UK Food Policy & Nutrition: Tracking
ProgressStrengthening accountability systems for nutrition in the UK
Foodfoundation.org.uk
Today’s speakers
@Food_Foundation
Lawrence HaddadSenior Research Fellow
IFPRI@l_haddad
Inge KauerExecutive DirectorAccess to Nutrition
@ingekauer
Boyd Swinburn - KeynoteProf. of Population,
Nutrition and Global HealthUniversity of Auckland
@BoydSwinburn
Fiona WatsonConsultant
The Food Foundation@Food_Foundation
Today’s panellists
@Food_Foundation
Lord Chris Haskins
Andrew OpieDirector of Food and Sustainability
British Retail Consortium @the_brc
Jo RallingCampaign Director
Jamie Oliver Food Foundation@FoodRev
Guy Poppy Chief Scientific Advisor Food Standards Agency
@GuyPoppy1
Corinna Hawkes - ChairProf. of Food Policy
City University London@CorinnaHawkes
www.foodfoundation.org.uk
Tracking progress on food and nutrition policies
Boyd SwinburnProfessor of Population Nutrition and Global HealthUniversity of Auckland
Co-Director, Global Obesity Centre, Deakin University
The Food Foundation SymposiumLondon, February 2016
Overview – healthy food policies
• What are the imperatives?• What are the priority policies?• How much progress is being made globally?• Strengthening accountability• INFORMAS
– International Network for Food and Obesity/NCD Research, Monitoring and Action Support
• Quasi-regulatory approaches• Importance of UK leadership
•
Lim et al Lancet 2012
Food environments
What needs to be done?
WHO’s Global NCD Monitoring Framework
Mortality & Morbidity
Cancer incidence by type of cancer per 100 000 population
Unconditional probability of dying
between ages 30 and 70 years from cardiovascular
diseases, cancer, diabetes or chronic
respiratory diseases
Salt
Fruits and Vegetables
Saturated Fat
Overweight and Obesity (2)
Physical Inactivity (2)
Blood glucose/diabetes
Blood Pressure
Total Cholesterol
Harmful use of Alcohol (3)Risk FactorsTobacco use (2)
Access to palliative careNational Systems ResponsePolicies to limit SFA and
virtual elimination of PHVOEssential NCD Medicines
HPV Vaccine
Marketing to childrenDrug therapy and
counselingCervical cancer Screening
Hepatitis B Vaccine
25 In
dica
tors
Very little in monitoring food environments and policies
• No country has turned around the epidemic• Some countries show flattening/declines in
some child populations– Young, white, high SES, girls– Increasing disparities by SES and ethnicity
• Some countries introducing food policies
World Cancer Research Fund
Why so little progress on healthy food policies?
1. Food industry actions– Direct opposition (esp Coca Cola & Pepsi on SSB taxes) – Self-regulatory pledges/codes etc
2. Lack of government leadership– Weak governance systems, conflicts of interest– Belief in education approaches and market solutions– Unwilling to battle food industry (chill effect)
3. Lack of sufficient public demand for policies– Usually high majority support for most policies
(moderate/minority support for SSB taxes)– Not translated into pressure for change
Bellagio Declaration Obes Rev 2013
• Need to shift from responsibility pledges to accountability systems– Multiple parties involved– Agreed actions– Power relationships (includes sanctions)– Independent vs mutual accountability
Accountability Framework (Kraak V et al PHN, 2014)
What evidence persuades change-agents?• Monitoring and benchmarking progress under
their jurisdiction• Case studies of successful changes
– Evidence of impact and support– Stories– Visits, networks, personal recommendations
• Evidence of impact of policies and actions– Changes in reach and uptake– Changes in environments and behaviours– Changes in obesity (often not possible)
INFORMAS (www.informas.org)
• INFORMAS is a global network of public-interest organisations and researchers that aims to monitor, benchmark and support public and private sector actions to create healthy food environments and reduce obesity, NCDs and their related inequalities
• Progress– Phase 1: (2012) frameworks & indicators
• 2013 Obesity Reviews suppl – 14 Foundation papers– Phase 2: (2013/4) protocols, pilot testing– Phase 3: (from 2015/6) available globally
• Currently 17 countries using INFORMAS modules (or have grants under review)
Objectives1. Develop a global network of public-interest and
research groups to monitor, benchmark and support efforts to create healthy food environments and reduce obesity, NCDs and their related inequalities
2. Collect, collate and analyse data on public and private sector actions, food environments, population diets, obesity, and NCDs
3. Compare and communicate the progress on improving food environments against good practice benchmarks, between countries and within countries over time
4. Use the results to strengthen public health efforts, particularly by supporting the translation of relevant evidence into public and private sector actions.
