Martin Caraher Professor of Food and Health Policy Centre for Food Policy City University London EC1V OHB m.caraher@city.ac.uk +44 (0)20 7040 4161

Country

100 80 60 40 20 0 20 40 60 80

`

-100 -80 -60 -40 -20 0 20 40 60 80 100020406080100 20 40 60 80 100

WOMEN MEN

%

% obese % obese% overweight

* Urban

** Self-reported

Albania *

GreeceIsrael **

CyprusCzech Rep.

EnglandWales, N. **

ScotlandGermany

FinlandSlovakia

Lithuania

Latvia

Croatia

Hungary

Russia

Ireland

Spain

Austria

Turkey

Sweden

France **

Belgium

Switzerland *Denmark

Kyrgystan

NetherlandsItaly **

Norway

European overweight and obesity adult prevalences (1992-2001)

Age-ranges vary but most cover 20+ years. IOTF data for UK.Health Select Ctte. May 2004

Women Men

Prevalence (%) of overweight (hatched bars) and obesity (solid bars) by socio-economic category in young people aged 4-18 years in 1997 (n=1555). Socio-economic category I-III vs. IV and V:

obesity, P=0.003; obesity and overweight, P=0.004. NM - non-manual. M - manual

Jebb SA, Rennie KL, Cole TJ. Public Health Nutrition, 2004: 7(3), 461-465. Socio-economic differences in overweight and obesity

The New Politics of Food

Policy battles and contradictions

1800s 1900s 1950 2000 2050

Productionist

paradigm Food Wars

The Era of Food Wars

Agricultural Revolution

Industrialis-ation of

Food

Chemical Revolution

Transport Revolution

Life Sciences Intensification

paradigm

Ecologically Integrated paradigm

LEGEND: = Key Battlegrounds in the Food Wars. These include: •Diet, health and disease prevention •What sort of food business •Environmental crisis •Competing visions and ideologies •Capturing the consumer •Controlling food supply

Capital

Science + Technology: Nutrition Chemistry

Engineering

Domestic Life

Distribution

HUMAN HEALTH

Processing

Nature: Land Water

Climate Plants Animals Etc.

Consumer Choice

Agriculture

Nutrition Ingredients Products

Information

Productionist Paradigm Approach to Health

Capital

Science + Technology: Nutrition Chemistry

Engineering

Domestic Life

Distribution

HUMAN HEALTH

Processing

Nature: Land Water

Climate Plants Animals Etc.

Consumer Choice Health Education

(1970s FF)

Agriculture

Nutrition Ingredients Products

Information

Productionist Paradigm Approach to Health

Life Sciences Integrated Paradigm Approach to Health

INDIVIDUAL HEALTH

Personalised Medicine & Diet

Predisposition Testing

Pharmacogenetics / Nutrigenomics

Nutrients

Metabolism

Gene Expression

Normal Cell Growth

Consumer Choice Food System:

Agriculture Processing Retailing Food Service

Genetic Inheritance

Activity

Nature: Land Water

Climate Plants Animals Etc.

Ecologically Integrated Paradigm Approach to Health

HUMAN & ENVIRONMENTAL

HEALTH

Lifestyle e.g. Physical Activity,

Pace, Alcohol

Consumer Choice

Food Culture

Foodservice

Natural Capital Land Air Water

Genes/Biodiversity Etc.

Retailing

Economic Capital Money Labour

Technology

Social Capital Community Trust Family Foodways

Nutrients

Genetic Inheritance

Processing

Agriculture

Individual responsibility

Change in the environment

Puska 2001

Systems map weighted causal linkages Foresight 2007 fig 5.4

Obesity system map + thematic clusters Foresight 2007 fig 8.1

The Main Determinants of Health

Individual!responsibility!!

Change in the environment!

!

Puska 2001!

The lifeworld

Eating out

Offer a salad

Make an express line with

an

emphasis on healthy products

Pay cash for desert not

accepted on cards

Move salad bar away from

wall

Use fruit bowls not

stainless steel

Hide the ice cream.

Close the lid Rename the food Move the broccoli to

the start of the queue

Shrink the bowl

Northern Ireland

•  More men and boys in NI were living in moderately or severely food insecure households

•  Lone parents in particular found healthy foods such as fresh meat, fruit and vegetables to be too expensive and reported to be unable to afford many of these food items. Many of the participants from these groups also reported making ends meet particularly difficult at holiday times when children were off school with the additional cost burden for food that this imposed (i.e. no school meals)!

What this means

• People go hungry • The poor spend proportionally more on food (UK figures) • Average 10-12% (on the rise) • Poor 25% • Nutritionally sound diet (MAFF) 30%

• THE WORKING POOR are new vulnerable • May be skills knowledge and financial deficits.

• But the price rises are hitting the poor disproportionally

UK food poverty • One in five families live below the poverty line putting them at

risk of food poverty; over 4 million children are at risk and 4 million suffer from serious nutrient related health problems.

• No links with benefits to food ‘necessary’ for healthy living.

