Shaping the food environment An urgent priority for improving health

How well are we tackling obesity and diet-related ill health in England, compared with best practice elsewhere? What would an end-of-term report on government food and health policies in England be saying today? ‘Good in places, but lacking a coherent approach’, might be the assessment based on a valuable new 'report card' of food policies from the Food Foundation.

Poor diet is now the leading cause of preventable disease in England (just ahead of tobacco) and there are clear warning signals that the crisis in our national diet continues to worsen. Child obesity rates rose again this year and the number of people in the UK suffering from diabetes – strongly associated with obesity – is now over four million (projected to rise to five million by 2025).

In recent decades, the nutritional quality of our diets has degraded. Major changes in the food environment – towards heavily marketed, processed convenience food and snacks – mean we now eat far more foods high in fat, sugar and salt and low in fibre. Food prices are expected to rise while incomes remain stagnant (recent analysis from the Institute for Fiscal studies shows that salaries in 2021 will be equivalent to those in 2008 due to inflation). The ability to afford even poor quality diets is getting harder for people on low incomes with record numbers using food banks this year.

Other countries are grappling with similar challenges. The Food Foundation’s analysis uses the Food Environment Policy Index (Food EPI, developed by an international network of experts) – a tool to identify and prioritise actions that are needed to fill critical gaps in government policies, compare national performance against international best practice and monitor progress over time. It has been applied in New Zealand and is now being used in other countries including Thailand, South Africa, Chile, Canada and Australia.

The Food EPI allows us to look ‘upstream’ at the policies and infrastructure that influence the food environment and dietary choices, which in turn can increase the risk of cardiovascular disease, diabetes and many cancers. What is distinctive is the process of consultation with policy officials as well as independent experts in food, nutrition and health policy. It captures judgements on the importance of different policies and the feasibility of them being implemented to give an accurate and realistic picture of policy action and gaps.  

So how well does the food environment in England compare? On the positive side, we score well on data collection and providing information to the public. According to the Food EPI, we have world-leading systems to monitor obesity rates and risk factors for diet-related diseases, and good public access to government food- and diet-related policies (through government websites and the Freedom of Information Act). We also have well-developed national dietary guidelines (revised this year to reflect new recommendations for lower intakes of free sugars) and a good standard of labelling on packaged foods (including widespread use of nutritional ‘traffic light’ labels). England is also ahead of many countries by having statutory food standards in most schools.

Where we do less well is on upstream policies and infrastructure actions to protect and promote nutrition and health. Restrictions on food advertising to children are very limited compared to jurisdictions like Quebec, which has a ban on advertising in any media to children under 13 and the lowest rates of childhood obesity among the Canadian provinces. We also lack a government-led, systems-based approach to improving the food environment. The Food EPI rating reflects that responsibilities in England are devolved to local authorities whose powers are limited and may lack the required leadership to ensure success. Scotland, by contrast, is due to launch a Good Food Nation Bill in 2017 which promises to address procurement, waste, health, education and social justice.

What the Food EPI methodology does not show us is how government policies and their implementation may widen inequalities in risk factors and in health. The latest childhood obesity figures for England show that the gap between the most and least deprived groups is growing. Nor does the tool currently look at policies relating to food insecurity or sustainable food and farming.

If we are to turn around an increasingly unhealthy and unfair food system, the piecemeal approach to food and nutrition must be upgraded to a coherent national plan and broadened to take account of widening inequalities and the needs of future generations. As a contribution to the evidence base, we are co-funding a project by the UK Health Forum called Eating Well Within Our Means. Next year, the project – which brings together perspectives from researchers and organisations working in health, environment and sustainable development – will produce analysis and recommendations that could inform a coherent national strategy for healthy and sustainable diets in the UK. A comprehensive approach will be essential in combating the rising tide of obesity and helping people overcome the multiple factors that get in the way of making healthy eating decisions for themselves and their families.

Jane Landon is a Strategy Advisor at the Health Foundation, on a 12-month secondment from the UK Health Forum where she is Deputy Chief Executive