By Dr Aiden Hannah and Dylan Powell, Deloitte Centre for Health Solutions
The opening salvo in the July 2021 The Plan: a National Food Strategy for England, an independent report led by Henry Dimbleby, noted that ‘the food system we have today is both a miracle and a disaster.1 A miracle because intensive agriculture produces more than enough calories (albeit very unevenly distributed) to feed the world; but a disaster because the food we eat and the way it is produced is doing terrible damage to our planet and our health.2 The last few years exacerbated by Brexit, the COVID-19 pandemic, and the current turbulence caused by the invasion of Ukraine has accelerated the fragilities of the food supply chain and demonstrated the crucial importance of UK food producers to our national resilience. Against this background, on 13 June 2022, the Department for Environment Food & Rural Affairs launched the Government food strategy. This week’s blog explores some of the crucial issues in these strategies and the planned interventions to deliver a healthier future.
Why does a healthy food system matter?
Rising rates of obesity
Over one billion people worldwide are obese, with this number continuing to increase.3 Although complex, one of the main contributors to rising obesity levels is the wide availability of cheap, highly processed, calorie dense foods and drinks. At the same time, the global food system is the single biggest contributor to biodiversity loss, deforestation, drought, freshwater pollution, and the collapse of aquatic wildlife; and the second biggest contributor to climate change, after the energy industry. Consequently, the reduced quality and nutritional density of diets is significantly negatively impacting planetary and population health. An estimated 300,000 years of healthy life are lost to diet-related illness or disease in the UK every year, rising to almost 1.5 million years once the years lost to premature death are factored in.4
Reducing health inequalities and levelling up
One of the core strategic objectives of the July 2021 National Food Strategy was to reduce diet-related inequality.5 The review’s recommendations note that overconsumption of sugar and salt are contributing to the poor health of the nation, with a variety of implications including increased risk of stroke, heart disease, diabetes and the associated operational and financial burdens to the healthcare system. Crucially, those in low-income households are disproportionately affected, with these individuals consuming more sugar on average. Research estimates that sugar constitutes 10 per cent of individual’s diets for the richest fifth of the population, but this increases to 12 per cent for the poorest fifth.6
In our January 2022 report Negating the gap: Preventing ill health and promoting healthy behaviours, we noted that failure to improve preventative services disproportionately affects people living in more economically disadvantaged areas. Moreover, poor diet and obesity are two of the main contributors to premature death in England, with those living in deprived areas often facing significant barriers to accessing affordable nutritious food.7 The pandemic and now the rising costs of living have exacerbated food insecurity levels in the UK, with 15.5 per cent of households experiencing food insecurity in the period between October 2021 to April 2022 (up from 7.6 per cent pre-covid).8
The Government’s strategy emphasises that the food industry has a central role to play in the levelling up agenda, both as an employer and significant investor in local communities. UK agri-food and seafood sectors create over £120 billion of value for the economy every year and employ over four million people. The strategy proposes that the UK should maintain the current level of food produced domestically while sustainably boosting production in sectors where there are post-Brexit opportunities, including horticulture and seafood. Initiatives include plans to increase pay, employment, productivity, and skills training in all areas of the UK, in addition to halving childhood obesity by 2030 and reducing the proportion of the population living with diet-related illnesses.
To achieve these objectives, interventions include increasing number of visas for seasonal workers, investing in research and innovation, a school food revolution, and a primary care pilot of the ‘Community Eatwell’ programme. It also suggests it will introduce new primary and secondary legislation as required. While these are welcome ambitions, history has shown that this will be extremely challenging unless the right penalties and incentives are implemented quickly.
The impact of implementing stronger policy including taxes on sugar and salt
The independent review recommended a tax on sugar and salt to decrease consumption, saving up to 79,000 healthy life years, and that a proportion of the revenue generated could be used to provide fresh fruit and vegetable to low-income households.9 In 2018 the government did introduce a Soft Drinks Industry Levy which is considered to have reduced the amount of sugar in drinks by around 44 per cent and having a positive impact in slowing the increasing rates of obesity.10 However, the new strategy is silent on introducing further taxes recognising the current burden of increasing food prices. Moreover, in May 2022 the Department of Health and Social Care (DHSC) announced that the upcoming ban on multi-buy deals for foods high in fat, salt and sugar had been delayed until October 2023 due to the current economic climate and the negative impact such restrictions may have on populations already struggling financially.11
The newly published Government food strategy acknowledges that it is not the cost of nutritious food alone that acts as a barrier to low-income households, but the added costs of cooking facilities and challenges such as having sufficient time to prepare fresh meals and gaining the education or training needed to do so.12 The strategy sets out a proposal to focus on ‘longer-term measures to support a resilient, healthier, and more sustainable food system that is affordable to all’. Initiatives include the Healthy Start Scheme, expansion of eligibility for free school meals and the cost-of-living support package.13,14 Further, the government intends to gather evidence via randomised control trials to assess the suitability of interventions that promote and support healthier diets.
A balance between personal responsibility and policy
Critics of the Government Food Strategy argue that the paper doesn’t do enough to support wider development and encouragement of habitual healthy lifestyle choices.15 Moreover, that its emphasis on personal responsibility may be reductionist, ignoring the wider biopsychosocial and socioeconomic drivers in health. Any policies introduced, such as the sugar tax, should be kept under review and adapted to provide maximise positive impact and mitigate unintended consequences.16
Moving forward a more connected approach of knowledge sharing of successful interventions between private, public and academic sectors could help aid our understanding about best practices in tackling these complex issues.
Adapting to an increasingly volatile world climate
The Dimbleby review noted that agriculture alone produces 10 per cent of UK greenhouse gas emissions, despite constituting less than one per cent of our GDP and that our eating habits are destroying the environment and threatening our food security. It suggests that the next big shock to our food supply will almost certainly be caused by climate change in the form of extreme weather events and catastrophic harvest failures. It outlined several important considerations for the future of UK agriculture including increasing self-sufficiency and diversification amongst arable and livestock farming.17
The Government’s response emphasises that as President of COP26 it is taking forward the Agriculture Breakthrough to make sustainable agriculture the most attractive and widely adopted option for farmers by 2030, as well as raising international ambition to transform our agriculture and food systems. It also commits to continuing to lead on both promoting and rewarding sustainable food supply chains and working in partnership to deliver its international commitments; including using the Agriculture Act (2020), Fisheries Act (2020) and Environment Act (2021) as frameworks to incentivise farmers and food producers to adopt more sustainable practices. Furthermore, the Government has stated its intention for future farming policy to ‘support innovative solutions to the environmental challenges we face’.18
The Government Food Strategy provides an important next step in challenging the status quo and tackling crucial areas of concern, however, more needs to be done to address the underlying drivers in food and health inequalities. The support and momentum raised by the independent Dimbleby review should be capitalised on and integrated more widely in future interventions to tackle the complexities of the wider determinants of health and disease. On a positive note, it appears most stakeholders are now aware of the cost of poor choices on health and, for the most part, are engaged, ambitious and ready to collaborate to improve their own and their family’s health.