Public sector policies and actions Private sector policies and actions
How much progress have (international, national, state and local) governments made towards good practice in improving
food environments and implementing obesity/NCDs prevention policies and actions?
(University of Auckland)
How are private sector organisations affecting food environments and influencing obesity/NCDs prevention
efforts?(Deakin University)PR
OCE
SSES
IMPA
CTS
OU
TCO
MES
Food composition
Foodlabelling
Food marketing
Food provision Food retail Food prices Food trade &
investment
What is the nutrient
composition of foods and non-
alcoholic beverages?(The George
Institute)
What health-related labelling
is present on foods and non-
alcoholic beverages?
(University of Oxford)
What is the exposure and
power of promotion of
unhealthy foods and non-
alcoholic beverages to
different population
groups?(University of Wollongong)
What is the nutritional
quality of foods and non-alcoholic
beverages provided in
different settings (eg.
schools, hospitals,
workplaces)?(University of
Toronto)
What is the availability of healthy and unhealthy
foods and non-alcoholic
beverages in communities
and within retail outlets?(University of
Auckland)
What is the relative price
and affordability of ‘less healthy’
compared with ‘healthy’ diets, meals & foods?
(Queensland University of Technology)
What are the impacts of trade and
investment agreements on the healthiness
of food environments?
(Australian National
University)
Population diet Physiological & metabolic risk factors Health outcomes
What is the quality of the diet of different population groups?
(University of Sao Paulo)
What are the burdens of obesity and other risk factors?
(WHO)
What are burdens of NCD morbidity and mortality?
(WHO)
INFORMAS module structure
ORG
ANIS
ATIO
NS
FOO
D EN
VIRO
NM
ENTS
POPU
LATI
ON
S
NZ Food-EPI • Positives:
international standard in 6
• Stronger infrastructure than specific policies
• Major gaps in implementation– Marketing to
children– Fiscal policies– Comprehensive
plans & funding
Top priorities (out of 34 actions)1. Comprehensive
plan2. Targets
– Childhood obesity– Population intakes
Na, SFA, sugar– Food composition
3. Funding (to $70m/y)4. Restrict marketing
to children
5. Healthy food policies – Schools– Early childhood settings
6. Health Star Rating food labelling
7. 20% excise tax on sugary drinks
Quasi-regulatory systems• Strengthens voluntary initiatives
– More accountable, credible, feasible, transparent, effective (for public health goals)
• Involvement of government– Including: set policy objectives, manage process,
determine the parameters, monitoring, communications, advocacy, threat of regulation etc
• Involvement of civil society– Including: advocacy for public health, independent
monitoring (process and impacts)• Example: Health Star Rating system
Importance of UK leadership• Strong public health traditions, culture, capacity
& expertise• Strong track record of public actions for healthier
food environments– Government– Academia– NGOs– Private sector– Individual champions
• World leading National Child Measurement Program
England’s National Child Measurement Program
0%
2%
4%
6%
8%
10%
12%
14%
Least deprived
Most deprived
Obe
sity
prev
alen
ce
Index of Multiple Deprivation (IMD 2010) decile
2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13
0%
5%
10%
15%
20%
25%
30%
Least deprived
Most deprived
Obe
sity
prev
alen
ce
Index of Multiple Deprivation (IMD 2010) decile
2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13
4-5 year oldsBy year & deprivation decile
10-11 year oldsBy year & deprivation decile
Future directions
Aims: 1. Monitoring progress for accountability 2. Underlying systems causes and solutions
www.lancetobesity.info
Conclusions• Current burden of unhealthy diets is very high
and future threats from climate change and population growth– Demands a robust food strategy and policies
• Accountability systems also needed to speed up progress– INFORMAS platform for creating the data for
monitoring, benchmarking, evaluating, and modelling• Excellent opportunities to build on UK expertise
– Regulatory, quasi-regulatory, programmatic, community systems-based approaches
Acknowledgements
• INFORMAS collaborators internationally and the coordination team at University of Auckland
• www.informas.org• Twitter: @_INFORMAS #INFORMAS • Funders:
www.foodfoundation.org.uk