Professor of Population Nutrition and Global Health University of Auckland, Boyd Swinburn's presentation to the Food Foundation, 10/02/2016. Audio: https://goo.gl/WMFWhp More info: http://foodfoundation.org.uk/blog/

1. UK Food Policy &
Nutrition: Tracking
Progress
Strengthening accountability systems for nutrition in the UK
Foodfoundation.org.uk

2. Today’s speakers
@Food_Foundation
Lawrence Haddad
Senior Research Fellow
IFPRI
@l_haddad
Inge Kauer
Executive Director
Access to Nutrition
@ingekauer
Boyd Swinburn - Keynote
Prof. of Population,
Nutrition and Global Health
University of Auckland
@BoydSwinburn
Fiona Watson
Consultant
The Food Foundation
@Food_Foundation

3. Today’s panellists
@Food_Foundation
Lord Chris
Haskins
Andrew Opie
Director of Food and Sustainability
British Retail Consortium
@the_brc
Jo Ralling
Campaign Director
Jamie Oliver Food Foundation
@FoodRev
Guy Poppy
Chief Scientific Advisor
Food Standards Agency
@GuyPoppy1
Corinna Hawkes - Chair
Prof. of Food Policy
City University London
@CorinnaHawkes

4. www.foodfoundation.org.uk

5. Tracking progress on food and
nutrition policies
Boyd Swinburn
Professor of Population Nutrition and Global Health
University of Auckland
Co-Director, Global Obesity Centre, Deakin University
The Food Foundation Symposium
London, February 2016

6. 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

7. Lim et al Lancet 2012

8. Food environments

9. What needs to be done?

10. 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
Factors
Tobacco use (2)
Access to palliative care
National
Systems
Response
Policies to limit SFA and
virtual elimination of PHVO
Essential NCD Medicines
HPV Vaccine
Marketing to children
Drug therapy and
counseling
Cervical cancer Screening
Hepatitis B Vaccine
Very little in monitoring food environments and policies

11. • 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

12. World Cancer Research Fund

13. 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

14. • Need to shift from responsibility pledges to
accountability systems
– Multiple parties involved
– Agreed actions
– Power relationships (includes sanctions)
– Independent vs mutual accountability

15. Accountability Framework (Kraak V et al PHN, 2014)

16. 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)

17. 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)

18. Objectives
1. 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.

19. 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)
PROCESSESIMPACTSOUTCOMES
Food
composition
Food
labelling
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
ORGANISATIONSFOODENVIRONMENTSPOPULATIONS

20. 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

21. Top priorities (out of 34 actions)
1. Comprehensive
plan
2. 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

22. 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

23. 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

24. England’s National Child
Measurement Program

25. 0%
2%
4%
6%
8%
10%
12%
14%
Least
deprived
Most
deprived
Obesityprevalence
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
Obesityprevalence
Index of Multiple Deprivation (IMD 2010) decile
2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13
4-5 year olds
By year &
deprivation
decile
10-11 year olds
By year &
deprivation
decile

26. Future directions
Aims:
1. Monitoring progress for accountability
2. Underlying systems causes and solutions
www.lancetobesity.info

27. 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

29. Acknowledgements
• INFORMAS collaborators internationally and the
coordination team at University of Auckland
• www.informas.org
• Twitter: @_INFORMAS #INFORMAS
• Funders:

30. www.foodfoundation.org.uk