• Food benefits FSMs and Health Start + free fruit and veg. • People go hungry

• The link is greatest between poverty and outcomes such as obesity

Oxfam report 2011 Amount spent on food as a % of household income is very high for the poorest households. 17% of those parents with children have gone without food in the last 12 months Two fifths (42%) of single people believe that healthy food is too expensive. Average UK spend on food? IS ??? The POOR???

Food prices and changes

• Between 2007 and 2011 food prices rose 25%, 12% in real terms. NO downward trend….

• Between 1998 and 2009 household income for low income households rose 22% to £208/week before housing costs but food prices rose by 33%. We estimated that a low income family would be disproportionally effected by a 5% increase by about 40%

• Food prices compared to the EU have risen by 2.7/Germany and 3/France

• 27 countries account for 90% of all UK food. Just less than half came from the UK

Cultural aspects of food poverty JRF

• Many people –informed by the media- assume that people receive too much in welfare

• The JRF work asked people what they would consider a reasonable amount to live on and they set the standard above the benefit levels

A minimum income standard for Britain

What people think

Jonathan Bradshaw, Sue Middleton, Abigail Davis, Nina Oldfi eld, Noel Smith, Linda Cusworth and Julie Williams

A minimum income standard based on what people said is needed to achieve an acceptable standard of living in Britain today.

While politicians from all parties are committed to tackling relative poverty, the debates lack a robust defi nition of a minimum income standard (MIS), below which people’s incomes should not fall. This study devised a minimum income standard for Britain based on what members of the public said, and shows the cost of covering basic goods and services for different household types.

The project blends the best elements of the two main methods that have been used to develop budget standards in Britain in recent years. It reconciles the views of experts with those of ordinary people, allowing budgets based on social consensus to be tested against expert knowledge and research. As such, the MIS represents a new and important tool for informing social policy in order to promote fairness and well-being in Britain.

Changes in provision

• Child Poverty Action group estimates that up to 70,000 families will lose the right to FSM

• The Trussell Trust is now distributing food parcels to job seekers

• Charitable or philanthropic food aid is increasing. Good or Bad????

The environment

genetics loads the gun but environment pulls the trigger

FOR NORTHERN IRELAND

July 2010

Professor Ron McQuaid, Dr Emma Hollywoodand Dr Jesus CanduelaEmployment Research InstituteEdinburgh Napier University

Employment Inequalitiesin an Economic Downturn

THE ANNUAL REPORT OF THE CHIEF MEDICAL OFFICER FOR NORTHERN IRELAND 2010THE ANNUAL REPORT OF THE CHIEF MEDICAL OFFICER FOR NORTHERN IRELAND 2010THE ANNUAL REPORT OF THE CHIEF MEDICAL OFFICER FOR NORTHERN IRELAND 2010THE ANNUAL REPORT OF THE CHIEF MEDICAL OFFICER FOR NORTHERN IRELAND 2010THE ANNUAL REPORT OF THE CHIEF MEDICAL OFFICER FOR NORTHERN IRELAND 2010THE ANNUAL REPORT OF THE CHIEF MEDICAL OFFICER FOR NORTHERN IRELAND 2010THE ANNUAL REPORT OF THE CHIEF MEDICAL OFFICER FOR NORTHERN IRELAND 2010

Part 2 - Chicken & Chips 98% HH within 10mins walk of grocery type store

But… 97% HH within 10mins walk of FFO

So while at school

• Shopping

• Preston and City and Hackney

• Assumptions that people can shop around

• More fast food outlets than shops -choice is in an obesogenic one

Sweetness Preference was Essential to Survive: now the amounts

Biology vs Technology: Shift from Water to Caloric Beverage

Fat Preference Key for Survival: Technology, Marketing have Utilized

this Preference for Fatty Food

3.4 Northern Ireland – nutrition delivery

Northern Ireland was one of the first countries to adopt a food strategy in 1996.

However, this food strategy is no longer driving the delivery of health improvements via

nutrition in Northern Ireland. It has, in part, been superseded by A Healthier Future

(2004) 54 and Fit Futures (2005). 55 Healthier Futures is driving the development of the

health and social services framework, including the delivery of public health nutrition.

One of the core drivers for the delivery of the strategy is reducing health inequalities.

The lack of development of the public health nutrition strategies can be partially

explained by the delay in setting up the Northern Ireland Assembly and the back-drop of

a review of health and social services which is now partly complete.

