"Public were way ahead of policymakers"

Former Royal Society for Public Health CEO Shirley Cramer on how citizen voice can move the debate on food forwards

29th June 2023

Food and health have always been a priority for the Food, Farming and Countryside Commission, recognising that the environment, nature, food, farming and climate change are essentially intertwined; and that to improve our lives, our countryside and prospects for a sustainable future requires us to find holistic solutions. Healthy food is at the heart of healthy communities. The evidence is very clear that our food system is failing the population, leading to the worst health inequalities in Europe.

So what are the facts? In the UK we have an ageing population, one of the oldest housing stocks in the world, a fragile welfare state, vast inequalities in jobs and education, inadequate transport and, most importantly, unequal access to healthy food and increasing obesity amongst both children and adults. We have a 19-year difference in life expectancy between the poorest and wealthiest in our society, despite having a universal health and care system, which in theory, should support us all equally.

Alarming rises in weight gain in the UK population have been met by inadequate responses from successive governments. Much of this policy direction is due to the political ideology that emphasises individual responsibility and a fear of the ‘nanny state’. In other words, we should be able to eat what we want, when we want. But what if the food offer is suboptimal for health and wellbeing? Researchers at the University of Cambridge show that from 1993 to 2015 we had 689 separate obesity policies and yet over this time obesity rose among adults from 15% to 27%. For three decades we have had similar and failing policies, when we know that obesity is determined to a large extent by environmental factors and our failure to tackle structural issues such as ultra-processed food. Obesity leads to a range of health problems including diabetes, heart disease and cancer, leading to years of ill health and inability to work. How is it possible to have the much-vaunted economic growth if we have huge numbers in the potential workforce who are chronically ill?

The facts speak for themselves. Food policy sits across several departments of government, making joined up policymaking difficult; and the producers of ultra processed food have endless lobbying power. The narrative has been that weight gain is ‘our fault’, it’s our own responsibility, when the evidence is that much of the food on offer is poor quality, cheap, with little nutritional value that is literally making us ill. The length and severity of the pandemic has added to the poor health condition of the nation and more than ten years of austerity has left most local authorities and the NHS barely able to cope with urgent health and care, let alone the necessary preventive programmes and structural changes to ensure a healthy and equal nation.

We need a national conversation about food to ensure that everyone is entitled to healthy, tasty, nutritional food that is affordable. To do this we need to move away from the discussion around individual choice to healthy food easily available everywhere. The default food offer should be both affordable and healthy. It is no coincidence that the most disadvantaged neighbourhoods have the worst food offerings and more people who are obese and have diet related illnesses, leading to gross health inequalities.

Is there any cause for optimism? There is certainly increased awareness about the consequences of ‘junk food’; the issues around trade and Brexit have highlighted food poverty and scarcity. There is also national concern about the prevalence and growth of food banks alongside the cost-of-living crisis, as basic food items become out of reach for many families. Many think tanks and commentators are increasingly weighing in on the issue, with Nesta recently stating that healthy eating needs to be made easier with reformulation helping access to a better diet.

The time is right for a national conversation about food; we need to understand what people want from our dysfunctional food system. From our work at FFCC we know that families would like a thriving local food system. There is a vast amount of evidence about what should be done to improve our food offering and the recommendations from the National Food Strategy would do much to change the system, as Henry Dimbleby (Chair of the Report) noted, 30% of our population is not fully food secure. Nearly a third of us don’t have enough to eat and don’t know where our next meal is coming from. This should be the catalyst for change.

Experience tells us that it often takes more than evidence alone to get societal change. The evidence is critical but not enough. What does make a difference is when the population unites and voices its clear opinion. People are, after all, voters and constituents, they have the power to change the faces of those in power. When I was a public health leader, we took the evidence and then we asked people for their views about the evidence and our recommendations for change, through focus groups, surveys and polling. Politicians and decision makers were not particularly interested in my evidence-based views but were extremely keen to know what the public thought. It was clear to me that the public were way ahead of the policy makers. In 2016, at the Royal Society for Public Health (RSPH) we asked young people for their views on the positive and negative health aspects of different social media platforms. The subsequent report provided part of the backdrop to the Online Harms Bill and was viewed internationally. Other areas of public harms such as tobacco, alcohol and gambling have been moved forward by the public view of the need for change. In all these areas hard lobbying by the tobacco, alcohol and gambling industries have been confronted by the public’s voice. Of course, in these areas, there are still gains to be made. ‘Big Food’ now needs to hear from the people whose lives they affect, to hear their views.

FFCC will kickstart the National Conversation about Food this summer to understand what citizens really want from our food system; and no doubt the myths created and spread around things like the ‘nanny state’ and ‘cheap’ junk food will be interrogated. The public’s voice will shape the political will to make changes to our imploding and unhealthy food system. Please join us and make a noise. Our ambition is for a more healthy and equal nation with a food system that supports producers and consumers alike.

Shirley Cramer is a commissioner for the Food, Farming and Countryside Commission and former Chief Executive of the Royal Society for Public Health. Full bio here