Meeting: Health Scrutiny Sub-Committee (County Hall, Durham - Committee Room 2 - 05/07/2004 10:00:00 AM)
Item: A9 'Choosing a Better Diet', ;Choosing Activity' - Dept of Health Consultation
| Health Scrutiny Sub-Committee
5 July 2004
Choosing a Better Diet
Choosing Activity | |
| Report of Head of Overview and Scrutiny |
Purpose of the Report 1. To explain two further consultation documents produced by the Department of Health as part of the White Paper on Public Health.
Background 2. This report is based on a briefing produced by the Democratic Health Network.
3. Two new documents have been produced by the Department of Health. The first is entitled ‘
Choosing Health? Choosing a better diet’ and the second, ‘
Choosing Health? Choosing activity’. They are part of the consultation exercise to inform the White Paper on public health, which is expected this summer.
Choosing a better diet 4. This consultation focuses on the government’s food action plan. It forms a key component of the wider
Choosing Health consultation. It will also inform the final food and health action plan which will coordinate action at national level to improve the health of the population through better nutrition. The document stresses that improving nutrition is an important issue for central government, the NHS, local government and community and voluntary sector as well as for individuals. It also identifies the role of the food industry, employers and the media in improving healthy eating.
5. The document sets out proposed goals and possible priorities for a food and health action plan. The action plan will also contribute to the joint Department of Health (DH) and Department for Environment, Food and Rural Affairs (Defra)
Strategy for Sustainable Farming and Food and will place nutrition and health in the context of sustainable development for England’s food supply.
6. There are high levels of preventable ill-health and mortality associated with poor nutrition. For example, about one third of all cancers can be attributed to poor diet. The growing levels of obesity, especially amongst the lowest socio-economic groups, are a major cause for concern since obesity is clearly linked to many health problems. Against this back-drop the aim of the food and health action plan is to identify ways of improving nutrition at all stages of life and for all groups of the population, with a particular emphasis on disadvantaged groups.
7. The consultation document covers seven areas of action:
· consumer choice
· food production and manufacture
· food supplied by retailers, caterers and the workplace
· nutrition in pregnancy and the early years
· nutrition in schools
· nutrition in the NHS
· nutrition in local communities.
Consumer choice 8. The proposed goals for improving consumer information and skills and influencing behaviour are:
· ensuring that everyone can get the balanced information they need to make choices about what they eat
· empowering all consumers, through health promotion and ongoing education and learning to develop the skills and understanding to use information effectively.
9. The consultation document asks what the priorities for action should be in order to identify education information needs, improve the quality and co-ordination of the information that is provided and ensure that all groups in society have access to it. Currently, though there is basic awareness of what makes up a healthy diet, many people need more information on recommended levels of fat, sugar and salt intake in order to stay healthy.
10.
Food labelling Surveys have identified clearer food labelling as the main way the food industry could help them make healthier choices, and health claims on food labels as a source of confusion (especially products which claim to be “low fat” or “reduced fat”).
11.
Food promotion Research suggests that food promotion and marketing is a major influence people’s choice of food, especially children. A Food Standards Authority (FSA) survey found that the balance of foods advertised to children is contrary to guidance on healthy eating. The FSA is currently undertaking a consultation on ways of improving the balance of promotions aimed at children.
12.
Improving food production The proposed key goals for improving the availability of healthy choices in food are:
· Reducing salt, total and saturated fat and added sugar
· Increasing fruit, vegetables and fibre in food.
13. This section focuses on the contribution of primary producers (farmers) and food manufacturers to providing healthier food. The report also recognises that taste preferences are not fixed and that advances such as reducing the sweetness of baby foods may, in the long term, encourage the preference for less sweet food. There is also evidence that reducing the salt content of food over a long period has a significant dietary impact without affecting sales of food. Another concern is the gradual increase in portion size of prepared foods as a contributor to obesity. Advances such as the reduction in the fat content of livestock and efforts by some food manufacturers to reduce the salt, fat and sugar content, and portion size of processed foods will have a significant impact on improving nutrition.
