Choosing a Better Diet consultation

Choosing Health?
Choosing a Better Diet
A consultation on priorities for
a food and health action plan
SPRING 2004

Choosing Health? Choosing a Better Diet
A consultation on priorities for a
food and health action plan

READER INFORMATION
Policy Estates
HR / Workforce Performance
Management IM & T
Planning Finance
Clinical Partnership Working
Document Purpose Consultation/Discussion
ROCR Ref: Gateway Ref: 3143
Title Choosing Health? Choosing a Better
Diet: a consultation on priorities for a
food and health action plan
Author DH
Publication Date 6 May 2004
Target Audience PCT CEs, NHS Trusts CEs SHA CEs,
Care Trusts CEs, WDC CEs, Medical
Directors, Directors of PH, Directors
of Nursing, NHS Trust Board Chairs,
Special HA CEs, Directors of HR,
Directors of Finance,
Communications Leads
Circulation List Local Authority CEs, Voluntary
Organisations, Government office
for regions, OGD‘s
Description This is a consultation on a food and
health action plan for England, a
commitment in the Government’s
Sustainable Farming and Food
Strategy. The consultation, an
important strand of the Choosing
Health? debate, will run from 6 May
to 30 June 2004.
Cross Ref Food and Health Action Plan: Food
and Health Problem Analysis for
Comment. 31 July 2003
Superseded Docs N/A
Action Required NHS views invited on consultation
Timing 30 June 2004 consultation
deadline
Contact Details Choosing a Better Diet – Consultation
Health Improvement and Prevention,
Dept Health
Area 704 Wellington House
133-155 Waterloo Road
London SE1 8UG
Nutrition Support – 020 7972 1305
www.dh.gov.uk/consultation/
liveconsultations
For Recipient Use

Contents
Foreword 1
Chapter 1: Introduction 3
Chapter 2: Consumer choice? 8
Chapter 3: Improving Food Production and Manufacture 12
Chapter 4: Improving Food Supplied by Retailers, Caterers and the Workplace 16
Chapter 5: Improving Nutrition in Pregnancy and the Early Years 19
Chapter 6: Improving Nutrition in Schools 21
Chapter 7: Improving Nutrition in the National Health Service 24
Chapter 8: Improving Nutrition in Local Communities 27
Chapter 9: The process of consultation and how to contribute 30
Annex A: Abbreviations 32
Annex B: Cabinet Office Code of Practice 33
References 34
SPRING 2004 Choosing Health? Choosing a Better Diet

Foreword: by the Minister for
Public Health
We are currently seeing a huge surge of interest from people looking to improve their
health and wellbeing. In response to this, the Government launched in March this year
Choosing Health? a consultation on action to improve people’s health. This gives us the
chance to have a serious discussion about the issues that really matter to individuals, their
families and their communities. It is an opportunity to think about what we can all do
differently to make healthy choices easier.
I am pleased to present Choosing a Better Diet: a consultation on priorities for a food and
health action plan – an important strand of the Choosing Health? consultation. Choosing a
Better Diet presents an important opportunity to identify priorities for action and clarify
roles and responsibilities for improving diet and nutrition, within the context of the overall
health improvement debate set by Choosing Health?
As we have made clear with Choosing Health? the Government is absolutely committed to
achieving better health for everyone, and diet and nutrition is one aspect of people’s lives
where we can make a difference. But others have to play a role too. Lasting improvements are
only achievable if Government and key stakeholders work together over the coming years to
tackle the issues. We must recognise, however, that individuals also have to take responsibility
for their diets and for the diets of people in their charge. The Government and others can, and
should, support consumers, providing them with easier access to a wider range of healthier
foods and, crucially, the information and knowledge needed to make informed choices about
their diets. And this may mean targeting action to meet the needs of particular groups and
tackle inequalities.
The final food and health action plan will shape, co-ordinate and drive action to improve
the health of the population of England through better nutrition. It is a plan for a range of
stakeholders, inside and outside Government. Many people contributed to the thinking that
led to the proposals for priority action in this consultation, for example, through the
responses, last summer, to an analysis of the problems of diet and health and the
stakeholder conference in February 2004.
The Choosing Health? and Choosing a Better Diet consultations present an opportunity for
a wider group of people to inform the development of – and contribute to – this important
work on nutrition and health. Responses to these consultations will inform a White Paper,
to be published later this year, which will set out a programme to help and support
individuals and communities to improve their health.
I hope you will take part in this consultation and encourage others to do so.
Melanie Johnson
May 2004
SPRING 2004 Choosing Health? Choosing a Better Diet 1

