Eating for Health: a Diet Action Plan for Scotland

4.1 Consumer demand drives the entire food network. But that demand is shaped by many factors. The most influential is the impact of the large multiple retailers on consumer choice, through their contractual relationships with primary producers and food manufacturers and their extensive promotional activity.

4.2 Over the last 30 years, 60% of all food sales in the UK have transferred from small independent retailers to be concentrated in a small number of large multiple retailers. The success of supermarkets has in the main been due to their ability to anticipate the needs and expectations of consumers, and to deliver to them a wide range of products of high quality and freshness at competitive prices. Supermarket 'own brand' goods have also contributed to the shift in the market: over 50% of the major retailers' sales now consist of such products, the composition of which is determined by the supermarkets' own specifications. 'Own brands' are confidently expected to continue to increase their market share.

4.3 Whilst supermarkets are now dominant in food sales, independent traders are still important. Their role is to provide a local source of supply to those who cannot, or do not wish, to shop in supermarkets and a "topping up" service to those who do. Some, such as bakers, and greengrocers and fishmongers of whom there are higher than average numbers in Scotland, provide predominantly fresh foods and are in a position themselves to provide direct encouragement to consumers to increase their consumption of bread, fruit and vegetables and fish. The majority of independent grocers are supplied through wholesalers and "cash and carries" or are members of central buying groups. However, although they are not well placed to influence directly the composition of the foods they sell, they are in a position, in common with the large multiples, to modify the purchasing patterns of their customers through pricing, promotions and imaginative shop displays.

4.4 In the last 10 years most supermarkets have become increasingly sensitive to the concept of healthy eating and have promoted healthy foods. Better organisation of production, improved sourcing and distribution, and the allocation of greater shelf space have all contributed to the increased availability to consumers of a wide range of fruit and vegetables. Supermarkets have also been successful in developing product substitution, particularly in the dairy sector where semi-skimmed milk, low fat spreads and yoghurts have increasingly become the "norm". They have also assumed a health education role with their in-store provision of healthy eating leaflets and recipes.

4.5 It is essential, however, that supermarkets adopt an holistic approach to the development of their healthy eating strategies to ensure that the message to consumers is consistent. For example, the food available in in-store cafeterias should include a range of healthy choices and should not represent a balance which directly contradicts the promotion of healthy eating products on sale in the store itself.

4.6 The Group considers, in consequence, that, because of their awareness and ready acceptance of the need for healthy eating and their pivotal and influential role in the food network, further action by the big supermarket chains offers the best prospect for achieving the dietary change essential in Scotland. The Group strongly believes that the multiple food retailers should grasp the opportunity which this presents for them to develop further their contribution to improving the diet of the Scottish people.

4.7 The Group identified a range of ways in which supermarkets' contributions could be taken forward. These are described in the following paragraphs.

Extension of Product Substitution and New Product Development

4.7.1 Possibly around 20-30% of the target reductions in saturated and total fat, 80% of the salt reduction and 50% of the child sugar reduction could be met from changes in the processed food available in shops. The Group acknowledges, however, that to achieve such targets through fundamental shifts in dietary pattern is a difficult short term objective. Converting a population from high fat products and sugar confectionery to fruit,and from biscuits to bread, will be achieved only as the values and attitudes of a population change over time in response to education, understanding and, finally, acceptance.

4.7.2 Whilst these more fundamental changes in diet are evolving, supermarkets should continue to expand their ranges of healthier alternatives to traditionally accepted products high in fat, salt and sugar. So far these alternatives have had the greatest impact on consumer uptake and provide the most significant opportunities for modifying nutrient intake in the short term. In addition, and consistent with the recommendations already made for food manufacturers and processors, compositional changes which optimise nutritional values and palatability are also possible, as is the ability to effect gradual but continuous changes in product composition so as to wean consumers into accepting palatability changes. Given their now substantial market share, supermarkets' own brand products offer the ideal opportunity to pursue these approaches across entire product ranges. This approach could also be adopted by supermarkets in their development of new products which would not only use lower levels of fat, salt and sugar but also reflect the need to introduce, more widely, the healthier primary produce, eg fruit and vegetables and fish, particularly oil rich fish.

4.7.3 In this way, progress towards dietary targets could be made, proactively, by efforts from within the food industry itself, first to modify the supply end of the market without the initial trigger of consumer demand and, second, to provide consumers with a much greater variety of healthy food choices. It is vital, however, that all the major multiple food retailers should participate in this initiative if it is to impact on the dietary targets and to avoid retailer concerns about competition.

4.7.4 The Action Group recognises that the structure of the multiple food retail sector makes it difficult to take forward such an initiative in Scotland alone. First, there are no longer any major supermarket chains, or independent buying groups, based in Scotland. Second, while some food manufacturers and processors vary product composition and range according to specific regional preferences, the majority work to a single recipe specification for each product for the UK as a whole. The supermarkets may consider, therefore, that a UK approach would be more appropriate although they may wish to examine whether it would be productive for them to make more use of their Scottish stores when conducting consumer trials of new products. The success of such product adjustment could only be achieved by concerted action by the major multiple food retailers. The Group recommends, therefore, that senior executives from the major retailers operating in Scotland should be approached by The Scottish Office to develop arrangements for co-operating with Health Boards and the Health Education Board for Scotland, as well as other public sector bodies, to facilitate and promote a healthier diet. Joint public-private sector promotional schemes could be developed whilst maintaining the competitive element; and some potential initiatives are discussed below.