14.
Improving food supplied by retailers, caterers and the workplace The proposed goals for improving food supplied by retailers, caterers and the workplace are:
· the reduction of salt, total and saturated fat and sugar content of food sold and better access to fruit, vegetables and foods that are high in fibre
· employers who have catering facilities providing greater access to food which contribute to a healthier lifestyle.
15. The report stresses that retailers and caterers are well placed to influence eating habits, in particular large supermarket retailers where 90% of people do most of their shopping. Many more people are eating outside the home. The consultation documents cites a survey finding that 25% of respondents now regularly use some form of fast food or takeaway outlet. Teenagers are more likely than adults to eat more “fast food”. Such foods are more likely to have a higher fat, salt and sugar content than foods prepared at home.
16.
Current evidence and research Recent research has shown that relatively simple changes such as menu or shelf signs identifying healthier choices can increase sales. Pricing is also important in influencing purchasing patterns.
17.
Current action Some retailers and caterers have already made improvements to the food they sell by introducing “healthy eating” ranges with lower fat, sugar and salt content, offering a healthier range of foods in city centre locations that are remote from major supermarkets, being more responsible about targeting particular groups (for example, not displaying sweets at the checkout) and for caterers, improving the range of healthier foods available.
18. Health promotion interventions in the workplace can be particularly effective in improving diet. Schemes such as the
Heartbeat Award include education programmes and environment changes as well as providing healthier meals. The report highlights the role of the public sector as major employers who cater for many people either as employees or as service users and concludes:
“The way the public sector purchases, prepares and serves food is likely to have an important influence on the health of individuals and communities”. To this end, Defra is leading a Public Sector Sustainable Food Procurement Initiative which offers guidance and tools for public sector buyers to ensure they make healthy food a priority.
19
Improving nutrition in pregnancy and the early years The proposed goals for this action area are:
· all relevant stakeholders promoting and providing practical support for exclusive breast feeding to six months
· the promotion of access to nutrition and health for mothers and children
· targeting low income and other disadvantaged groups through locally based initiatives such as Sure Start
· the development of a coherent approach to health eating in early years settings.
20.
Evidence and current action Evaluative research on effectiveness of programmes to increase breastfeeding amongst low income groups show that peer support programmes and training for health professional were the most effective interventions. The eating patterns of mothers are doubly important as they need to maintain their own health as well introduce healthy eating to their children. Agencies such as nurseries, children’s centres and playgroups also have an important role to play in providing guidance and support on infant feeding, weaning, healthy eating and cooking skills. It is proposed that the Welfare Food Scheme (where tokens are provided to low income families to buy milk and infant formula)is reformed to provide greater access to healthy food, and to promote breast feeding. The NHS is clearly in the best position to encourage and support breastfeeding, as well as more general advice and information.
21.
Improving nutrition in schools The proposed goals for this action area are:
· to supply the range of foods children need for a healthy diet
· to give children and information and skills they need for a lifetime of healthy eating.
22.
Evidence and current action School-based action may not only positively influence children and young people but also have a wider influence on families and communities. For example, the National School Fruit Scheme has increased the level of fruit consumption in 25% of families and has had the most positive impact on parents from lower socio-economic groups in terms of increased knowledge of healthy eating. The current action in schools includes the national Healthy Schools Standard, the Food in Schools Programme and the National Curriculum, and the food provided in schools.
23.
Improving nutrition in the NHS The proposed goals are to:
· strengthen current NHS initiatives on diet and nutrition
· provide healthier foods to employees and patients
· ensure that the NHS workforce is trained to deliver action to improve the diet of individuals and communities.
24.
