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