Introduction
The context
1.1 Improving health and narrowing health inequalities are priorities for the Government.
However, although there is much Government can do to maximise opportunities for
people to enjoy better health, these are issues for society as a whole. The NHS and
other public bodies, local government, the voluntary and community sector,
individuals, communities, the food industry, employers and the media all have a role
to play.
1.2 On 3 March 2004, we launched Choosing Health? a consultation on action to
improve the people’s health (available on the Department of Health website1
) so that
we could hear the views of all these stakeholders. That consultation sets out the
major health challenges, including problems of health inequalities, in England and has
started a debate on the range of levers we have to bring about change and how they
can be used by Government and other stakeholders. The ideas that develop from the
Choosing Health? consultation will lead to a White Paper on improving health, to be
published this summer.
1.3 Choosing Health? provides the opportunity for a debate about what is effective and
what should be given priority. It will help us define our respective roles and
responsibilities and help us decide how we can best work together to give people
opportunities to lead healthier lives.
1.4 The Choosing a Better Diet consultation is an important strand of the Choosing
Health? debate. It presents an opportunity to prioritise the actions that different
stakeholders might take towards improving diet and nutrition. To stimulate discussion,
this document sets out proposed goals and possible priorities for a food and health
action plan.
1.5 A food and health action plan will also form part of the key deliverables arising from
the Consumer Health Needs work stream of the Government’s Strategy for
Sustainable Farming and Food, on which the Department of Health is working with
the Department for Environment Food and Rural Affairs (Defra). In particular it will
contribute to the Strategy’s key principle to “produce safe, healthy products in
response to market demands, and ensure that all consumers have access to nutritious
food, and to accurate information about food products.” It also responds to the call
by Sir Don Curry and the Policy Commission on Farming and Food for a “strategy on
all aspects of encouraging healthy eating” and will place nutrition and health in the
context of sustainable development for England’s food supply.
1.6 The Government is also exploring whether and, if so, how, action taken in response
to many of the other recommendations of the Strategy can be beneficially joined up
with action to improve health and nutrition. Possible areas include, for example,
research priorities, local food networks, food chain, school visits to farms, industry
1

nutrition group, farmers’ markets and regional development agencies and local food
buying co-operatives.
Why have a food and health action plan?
1.7 The food we eat, and the way it is produced and manufactured, has a significant
impact on our health. Cancer and cardiovascular disease, including heart disease and
stroke, are the major causes of death in England, together accounting for almost
60% of premature deaths. About one third of cancers are attributed to poor diet and
nutrition.2
1.8 Unhealthy diets, along with physical inactivity, have also contributed to the growth of
obesity in England. 22% of men and 23% of women in England are now obese, a
trebling since the 1980s, and 70% of men and 63% of women – 24 million adults –
are either overweight or obese. The greatest problems are in the lowest socio-
economic groups. It is a growing problem with children and young people. Around
16% of 2 to 15 year olds are now obese.3
Obesity brings its own health problems,
including hypertension, heart disease and type 2 diabetes. In total it is thought that
treating ill-health caused by poor diet costs the NHS at least £4 billion each year.4
1.9 The Government is committed to achieving better health for everyone, and diet and
nutrition is one aspect of people’s lives where we can make a difference. However,
many others – the food industry, consumer groups, health experts, the media and
others, including individuals and communities – have a role to play too.
What are we trying to achieve?
1.10 The aim of the Choosing Health? consultation is to develop proposals for a strategy to
improve the health of the whole population of England. As part of that strategy, a
food and health action plan will focus on the ways that better health can be achieved
through better nutrition at all stages of life and for different groups in society,
recognising and addressing different needs, particularly those of disadvantaged
groups. As for the wider Choosing Health? consultation this consultation offers an
opportunity to focus the debate. We know a lot about what needs to be done, but
need to focus on what our priorities are, how to achieve them and how to overcome
barriers to change. There is also a lot of work already underway and we need to build
that into a coherent strategy.
1.11 A plan will also contribute to wider policy agendas, for example on health inequalities
and farming and food, but we are not proposing that it should cover food safety.
4 Choosing Health? Choosing a Better Diet SPRING 2004

