could be affected by tariffs after Brexit.
2) What are some of the key ways in which diet (including food insecurity) impacts on public health? Has sufficient progress been made on tackling childhood obesity and, if not, why not?
2.1. Recent data shows that diet has overtaken tobacco in having the greatest impact on health in the UK. Unhealthy diets are attributed to a number of health conditions including cardiovascular disease, type 2 diabetes and certain cancers which in‐turn have a massive burden on health and social care institutions. Overweight and obese children also have a 40-50% increased risk of asthma compared to children with normal weight.
2.2. Individuals and families who experience food poverty are more likely to eat a diet which unhealthy; characterised by food that is higher in saturated fat, salt and sugar. Furthermore, they are more likely to eat processed foods which are both cheap and energy dense.
2.3. Food poverty and insecurity has significant and life-long impacts on the mental and physical wellbeing of children.
2.4. Sufficient progress has NOT been made on tackling childhood obesity. In 2017/18 over a third of children aged 10 or 11 are either overweight or obese a figure with no sign that obesity levels will start to decrease with 25% of children predicted to be obese by 2050. There is also a steady rise in childhood obesity prevalence with increasing deprivation.
2.5. Attempts to tackle obesity are thwarted by the strongly obesogenic environment we live in perpetuated by the lobbying and resistance of food industry to making meaningful change.
3) How accessible is healthy food? What factors or barriers affect people’s ability to consume a healthy diet? Do these factors affect populations living in rural and urban areas differently?
3.1. Consuming a healthy diet is not only a behavioural choice but is also influenced by factors such as cost, access and knowledge. We are living in an obesogenic environment which encourages unhealthy food choices with large numbers of fast food outlets particularly in deprived areas. In the UK calories from healthy foods consistently cost more than those from less healthy foods.
3.2. Children who live in the most deprived areas are at an increased risk of adult cardiovascular disease, partly reflecting lower exposure to healthy foods. This learned behaviour can then reinforce adult food preferences for less healthy foods.
3.3. The national Healthy Start programme supports young women and those on low-incomes who are pregnant and/or have children under 4 by providing free vitamins and vouchers for milk and fresh and frozen fruit and vegetables. This initiative should be supported to improve access and increase uptake among this population. https://www.healthystart.nhs.uk/
4) What role can local authorities play in promoting healthy eating in their local populations, especially among children and young people, and those on lower incomes? How effectively are local authorities able to fulfil their responsibilities to improve the health of people living in their areas? Are you aware of any existing local authority or education initiatives that have been particularly successful (for example, schemes around holiday hunger, providing information on healthy eating, or supporting access to sport and exercise)?
4.1. Local Authorities can play a role in promoting healthy eating but it faces barriers including the ongoing and deep cuts to local authority funding and the public health grant that curbs our ability to improve the health of our people. There is also the risk of the perception both politically and in the community of being a “nanny state”. It must also be recognised that any public health budget is dwarfed by the marketing budget of the food industry.
4.2. Despite these barriers local authorities are well-placed to work widely across areas such as public health, planning, education, adult and children services to create healthier places to live provided they are given sufficient resources.
4.3. Initiatives in Blackburn with Darwen (BwD)
5) What can be learnt from food banks and other charitable responses to hunger? What role should they play?
5.1. Food banks should have NO role in a 21st century Britain.
6) What impact do food production processes (including product formulation, portion size, packaging and labelling) have on consumers dietary choices and does this differ across income groups?
6.1. It needs to be made easier for consumers to have a healthier diet. Education and information interventions always putting the onus on the individual does not work when people are short of both money, time and resilience and can widen inequalities.
6.2. Compulsory reformulation of products so that they are lower in fat, sugar and salt is possible as demonstrated by the drinks industry reducing sugar content in response to the sugar tax.
6.3. As a minimum if we wish to help individuals to make informed dietary choices compulsory clear and consistent food labels are required.
7) What impact do food outlets (including supermarkets, delivery services, or fast food outlets) have on the average UK diet? How important are factors such as advertising, packaging, or product placement in influencing consumer choice, particularly for those in lower income groups?
7.1. There are clear inequalities in Child Poverty and Obesity in Reception/Year 6 across Pennine Lancashire and we have some of England’s highest levels of fast-food outlets per head, which demonstrate embedded local inequalities. Our analysis confirms that children and young people (CYP) obesity is correlated with the number of neighbourhood fast-food outlets.
7.2. Children who live in the most deprived areas are at an increased risk of adult cardiovascular disease, partly reflecting lower exposure to healthy foods. This learned behaviour can then reinforce adult food preferences for less healthy foods.
7.3. It should be evident that advertising, packaging or product placement plays a key role in influencing consumer choice or else why do food companies spend millions on advertising and paying to place products at the end of supermarket aisles. Companies are also aware of the benefit of advertising their food product as healthy as can be seen by using labels such as “low in fat”, “organic”, “high in fibre” which can often mask other unhealthy components of the food such as high sugar levels. This is known as the “Framing Effect”. Marketing companies are very effective at using Behavioural Economics to identify the triggers, or biases and nudges that affect the decisions people make.