Evidence and current action As a major employer and provider of services, the NHS is in a strong position to make a positive contribution to healthy eating. In addition, NHS bodies can provide advice on healthy eating and shopping and have a positive effect on eating habits and health. Current action in the NHS includes participation in the Better Hospital Food initiative aimed at improving standards (though participation is patchy with only 60% of London hospitals participating), guidance and advice on healthy eating at primary level, targeted intervention to patients with particular conditions such as diabetes, CHD, and work with families of patients treated for obesity.
25.
Improving nutrition in local communities The proposed goals for this action area are to:
· improve access to a wider range of the foods needs for a healthy diet in local communities and in the public sector workforce
· ensure that consumers get the information they need to make choices about what they eat, and develop the skills and understanding to use that information effectively.
26.
Evidence and current action The report highlights that local authorities can promote and encourage healthier eating through a wide range of services and functions, and that such action is clearly compatible with their requirement to promote social, economic and environmental well-being. The report also acknowledges the central role of local authorities in helping the DH achieve its Public Service Agreement to reduce health inequalities. Research indicates that community interventions can influence access to, awareness and consumption of healthier foods and are particularly effective in deprived communities. Broader policies, such as transport, regeneration and planning policies need to take into account improving access to healthier and affordable food for the poorest communities.
Choosing health? Choosing activity 27. This consultation document is a companion to
Choosing Health? Choosing a better diet and is forms part of the wider consultation
Choosing health? The Chief Medical Officer’s report
At Least Five a Week; Evidence on the impact of physical activity and its relationship to health was published in April and sets out the scientific evidence on the contribution of physical activity to a healthy lifestyle. Lack of physical activity contributes to a rise in obesity and to an increase in many of the biggest killers: coronary heart disease, cancer, stroke. The benefits of increased physical activity are well documented, reducing the risk of osteoporosis, back pain and osteoarthritis, as well as having positive effects on psychological well-being and mental health.
28. The responses to the consultation will inform the development of action plan to increase physical activity. It is a major strand of the government’s strategy to improve health. The aim of the action plan will be to promote activity for all in accordance with the recommendations of
At Least Five a Week: · children and young people should achieve a total of an hour of moderate physical activity a day, including activities to improve bone health, muscular strength and flexibility at least twice a week
· adults should achieve a total of at least 30 minutes of moderate physical activity at least five times a week
· increased activity can be achieved through structured exercise, sport or changing to a more active lifestyle
· to prevent obesity, most adults need to engage in 45-60 minutes of physical activity
· it is particularly important for older people to maintain recommended levels of physical activity.
29. The report stresses that tackling health inequalities as a major priority for government, and to this end specific priority group have been identified: notably, economically disadvantaged groups and their children, women, older people, people with disabilities and black and minority ethnic groups.
30. The report outlines goals and proposes priorities for action in several areas:
· choosing activity
· activity in education
· activity in the workplace
· active travel
· enabling an active community
· an active health system
· enabling local delivery.
31. This briefing summarises the goals, current evidence and action for each of the areas.
Choosing activity 32. The proposed goal for helping people to choose increased activity is:
· ensuring people in all parts of society get the information they need to understand the links between activity and better health.
33.
Current evidence and action Evidence suggests that there is confusion over how much exercise, and of what sort, people need to take to maintain health. Work by the Heath Development Agency (HDA) suggests that community based interventions are effective in encouraging increased physical activity in the short and medium terms. Moreover, interventions which promote lifestyle changes, such as increased walking are more effective than those based in access to sporting or leisure facilities. That said, evidence also suggests that if such facilities are made more accessible and if people are informed of this, they will be better used. International research suggests that a national information campaign could be effective.
34.
Choosing activity in education The possible goals for this area are:
· encouraging activities in early years, schools, further and higher education settings
· extending the use of schools and educational facilities for community use.
The document asks what barriers prevent the community from using educational facilities and how these could be overcome.
35.
Current evidence and action There is a positive correlation between physical activity and academic achievement. Physical activity also plays a positive role in improving behaviour and increasing social interaction skills.