Fit Futures (2005) – the Northern Ireland obesity strategy – is a combined nutrition and

physical activity strategy – and, as with many strategies, it has specifically defined

outcomes. The overall aim is a modified version of the Westminster government’s PSA

target of the time: ‘By 2011, halt the rise in obesity’. 56 The strategy is targeted at

children and young people, and several of the specifically defined outcomes are

targeted at reducing health inequalities – for example:

“To support the development of good practice guidance on tackling food poverty and the

development of food poverty networks.” 57

Fit Futures sat on the shelf for a while, awaiting implementation and the solutions to

wider political issues. In 2008 an obesity prevention steering group was set up. Children

and their parents were involved in consultation on the development of the action plan to

implement Fit Futures. One outcome was that the obesity prevention steering group is

expanding the Fit Futures recommendations to take into consideration the whole ‘life

course’. Individual areas such as ‘Food and nutrition’ and ‘Physical activity’ are being

54 Available at http://www.dhsspsni.gov.uk/healthyfuture-main.pdf. Accessed 3 November 2008.

55 Available at http://www.dhsspsni.gov.uk/ifh-fitfutures.pdf. Accessed 3 November 2008.

56 Available at http://www.pfgbudgetni.gov.uk/finalpfg.pdf Accessed 30 January 2009.

57 Northern Ireland Ministerial Group on Public Health (2007) Fit Futures: Focus on Food, Activity and Young People. Response

from the Ministerial Group on Public Health including Consultation on Fit Futures Implementation Plan.

32

So the environment • In the UK at a time when many high street retail shops are facing closure, one area of growth is the fast food sector with Domino’s Pizza, KFC and McDonalds reporting increases in profits and plans to expand in the next couple of years.

The last 3 years Globally what has happened is extraordinary. Some changes that have taken over 30 years to develop have been reversed.

Some issues of concern •  Middle-income consumers are now eating out less and buying fewer luxury goods but

buying luxury or niche foods for occasions, this has seen a reduction in people buying specialty chocolate but an increase in sales of Nestle brand chocolate.

•  Also reemergence and re-launching of comfort foods eg tinned goods and those popular in the 1970/80s

•  In the UK for those on low incomes there has been an increase in eating out from FFOs, as food prices increase and fuel cost many find it makes more sense to buy from a FFO as the squeeze on the household budget bites. SEE Tay Barns

•  NI data suggests something slightly different

The new food insecure •  Higher housing and fuel costs

•  In Australia increase in cost of food -butter up 23%; tomatoes 23%; baby food 29% NOW wheat crop failure due to Queensland floods and China!!

•  In the UK 20% rise in prices in some commodities.

•  In the UK middle income groups are •  eating out less. •  buying better quality in some product lines but economizing by

buying own brand basics such as pasta. •  Those in low- income groups are eating more fast food! •  Due to rise ion food prices, rise in fuel prices and squeeze on the

household budget

Foodbank WA report that:

Foodbank Western Australia- In a state with 2.2 million pop •  30,0000 grandparents raising children •  432.000 West Australians are below the poverty line this means almost

one in 4? •  Lone parents comprise 15% of all families •  Limited access to healthy food is contributing to poor health •  70.000 hseholds report going without food as they could not afford it. •  Huge economic but probably even bigger social cost Toronto •  More foodbanks than McDonalds outlets Germany •  In Germany, around 14 million people, or 17% of the population, live below the

poverty line!•  There has been a rise in the number of foodbanks as welfare reforms bite. !

Mc Donalds Sustainable

Control

Shifting power in the food value-added chain

PERIOD FARMING MANU-FACTURE

WHOLE- SALE

RETAIL

FOOD-SERVICE

≤ 1900 Dominant Minor Major in a few trades

Very Minor Dominant?

1900 1950

Declining (but WW2)

Dominant Major in many trades

Minor Declining (but WW2)

1960 1970

Rebuilding (CAP!)

Dominant Dominant Emerging Latent

1980 2000s

Declining Declining Rapidly Declining

Dominant Was beginning to emerge as dominant now

2000s-?? Returning Uncertain Minor Dominant

?

adapted from: C. von Schirach-Szmigiel (2005) “Who is in Power Today and Tomorrow in the Food System”, keynote speech to the Policy and Competitiveness in a Changing Global Food Industry conference, USDA Economic Research Service, Washington DC, April 28

Conclusions

Conclusions

•  We need to focus on solutions to the problem not just on measuring it

•  The problem is poverty not food poverty. Food insecurity is tackled in 2 ways immediately and by long term structural solutions not primarily by encouraging people to manage their meager resources better So -TACKLE INEQUALITY AS A PRIORITY.

•  We need to go beyond the rise of foodbanks to the cause

•  Food policy needs to be broad and incorporate the food chain and regulation.

Local

Imported

Raw

Processed

Fairtrade

Free market

Consumer

Citizen

Conclusions !  We should include production, manufacturing and marketing not just

consumption -pre-swallowing as well as post swallowing - The Food Chain in its entirety.

!  Balance and link bottom up with influencing/advocacy upstream. Community activism for public health advocacy? Cooking and food literacy help people manage in bad situations but do not change the situatinos

!  Locate the debate in a citizenship and equity model not just a consumer one.

!  Welfare systems need to have a minimum income allocation for food and this should include cultural and normative elements

Action

Got to act as if what you are doing can made a difference

Responses cont’d

!  Challenge and make people aware of the limits of current welfare payments for food and nutrition

!  Seriously examine and challenge the impact of existing welfare changes (eg Universal Credit) on health and food choice.

!  Protect existing food welfare systems and extend them eg FSMs and Healthy Start.

!  Focus on food choice not nutrition, people do not eat nutrition.

Individual!responsibility!!

Change in the environment!

!

Puska 2001!