Summary
There are clear areas of opportunity and challenge in progressing a healthy and sustainable Scottish National Food and Drink Policy ( SNFDP).
Eating and drinking are essential to human existence and part of the pleasure of life. The art and science of balancing our food and drink intake within the limits of our natural resources offers opportunities to enhance prosperity, well-being and the livelihoods of citizens and communities in Scotland and beyond. The global economic crisis, predictions on climate change and health inequalities sharpen the need to urgently develop a food system that moves from a primary focus of profitability to one which embraces the principles of public heath and sustainability and reduces the economic drain of health care costs on diet related diseases. The total cost to NHS Scotland of managing obesity and obesity related diseases approximates to £171m (Walker 2003) of which obesity alone accounts for £3.8m. The total cost of food related ill-health in the UK is estimated to be £6000m (Raynor et al 2005).
The development of a food system in Scotland appropriate for the 21 st century is first contingent on finding agreement as to what constitutes a healthy and sustainable food system and second, contingent on finding market, partnership and policy mechanisms to steer the food system in an appropriate direction.
We recognise that Scotland is not a closed economy and that imported foods constitute an important part of the Scottish diet, sometimes, as with high sugar consumption, with adverse effects. Scotland also exports a significant amount of food and drink.
Partnerships between different actors along the food supply chain can effect improvements in health and/or sustainability of food choices, but these are part of a wider package of public policy measures and socially constructed changes in the demand for food that will be needed to deliver the sought for improvements in the healthiness and sustainability of Scottish food.
The proposed way forward can be summarised as:
1. Identifying a comprehensive approach to defining healthy, sustainable food choices (Recommendations 1 to 4)
2. Ensuring that current educational endeavours directed at the general public are maintained and widened (e.g. to include sustainability measures and specific information related to reduced calorie intake). However, education alone will have minimal influence on dietary behaviours and requires to be supplemented by the following:
a) Addressing approaches used by the media, commercial marketing and the food industry which have diluted excellent educational efforts and contributed to consumer confusion and the continuance of inappropriate food choices from a health and sustainability perspective.
b) Recognising the importance of the combined factors of Price, Availability and Marketing on food choices. Healthy, sustainable choices cannot effectively compete with cheap, well marketed and widely available high in fat, sugar and salt ( HFSS) alternatives. Increasing the proportion of healthy, sustainable foods to at least 50% of all available options with preferential pricing and excellent marketing and branding would provide a realistic platform for the new Scottish diet.
Work in the Public sector (Workstream 4) has paved the way for this type of approach but must be moved into the private, retail and food service sector (Workstream 3). ( Recommendations 5 to 10)
3. Supporting the Scottish food industry (Workstream 1) to develop a wider, enjoyable and varied selection of healthy, sustainable food choices. The following are proposed:
a) Reviews of :
- Scottish agriculture and land use in relation to the scope for primary production and diversification (e.g. changing emphasis from livestock and dairying to cereal, fruit and vegetables), (Workstream 5)
- Gaps in processing requirements (e.g. rape seed oil crushing/processing equipment)
- Gaps in the skill base and training in food processing and product development
b) Emphasis on the further development of product ranges based on primary products with minimal processing e.g. Fruits (including berries), Vegetables (including potatoes, brassicas, other root and salad vegetables (in season), Cereals (including oats, barley, wheat), Fish (from sustainable fish stocks).
c) Reformulation activity. Current efforts by the food industry in Scotland towards healthier choices are directed at reformulation of current products (e.g. "the healthier biscuit") but in reality, many of these foods can only fit in a healthy diet in small portions or through infrequent consumption. Support for pro-biotic products, "enhancing" foods such as crisps, and the addition of omega3 oils may make small beneficial contributions to dietary change but will not alter the main problems of public health nutrition in Scotland and are unlikely to reach far into the most deprived sections of Scottish society. Greater efforts must be made to make better use of Scotland's superb primary products for the benefit of health.
d) Portion size activity. Actions should be taken now across all sectors and particularly manufacturing, food service and retailing to reduce portion sizes of energy-dense foods (e.g. cakes, pies) through removal of large/super size portions and decreases in average size portions.
e) With the alcohol and soft drinks industry, the target must be reduced consumption. (Recommendations 11 to 13)
4. There is a clear need for deeper policy integration at national level through for example the formation of a Scottish Council of Food Policy Advisors to take forward the Scottish National Food Policy work .
Widening engagement of Scottish people with food issues, and " winning hearts and minds" is essential to gain support for the implementation of the Scottish National Food and Drink Policy. Supporting the Scottish food economy, supporting health and sustainable food choices means supporting global, national, community and individual health. A new approach is needed that complements existing education and social marketing efforts, is able to voice public concern about misleading food information and adds significant capacity to changing the food culture of Scotland. The creation of a Scottish Food Advocacy Group could be a useful catalyst to assist the promotion of a cultural shift and it is recommended that this is initiated as soon as possible. (Recommendation 14)
5. A research agenda for research to inform future developments in the Scottish National Food and Drink Policy ( Recommendation 15) is outlined.