8) Do you have any comment to make on how the food industry might be encouraged to do more to support or promote healthy and sustainable diets? Is Government regulation an effective driver of change in this respect?
8.1. The failure of the “responsibility deal” approach taken by the government has shown that the food and drink industry will only act if they are forced to by regulation such as the sugar tax. Government regulation can be an effective driver and consideration should be given to introducing compulsory salt and fat reduction in processed foods, extending the sugar tax to all types of food and banning junk food advertising.
9) To what extent is it possible for the UK to be self-sufficient in producing healthy, affordable food that supports good population health, in a way that is also environmentally sustainable?
10) Can efforts to improve food production sustainability simultaneously offer solutions to improving food insecurity and dietary health in the UK?
10.1. There should be synergies between improving food production sustainability and improving food insecurity and dietary health. The Food Foundation recommends “establishing a coherent agricultural policy that addresses and seeks to improve the multiple impacts of agricultural production (environmental sustainability, livelihoods and nutrition/health outcomes) and drives up consumption of safe, high quality, sustainable and healthy food particularly among low income populations”
10.2. Across Lancashire we are aiming to boost local food production and local food networks bringing food growers and suppliers closer to the communities they serve and potentially reap sustainable economic and environmental benefits for all residents. Connecting urban consumers with the local farmers in and around Blackburn with Darwen will help develop a deeper understanding of the value of food and its relationship to our health and the environment.
10.3. More localised food networks will also reduce “food miles” and help reduce greenhouse gas emissions improving air quality.
11) How effective are any current measures operated or assisted by Government, local authorities, or others to minimise food waste? What further action is required to minimise food waste?
11.1. WRAPs Courtauld Commitment 2025 aims to reduce food and drink waste by 20% by 2025 but unfortunately this is yet another voluntary scheme. It is hard to judge how effective this has been as only 2015 baseline data appears to be available.
11.2. Other actions that could be taken include reducing promotions that encourage multiple product purchases, reducing package sizes of more perishable foods alongside a comparable reduction in price.
12) A Public Health England report has concluded that “considerable and largely unprecedented” dietary shifts are required to meet Government guidance on healthy diets.2 What policy approaches (for example, fiscal or regulatory measures, voluntary guidelines, or attempts to change individual or population behaviour through information and education) would most effectively enable this? What role could public procurement play in improving dietary behaviours?
12.1. A recent systemic review showed that certain interventions such as price related interventions i.e. taxes or subsidies are more likely to reduce inequalities while some such as those targeted at individuals using information and education were more likely to actually widen inequalities. Available from https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1781-7#Sec1
12.2. The following approaches could be taken:
12.3. Role of public procurement: The public sector spends about £2.4bn per annum producing food and catering services. Food procured for institutions such as schools, hospitals, care homes, prisons, central and local government workplaces, etc can significantly affect the health, wellbeing and eating habits of the people living and working in these settings. There are Government Buying Standards, which include standards and best practice on nutrition, production, environment and resource efficiency, for Food and Catering Services but these are only mandatory for Central Government procurers.
12.4. A DEFRA report highlights how effective public procurement can support a thriving local economy and also supply quality nutritious food for its customers. It can also help in;
12.5. The Sustain Better food. Better farming. Better lives. Strategy (2014) https://www.sustainweb.org/publications/better_food_farming_lives/ details the need for strengthening public sector standards for food and to ensure public money is invested in wider social, economic and environmental benefits ensuring that all public sector settings are serving healthy, sustainable diets.
13) Has sufficient research been conducted to provide a robust analysis of the links between poverty, food insecurity, health inequalities and the sustainability of food production? How well is existing research on the impact of existing food policy used to inform decision making?
13.1. There is clear and probably sufficient research demonstrating the clear links between food poverty, food insecurity and health inequalities. The problem is that Government has not acted upon the evidence. A nationally collected measurement of food insecurity among both adults and children should be introduced as an Official National Statistic or in the Public Health Outcomes Framework to monitor trends and for more effective planning.
13.2. The Trussell Trust in collaboration with a number of universities have conducted research on food poverty and insecurity https://www.trusselltrust.org/what-we-do/research-advocacy/
14) What can the UK learn from food policy in other countries? Are there examples of strategies which have improved access and affordability of healthy, sustainable food across income groups?
15) Are there any additional changes at a national policy level that would help to ensure efforts to improve food insecurity and poor diet, and its impact on public health and the environment, are effectively coordinated, implemented and monitored?
15.1. Any national policy changes or interventions should be assessed to look at the impact across different socioeconomic groups.
15.2. The Food Foundation (https://www.ukssd.co.uk/measuringup) recommends the following actions to transform our food system to deliver healthy, affordable and sustainable diet for all;
Professor Dominic Harrison, Director of Public Health and Wellbeing, Blackburn with Darwen Council and Emma Savage, Specialty Registrar in Public Health
11 September 2019