Nutritional Priorities and Objectives for the Whole Population
1.12 One of the aims of a plan will be to promote a healthy diet in accordance with the
recommendations of the Committee on Medical Aspects of Food and Nutrition Policy
(COMA), the Scientific Advisory Committee on Nutrition (SACN) and the World Health
Organization (WHO).
1.13 Maintaining energy balance (where energy intake from food and alcohol equals
energy expenditure) is key to reducing the prevalence of obesity. As fat is the most
calorific of all nutrients (it provides 9 kcals per gram), current trends in its reduction
need to continue. Reducing the population energy intake of total fat will remain a
priority. Although alcohol is not classed as a nutrient it can make a significant
contribution to total energy intakes (it provides 7 kcals per gram). Increasing public
awareness of the energy content of alcohol also needs to be considered.
1.14 Action addressed at the whole population over the age of 5 years (the
recommendations do not apply to children under that age) will be directed by the
nutritional priorities set out in the box below. The Food Standards Agency is also
undertaking a secondary analysis of data from the National Diet and Nutrition Survey,
which will be used to support continuing work with stakeholders on targeting specific
groups of the population.
Case Study 1: Public Health Programmes in Australia and Finland
Two examples of programmes that led to improvements in diet and health.
Experience in Australia demonstrates that public health programmes with a focus
on nutrition can have significant impact on a population’s health. There have been
numerous public health programmes in Australia to reduce coronary heart disease
since the 1960s, including the National Food and Nutrition Programme (1979) and
National Food and Nutrition Plan (Phase 1 – 1993, Phase 2 – 1997).
Deaths from coronary heart disease in Australia have declined significantly since the
late 1960s and around 56% of the decline has been attributed to reductions in
blood pressure, saturated fat intakes and smoking. The public health programmes
to reduce fat and saturated fat intake were responsible for 20% of the decline in
blood cholesterol levels and the estimated benefit-cost ratio (costs being public
health programmes) was calculated to be 11:1, a net benefit $8.5 billion.5
The North Karelia project in Finland was introduced in 1972 as a community based
and later as a national programme to influence diet and other lifestyle factors to
prevent cardiovascular disease. The project was based on low cost community
interventions supported by national activities, including media activities and
industry collaboration. In Finland as a whole, nutrition policies have resulted in
reduced saturated fats (21% of total energy in the early 1970s to 14% by 1997),
and total fat (from 38% to 33%).6

Nutritional Priorities in Tackling Inequalities and for Specific Groups
1.15 Dietary intakes averaged over the whole population do not fully reflect variations and
problems within specific population groups, such as low income or minority ethnic
groups and older people.
1.16 Tackling health inequalities is a Government priority and action needs to be prioritised
to identify and address the specific risk factors and problems of access that arise in
the most deprived areas. Children from disadvantaged households eat on average half
as much fruit and vegetables as children from high-income group households and
mothers from disadvantaged groups are least likely to breastfeed.
1.17 While activities aimed at the general population will benefit everyone, action also
needs to be targeted at certain groups along the life course (such as women of
child-bearing age, pregnant women, infants and children under 5) and at vulnerable
or disadvantaged groups.
Next steps
1.18 The suggested goals set out in the following chapters of this consultation have
evolved from discussion with stakeholders. Last summer, the Government consulted
stakeholders on a Food and Health Problem Analysis, which discussed trends in
nutrient and food intake that impact on health and diseases, and key influences on
diet and eating patterns (the document and a summary of responses is published on
the DH website7
). Subsequently, the Government and stakeholders explored possible
actions to tackle the problems, culminating in a conference on 23 February 2004.
1.19 The responses to this consultation will inform development of a plan for action.
We will be consulting separately on the steps that will be needed to secure delivery –
including what needs to be done in terms of monitoring and evaluation.
The nutritional priorities, for the population of England as a whole, are:
● increase average consumption of a variety of fruit and vegetables to at least
5 portions per day (currently 2.8 portions per day);
● increase the average intake of dietary fibre to 18 grams per day (currently
13.8 grams per day);
● reduce average intake of salt to 6 grams per day (currently 9.5 grams per day);
● reduce average intake of saturated fat to 11% of food energy (currently
at 13.3%);
● maintain the current trends in reducing average intake of total fat to 35%
of food energy (currently at 35.3%); and
● reduce the average intake of added sugar to 11% of food energy
(currently 12.7%).
More information about the rationale for these priorities including key priorities
for specific groups can be found as a supplement to this document on the
Department of Health website.1

1.20 We plan to continue dialogue as the Government develops its detailed plans for the
White Paper. This consultation will be supplemented by meetings with stakeholders
and specific events, such as the “Choosing Health? Achieving a Balance Between Diet
and Exercise” conference due to take place on the 6 May.
1.21 Information on how to participate in the consultation is set out in Chapter 9.