THE FRAMEWORK: What is a healthy, sustainable food supply?
Recommendation 1: Nutrition and Heath Framework
a) The nutritional aspects of the current Scottish Diet targets (goals) should be fully adopted within the SNFDP and form a core part of monitoring progress.
b) The Scottish Diet targets/goals should be reviewed at regular intervals to ensure the full range of nutritional challenges are embraced and that specific, evidence-based targets/goals are identified.
This work should be lead by FSA with Scottish Government health department (including nutrition expertise), backed by an independent expert committee.
Recommendation 2: Food and Heath Framework
a) The food aspects of the current Scottish Diet targets (goals) should be fully adopted within the SNFDP. These foods should form the main focus of the implementation plan and form a core part of monitoring progress.
b) Consumers are currently provided with nutritional guidance for "healthy" and "less healthy" foods for fat, saturated fat, sugar, salt.
The FSA guides consumer choices in terms of "low", "medium" and "high" amounts of nutrients (per 100g) and this information is available in leaflet format, within the FSA website (Eat well, Be Well) and on front of pack information and should to be used as the basis for guiding provision and selection of healthy food choices.
This information also sets the direction of travel for reformulation efforts although it should be noted that FSA also provide specific nutrient "targets" for industry to assist them in the reformulation of their products.
In recognition of concerns about advertising inappropriate food to children, the FSA have developed a nutrient profile system for use by OFCOM. However, because such data is not readily accessible by all retailers a food based profiling approach (based on promotion of the Scottish Dietary Targets) has evolved for use in Scotland and should be fully utilised for marketing purposes (see also Rec 7a) A proposed approach is outlined at Annex 7.
The food and nutrient definitions for the new School food system could be used to inform further practices in commercial catering.
This work should be lead by the FSA Scotland who should take the lead on advising, supporting and monitoring this activity.
Recommendation 3: Food and Sustainability Framework
a) The Scottish Government must identify and agree a framework with specific targets/goals for a reduction of greenhouse gas emissions across the whole food supply chain and for a reduced ecological framework from the Scottish food system. An immediate improvement could be effected by imposing a condition of cross compliance on all grant aid going to food businesses from Scottish Enterprise, Scottish Government and other public bodies. All businesses should be required to produce a carbon reduction action plan with input from a government-approved body such as the Carbon Trust or the Energy Saving Trust.
b) The Scottish Government (with an expert committee and relevant research) should identify an evidence-based, food sustainability profile system for defining "more sustainable" and "less sustainable" foods.
Recommendation 4: Joint Health and Sustainability Framework.
The Scottish Government urgently need to agree a combined nutrient, food and sustainability framework (Scottish, Sustainable Diet targets/Goals).
SETTINGS AND APPROACHES for implementing a health and sustainability framework
Recommendation 5 Education
a) Educational efforts about food help to create consumer awareness and should be maintained and widened (e.g. to include sustainability measures and specific information related to energy) and recognise the importance of "teachable moments" e.g. at or near to a diet-related disease diagnosis in the family.
b) Educational efforts which focus on food skills may assist with consumer awareness but have not been demonstrated to be effective in terms of improving dietary intake. If there is further investment in this area, then it should embrace the proposed health and sustainability framework but take account of limitations such interventions have on promoting behaviour change.
c) There is now a significant evidence base to show that education alone will have minimal influence on consumer demand and dietary behaviours. The full potential of educational efforts will not be realised if the foods promoted by educational efforts have to compete with a wide range of cheap, well marketed and widely available High Fat, Sugar or Salt ( HFSS) alternatives and misleading messaging from the media and commercial marketing.
All stakeholders need to work together on promoting the joint health and sustainability framework. The food service sector is of particular importance and will need significant support to provide clear, consistent messaging (including calorie information) (e.g. from FSA).
Recommendation 6 Labelling
It is strongly recommended that no further work is undertaken on a product origin label until an agreed health and sustainability framework is identified.