36. Activities for early years could include: baby massage, water-based activities for babies and infants and their parents, toddler gyms, supervised play and learning through play. Some such services are part of Sure Start programmes.
37. For primary and secondary schools, evidence shows that appropriately designed curricula can increase levels of physical activity, especially schemes which target girls. Such schemes are more effective when they involve young people in their planning and when they are appropriate for groups with particular religious or cultural requirements. The National Healthy School Standard Guidance, issued by the DfEE in 1999 specifies that a whole school approach incorporating physical and health education, extra-curricular activities, links with the community and safe routes to school is likely to be most effective.
38. The document then summarises a number of schools-based initiatives including:
· School Sports Partnerships (aimed at increasing the involvement in PE and sporting activities to two hours a week to 75% by 2006)
· increased physical activity by imaginative use of school playgrounds and encouraging planning play activities at play times
· using legislation to halt the sale of school playing fields
· the Step into Sport initiative which encourage young people to volunteer in school and local sports clubs
· encouraging the use of education facilities as a resource for the community through the Extended Schools programme, the Out of School Hours Learning Programme and Summer Schools
· projects to encourages young people aged 15 - 18 to maintain sporting and other physical activity
39.
Choosing activity in the workplace Possible goals for this area include:
· encouraging employers in the public, private and voluntary sectors to motivate staff to be more active
· provide information and assistance so that employers can promote physical activity.
40.
Evidence and current action Though limited, current evidence suggests that increased physical activity benefits employers through reduced absenteeism and higher productivity and employers through enhanced physical and mental well-being. Employers can encourage increase physical activities in a variety of ways: by providing information about local facilities, providing an environment that encourages physical activity through the provision of showers, bicycle racks and gym facilities, promoting physical activity as part of everyday life. It highlights the role of public sector employers to act as leaders in this field.
41.
Choosing active travel The possible key goals are:
· ensuring high quality, well-targeted facilities for walking and cycling
· extending further school travel plans and encouragement of safe, healthy travel to school
· raising awareness of the health benefits of walking and cycling as part of a daily routine.
42.
Evidence and current action The Department of Transport is to publish an action plan to increase levels of walking and cycling and will set measures for both central and local government. The government selected three local authorities as “sustainable travel model towns” to encourage walking and cycling and to disseminate the good practice arising from the schemes. This section of the document includes many good examples led by local authorities, voluntary agencies and employers to encourage cycling and walking as a substitute to car journeys. A key example, is the appointment of advisers within local authorities to encourage walking to school, which shows that school travel plans can reduce car usage by 20-30%.
43.
Enabling an active community Possible goals for this action area include:
· continuing to make public spaces more accessible and attractive, and creating and maintaining a wider range of opportunities for activity through sport and other recreational activities
· developing more opportunities for people who are not in education or work, in particular older adolescents, disabled people, parents of young families, and unemployed and retired people.
44.
Evidence and current action The Living Places report published by the Office of the Deputy Prime Minister (ODPM) sets out an action plan for improving the quality of parks and open spaces. It also points to community safety work undertaken by local authorities and the appointment of Community Support Officers and neighbourhood wardens as evidence of government commitment to making public spaces more accessible. Although it summarises several government schemes for improving existing and developing new recreational facilities, it acknowledges that this provision is not well-resourced and new investment is needed.
45. Research shows that outdoor recreation is a popular way of increasing activity but certain groups visit the countryside less than others. The report highlights the role that Sport England has played in developing a framework for increasing participation in sport.
46.
Priority groups in the community The consultation document identifies the following groups as need specific consideration:
· children - in particular assisting parents and their children to make informed choices about the risks and benefits of outdoor play
· disabled people
· older people - whose activity levels are, on average, lower than the rest of the population, despite having more free time.
47.
