Eating for Health: a Diet Action Plan for Scotland

EXECUTIVE SUMMARY

The Group was asked to set out what has to be done in Scotland to make its men, women and children healthier, through a better diet.

Plainly, the choice of food we make, day in and day out, is the nub. We are not short of advice, and surveys show that most people know what makes a healthy diet and what does not. It is the widespread failure to act on that knowledge which is the reason for this Action Plan, and for the complex, widely cast but practical and effective things to do that make up the Group's recommendations.

Eating well is a long-term investment in good health, which is within the reach of most Scots. Yet the image, and too often the reality, of a Scotch pie and chips, washed down by a sugary drink or a beer, is the reverse. The conditions to which poor diet and obesity give rise are, in health terms, burdensome to treat, poor in outcome, and more common in Scotland than almost anywhere else. In human terms, they account for diminished lives, pain and stress. Children form tastes early: building from what we know of their present diet, prospects for their health in middle and old age look bleak.

Of course, food cannot simply be approached in terms of health. Most of the Group members are drawn from fields outside health, and all members have been keenly aware that food is an industry - competitive, complex and changing - a strong feature of Scotland's economic life. Food is also a part of people's enjoyment of life. Eating out, linked both to work and pleasure, has become common. Eating in the home has been affected by changes in lifestyle, working hours and cooking methods which have tended to replace few and formal meals that rely on long preparation time by diets which draw more on "short order" meals and snacks. And many people are fed by others. This is true in households, but also in workplaces, schools and other institutions.

The concept of diet as medicine is profoundly unappealing and will not work. But a framework of healthy eating, which looks more to fruit and vegetables, cereals, fish and leaner meat, and less to fat, sugar and salt, can offer plenty of room for enjoyable, varied, and adventurous life-long eating, that takes account of the cornucopia of foods available in Scotland, and the restrictions on those whose income limits choice.

In this report, we examine every sector of the food industry and other areas that present the hardest challenge to healthy diet. For each, we identify measures we see as practical over the next few years and offering singly, but more so together, a real impact on diet.

The Plan bears on those organisations which could be expected to lead the nation's health - The Scottish Office and national agencies, the National Health Service and local government. Industry may take comfort in that, but the Plan depends, very substantially, too on its contribution. Two elements of commercial interest - the capture of changing public tastes and the prospect of larger markets for the commodities which Scotland produces - may make that contribution palatable. The third element, which has been pressed in the Group's discussions as strongly by industry representatives as from elsewhere, has been a wish to see Scotland a healthier place.

THE PLAN

Shaping Consumer Tastes and Making them Count

The Group has looked closely at measures that will encourage people to make healthier choices and to demand healthier foods. Key steps are through advice, health and practical skills, targeted on:

All households in Scotland, through, a booklet which will focus on what they can do and what they should be expecting others, through advice and services, to do to support healthy dietary choice. (Recommendation 67) Parents and young children, through the professionals who work with them and through the food products available. (Recommendations 6, 32) All schoolchildren, through a cookery skills course to help them put into practice their knowledge about healthy eating and to examine their own eating patterns. (Recommendation 38). Help in low income areas, through measures, co-ordinated by a national project officer funded by The Scottish Office, to encourage local initiatives and to improve access to a range of healthy food at reasonable prices. (Recommendations 17, 21)

Supplying food for a healthier diet

Next, we have considered the "supply" changes through which the food industry can help support dietary change. Recognising the competitive and fragmented nature of parts of the industry, these concentrate on steps that will be 'with the grain' of sectional change.

Key steps are:

For food producers, stimulating demand through the marketing and supply of fruit and vegetables, leaner meat and fish. (Recommendations 1, 2, 5) For food manufacturers and processors, innovative development of intrinsically healthier products and, in existing products, introduction of small stepped reductions in the fat, salt and sugar content of products, without sacrificing taste. (Recommendation 9). For multiple food retailers, product development as for food manufacturers and processors but, in addition, marketing and display, point of sale labelling, in-store promotional campaigns and pricing strategies which support healthier choice; with Scottish Office initial involvement to consider with retailers how they might best co-ordinate their contribution. (Recommendation 14)

All of these areas are important, but the enormous impact of supermarkets on our shopping habits, and the way in which their food products dominate Scotland's eating patterns, make their role critical.

Understanding Food Better

Thirdly, we have considered the poor place of nutrition, despite the dominance of food, in popular life. If those providing food do not know and act on what is healthy, we cannot be surprised if consumers falter.

Key steps are:

A model contract for catering specifications, for wide use by public agencies, and hopefully throughout industry, wherever a canteen or restaurant is provided. Its first use and most profound impact should be in schools, where shaping eating patterns and supporting healthy growth through diet are so important. (Recommendation 42). Training for all catering staff in the basics of nutrition and diet, so that in providing for, and serving, customers they are aware of what makes a healthy balanced meal. (Recommendation 49). Better information on nutrition and diet for all groups of NHS staff. (Recommendation 56). Development by local authorities of healthy eating awareness amongst relevant staff involved in the wide range of their responsibilities. (Recommendation 64).

Influencing

Though The Scottish Office will be charged with monitoring the steps we commend, and - together with the Health Education Board for Scotland - helping make many of them happen, there are others whose influence is important to efforts to meet Scotland's dietary targets. These are:

The NHS, for its work on health promotion and throughout the many NHS services where people draw on advice about health. Local authorities, for the vast range of their responsibilities that bear on education, on providing food, and on topics that are profound but less obvious in relation to local residents and healthy eating, from their policies in deprived areas to those that bear on the siting of supermarkets. Supermarkets and the fast food industry, for the huge market share they hold, and the powerful influence they can bring to bear on the public's eating habits. Consumer bodies, principally the Scottish Consumer Council, for their role in helping consumers see a healthy diet as an investment and an entitlement, on which they can expect advice, services and products.

CONCLUSION

The Group believes that the successful implementation of the aspects of the Plan highlighted above is the key to the delivery of the changes required to meet Scotland's targets for dietary change described in paragraph 1.7 of the Plan. But these 15 key recommendations alone will not achieve the dietary improvement sought. They are supported, therefore, by a range of complementary and important further recommendations which, together, should enable the Scottish population to enjoy very much better health. These and our key recommendations are listed at the end of this Summary.

The sections which follow map the path to dietary change, topic by topic, beginning with the various links in the food chain. They develop our recommendations, placing them within the complex setting in which food policies must operate.

The changes - especially eating more fresh fruit and vegetables - will bring gains to health. These gains will not necessarily come quickly - some will take 20-30 years to achieve their full impact - but they will be very substantial, and so worth the effort needed now.