Recommendation 7 Advertising and Marketing
a) The industry should adopt voluntary measures (in the first instance) to increase volume of commercial marketing of healthy, sustainable foods. At least 50% of all foods marketed should meet the agreed joint framework criterion. Independent monitoring should be undertaken.
b) Scottish action is needed to constrain the non-broadcast marketing of HFSS foods. The Scottish Government should map and explore possible actions to a Scottish approach to non-broadcast marketing of HFSS foods to children using the model presented by "Which" (See Appendix 1).
c) Preferential pricing will be a key factor influencing food choice in times of economic constraint and all efforts should be taken by the food industry and government to ensure that healthy, sustainable foods are not disadvantaged by price. The Scottish Government and industry/retailers should further explore marketing using price promotions. The industry should adopt voluntary measures (in the first instance) to ensure that at least 50% of all price promotions (such as BOGOFs and other special deals) are healthy, sustainable foods. Independent monitoring should be undertaken.
d) Supported by industry/retailers, the Scottish Government should increase social marketing to influence cultural norms and unacceptability of excessive consumption and unsustainable foodstuffs and undertake appropriate monitoring.
The above measures set the context and a realistic platform for the new Scottish diet and an exemplar Scottish food industry.
Recommendation 8 Retailers
a) The Scottish Government should make greater efforts to engage with the major retail providers to prioritise public health in the contribution to drive forward the healthy, sustainable Scottish National Food and Drink Policy.
b) The Scottish Government and the industry should explore all opportunities to develop new routes to market including farmers markets, local food suppliers, social enterprise action and look for opportunities to scale up existing good practice where possible.
Recommendation 9 Media
Greater efforts are required by advocacy groups, FSA and Scottish Government to influence media communication on food and health to reduce public confusion and misunderstanding. FSA and Government departments have effective communication strategies on healthful diets and implementation but do little to advise consumers about inappropriate marketing, promotions and misleading media stories. The NGO sector often take the lead in this latter arena and can be an important contributor to helping gain support for policy development and should be supported in their efforts to do so in Scotland.
Recommendation 10 Regulation
The Scottish Government and industry should work together to become both a leader and a role model for future action on change of the food environment through multifaceted, strategic and regulatory action on the proportion of healthy sustainable foods available, pricing and promotions.
SUPPORTING THE SCOTTISH FOOD INDUSTRY to grow and develop a wider, enjoyable and varied selection of healthy, sustainable food choices.
Recommendation 11 Working with the Food Industry
a) Some innovative work has been initiated by industry through reformulation and retail promotions. However, efforts by industry need to be much more substantial, with a focus on increasing the availability of enjoyable and varied forms of the basic food components of a healthy sustainable diet e.g. breads, cereals, potatoes, fish, fruits and vegetables.
b) The Scottish Government should provide greater recognition of Scottish SMEs which attain health and sustainability targets, and nurture their development by financial incentives, grants and other support.
c) The Scottish Government should establish an independent group to monitor the food industry and food service sector in their efforts in meeting combined health and sustainability criteria.
Recommendation 12: Working with the Soft Drinks Industry
a) Industry needs to make greater efforts to reduce intake of sugary drinks in Scotland. The Scottish Government should monitor availability in all settings with clear disincentives made for any promotions directed at children.
b) On sustainability and health grounds, fresh, tap drinking water should be actively promoted (and an acceptable substitute for bottled water).
Recommendation 13 Working with the Alcohol Industry
a) Current efforts by the Scottish government in their population-wide, evidence-based approach to decreasing overall consumption at population level should be maintained and enhanced.
b) Consideration should be given to exploring warning labels (similar to the graphic images now displayed on tobacco packets).
c) Alcohol advertising and promotion is clearly implicated in the onset and level of drinking by Scottish youngsters and needs to be urgently addressed.
d) Greater efforts need to be made to ban alcohol sponsorship of events for young adults and sponsorship of events and sports that have an appeal to children and young adults.
WORKING TOGETHER- enhancing capacity
Recommendation 14 The Actors
a) There is a clear need for deeper policy integration at national level through, for example, the formation of a Scottish Council of Food Policy Advisors to take forward the Scottish National Food Policy work (similar to that currently working in England). This approach necessitates partnership, cross-government working and input from independent experts and should be lead by the Scottish Government.
b) A Scottish Food Advocacy Group (on the lines of ASH or Centre for Science in the Public Interest) should be established. Scotland has little current capacity regarding food advocacy and would benefit for an active and well-resourced advocacy sector (including food, nutrition, health and sustainability issues) to work in partnership with other actors to increase the engagement of Scottish people with food issues and support for the implementation of the Scottish National Food and Drink Policy.
Recommendation 15 Research
Research should include the following areas and should be commissioned by a joint government grouping (e.g. both the Rural and Environment Research and Analysis Directorate ( RERAD) plus Public Health. There is a need to shift emphasis from an emphasis on biological sciences to foods and society, specifically to:
- investigate how to create active food citizenship;
- identify the emotion of engagement, behaviour change and maintenance needed to effect the transition to a more healthy diet;
- to investigate ways to harness joint action around marketing, access, affordability and raised awareness/emotional demand; and
- to better understand diet and health inequalities and develop an agenda for their reduction.
A system to benchmark and measure change within three pillars/dimensions of sustainability is required.