An active health system Possible key goals are:
· health professionals increasing the provision of advice to patients on lifestyle both routinely and opportunistically
· services developed within the community healthcare system to provide ongoing support to achieve sustainable behaviour changes
· NHS providers and PCTs, working more closely with local government and private and voluntary sectors to create access to opportunities for physical activity.
48.
Evidence and current action Research indicates that even brief advice from a GP, supported by written information can be effective in a “modest, short-term” increase in physical activity. Several of the existing National Service Frameworks consider the important beneficial role of physical activity in prevention, secondary prevention and rehabilitation for many health problems. The report does recognise the pressure on those in primary health care and the need, therefore, to look at innovative ways of imparting information. All primary care staff need training and development in order to play their part. The consultation document acknowledges the contribution of “exercise referral schemes”, provided by 89% of all PCTs.
49.
Enabling local delivery Possible goals for this action area are:
· development of a national framework for increasing activity in the contact of the White Paper on improving health
· supporting the coordination at regional and local level for increasing physical activity
50
Evidence and current action The consultation rightly recognises the key role of local authorities in delivering coordinated programmes to increase physical activity. It stresses the contribution that Local Strategic Partnerships (LSPs) can make to better partnership working between local authorities, health partners, the private and voluntary sectors. Regional agencies can also make a valuable contribution, especially in integrating transport plans and physical activity strategies.
51. Central government will disseminate good practice to help local authorities and their partners at local level, work more effectively together on planning, development, and implementation on review of initiatives to promote greater physical activity.
52.
Comment on both consultation documents from the Democratic Health Network These consultation documents form part of the wider consultation on public health Choosing Health? and share many of its characteristics, both positive and negative. In particular, though the links between socio economic deprivation, poor nutrition and ill-health, and lack of physical activity and ill-health are recognised, neither document considers the role of central government in implementing action to reduce economic inequalities. The documents lack imagination or a sense of urgency. Most of the possible goals are not particularly imaginative or challenging and are not specific. For example, a proposed goal is to reduce salt, fat and added sugar in food products but there is no explicit percentage reduction. In Choosing a Better Diet the food industry, encompassing manufacturers, retailers and caterers are let off very lightly. There is no intention to introduce legislation to force businesses to improve the nutritional value of processed foods. The much talked about “fat tax” where the food industry would be financially penalised for producing high fat foods failed to materialise even though there is a good deal of public support for such measures.
53. The reports use case studies of current action, which are a welcome illustration of what can be done to improve access to healthier food or to improve the nutritional value of food or to promote the increase in physical activity. However, the report accentuates the positive effects of government policy without acknowledging the negative impact on healthy eating or physical activity of other government policies. For example, a major constraint on the provision of healthy school meals is the lack of money that schools can spend on this. Positive initiatives such as breakfast clubs only exist in some schools and are often the result of time-limited area-based initiatives that disappear once the specific funding has ceased. Likewise, the report is silent on the effect of choosing distant schools that score better in national league tables in increasing the numbers of children driven to schools rather than walking or cycling to schools that are nearer but perform less well.
54. Both of the consultation documents mention the need to reduce health inequalities but do not adequately consider the needs of specific groups. In relation to healthier eating, there is some evidence that particular groups, such as people whose first language is not English, older people and disabled people have poor diets because they do not have access to healthier food. There is also no acknowledgement of the importance of the provision of culturally appropriate food to service users and employees in the public services as a way of improving diet.
55. Both documents over-emphasise the role of personal choice in the adoption of healthier eating and increased physical activity. While it is true that all of us make choices which have either a positive or negative effect on our health, some of us have more choices because they can pay for healthier food or access to leisure and sporting facilities. This consultation represents a missed opportunity to make challenging proposals to improve access to healthier foods, especially for those in poor communities.
Recommendation 56. This report is for information but it also raises a great deal of issues which will be useful in the Sub-Committee’s work.
| Contact: Ian Mackenzie Tel: 0191 383 3673 |
Attachments
Item 9.doc