Campaigns for Health Promotion

4.7.5 Supermarkets, in consultation with the Health Education Board for Scotland, Health Boards and academic groups, could devise healthy eating promotional campaigns designed to encourage increased consumption of the healthier commodities, such as fruit and vegetables, fish, wholemeal breads, pastas and rice, and of those manufactured foods which contain leaner meats and reduced levels of fat, salt and sugar. Supermarkets might also consider making use of their pricing strategies in conjunction with specific promotional campaigns organised jointly with consumer and public health groups in ways which preserved the overall profitability of their sales.

Location and Presentation of Products

4.7.6 In their location of products, supermarkets should consider ways of giving greater prominence to healthy products. The promotion by some supermarkets of fruit, instead of confectionery, at check-outs is an example of the scope which exists for change.

4.7.7 The presentation of fresh fish by supermarkets could also be improved. Supermarkets have long been the principal outlet for frozen fish. In recent years, through the opening of fresh fish counters, they have become dominant in all forms of fish retailing. Recent research into consumers' attitudes to fish, undertaken by the Sea Fish Industry Authority, confirms that the healthy attributes of fish are well understood and important to consumers, but they fail to buy fish because of perceived difficulties in preparation and cooking, and the problem of bones and smell. These negatives affect, particularly, the oil rich species but neither problem is insoluble. Supermarkets are now beginning to appreciate the need for trained staff on their fresh fish counters. There is also a need for them, however, to examine their current marketing and presentation of fish in collaboration with the Sea Fish Industry Authority, the Scottish Salmon Board and Scottish Enterprise to focus consumers' attention not only on its nutritional benefits but also on its convenience and value for money.

Labelling and Point of Information Sales

4.7.8 As indicated in paragraph 3.16 labelling of "own brand" food products by manufacturers and processors should provide easy to understand information to customers about both product composition and nutritional values of foodstuffs. There is a role for supermarkets to ensure that suppliers do this.

4.7.9 More comprehensive in-store information should be provided about the relative nutritional value of products. Greater use of in-store food demonstrations might be made, accompanied by essential advice to consumers about effective food storage and cooking practices.

Low Income Communities

4.7.10 As indicated in paragraph 5.8 of the Plan, low income communities frequently do not have ready access to supermarkets. The least healthy 10% of the population live within these communities and the scope for improving diet, and consequently health, is greatest within this population group. However, their low car ownership constrains their access to the large supermarkets which, in recent years, have tended to locate increasingly at the periphery of cities. Supermarkets, therefore, should explore jointly with the national project officer, whose appointment is proposed in paragraph 5.14, the possibility of providing to low income communities the opportunity of free, or low cost, transport to their stores. They might also consider, with low income communities, alternative ways of improving the availability to them of supermarkets' generally high quality, competitively priced healthy foods.

4.7.11 The Action Group understands that the recently published National Planning Policy Guideline on Retailing, which updates the 1986 guidance, seeks, inter alia, to encourage the retail sector to locate in areas not dependent solely on access by car. The Group welcomes the potential benefit which future planning decisions may bring to low income communities by facilitating their access to supermarkets.

Mother and Baby Rooms

4.7.12 Supermarkets could also contribute to the achievement of the breastfeeding target by providing, more widely, "mother-friendly" in-store facilities for mothers where they can breastfeed their babies within a comfortable environment. They may also wish to consider a policy of welcoming mothers who wish to feed their child within in-store cafeteria areas. This issue is discussed further in paragraphs 6.9 and 7.16.

Electronic Point of Sale (EPOS) Data

4.7.13 Electronic point of sale information maintained by supermarkets could provide, in addition to the Scottish Health Survey, an invaluable source of data for the monitoring and evaluation of the various initiatives to promote improved diet. Supermarkets' customer Loyalty Card Schemes are proving attractive to consumers. If this continues, the Schemes should encourage customer allegiance to the supermarket of their choice, thus enhancing the quality and consistency of the EPOS data. We understand that some preliminary discussions about the use of EPOS data have taken place between supermarkets and the Department of Health and the Ministry of Agriculture, Fisheries and Food in the context of the Nutrition Task Force Programme. The Scottish Office Department of Health should, therefore, also consult the major supermarkets to explore the feasibility of accessing this data and to examine with them the scope for other uses to which loyalty card data might be put.

Action Points

In view of the crucial role of the multiple food retailers operating in Scotland, identified by the Action Group, in improving the diet of the Scottish people, The Scottish Office should take steps to bring together these retailers to consult and to consider with them how best to effect their potential contribution, including the opportunities for them to deliver a much wider range of healthy food products.
Supermarkets should further develop innovative ways, including in-store initiatives, of marketing healthy products to consumers. An holistic and consistent approach is vital.
Supermarkets should ensure that the labelling of 'own brand' products in their stores provides easily understood information on product composition and nutritional value to enable consumers to make healthy food choices.
Supermarkets should examine, in consultation with the proposed national project officer, the feasibility of measures, such as free, or low cost, transport, to facilitate access to their stores by low income consumers within the community. They should also consider, with low income communities, the development of alternative ways in which the healthy food products available in supermarkets could be made more readily available to these communities.
The Scottish Office Department of Health should explore with the major multiple food retailers the scope for access to their electronic point of sale (EPOS) information to facilitate the monitoring and evaluation of the various initiatives being undertaken to improve the Scottish diet. Further potential advantages provided by loyalty card data should also be investigated.