Consumer choice?
2.1 Consumer demand for healthier foods is likely to be the key driver for activities of
producers, manufacturers, caterers and retailers. Consumer demand reflects personal
preferences, motivated by taste, and influenced by cultural and social habits, product
marketing, family pressure, availability and cost.
Evidence and Current Action
Consumer awareness
2.2 The majority of consumers are aware, in general terms, of what constitutes a healthy
diet. The Food Standards Agency (FSA) Consumer Attitudes Survey 20038
found that
most respondents correctly identified that a healthy diet contains more vegetables
(80% of respondents) and fruit (76%), less salt (54%), and less foods containing
sugar (66%) or fat (66%). But consumers lack awareness of what this general advice
means in practice:
● only 59% of respondents to the FSA survey knew that the recommendation for
fruit and vegetables was to eat at least 5 portions per day, and only 26%
correctly identified the quantity of vegetables making up a portion. But the level
of awareness differs between socio-economic groups with over 75% aware of
the recommended “at least 5 portions per day” in the higher socio-economic
groups compared to less than 50% in the lowest groups.
● a recent Consumer Association survey9
found that “very few [UK] respondents
had any idea about the amounts of fat, sugar and salt they should be aiming
for”. It is also clear that in many cases, even where consumers have the
information, they are not changing behaviours.
Proposed key goals for improving consumer information and skills and
influencing behaviours:
● Ensuring that everyone can get the balanced information they need to make
choices about what they eat.
● Empowering all consumers, through health promotion and ongoing education
and learning, to develop the skills and understanding to use information
effectively.
Are these the right goals?
What are the priorities for action to:
● define the information people need to make choices about healthy eating;
● improve the quality and co-ordination of the information that is provided; and
● help people in all parts of society have access and understand it?
What role should different organisations play?
2

2.3 Evidence from other countries shows that increasing consumer awareness can
influence consumption. In the USA, evaluation of the National Cancer Institute’s 5
A DAY for Better Health campaign found that the strongest predictors of dietary
change were:
● knowledge of the recommendation to eat 5 or more servings of a variety of fruit
and vegetables per day;
● taste preferences; and
● confidence in their ability to eat vegetables and fruit in a variety of situations.
2.4 Several studies have shown that most consumers get their nutritional information from
the media, although the most trusted source remains the General Practitioner (GP).10
2.5 Many different agents, inside and outside Government, from national bodies to
individual health professionals, are putting across messages in a variety of forms,
including leaflets, CD-roms and the Internet. Case Study 2 illustrates two ways in
which Government provides advice to consumers.
2.6 The food industry and other stakeholders support consumer health education
campaigns too, for example:
● the Food and Drink Federation’s “Foodfitness” campaign, the British Retail
Consortium’s “Eat Well Drink Well” publication and materials provided by
numerous companies as Key Stage 1 and 2 resource packs for schools;
● many food retailers and manufacturers support the 5 A DAY Programme to
promote increased consumption of fruit and vegetables; and
● many retailers and food manufacturers cover healthy eating and provide advice
on exercise and diet through websites and consumer magazines.
Case Study 2: Consumer Awareness
Food Standards Agency’s website
The Food Standards Agency provides a range of information to children and adults
on healthy eating and the principle of a balanced diet, aimed at adults and
children. The Agency’s website, www.food.gov.uk, is a major source of
comprehensive information for consumers, and other stakeholders, on all aspects
of diet and nutrition. It provides advice on healthy eating to special groups, such
as students leaving school for a gap year or feeding themselves for the first time.
An interactive section of the website answers queries about healthy eating from
the public and health professionals.
Department of Health’s 5 A DAY Communication Programme
The Department of Health provides a range of resources, for health professionals,
industry and the public, to raise awareness on:
● the health benefits of eating at least 5 portions of a variety of fruit and
vegetables each day;
● what food counts towards 5 A DAY and what constitutes a portion; and
● how to increase the frequency of fruit and vegetable consumption.

Labelling and health claims
2.7 Food labelling is a key source of consumer information and there is evidence that it
can influence consumer choice. In the UK, the IGD Consumer Watch report of June
200311
found that 34% of consumers identified clearer food labelling as the main way
industry could help them make healthier food choices. There is some evidence that
consumers understand non-numeric labelling better than numeric, and when
nutrients are expressed as a percentage of Recommended Daily Amounts.12
Consumers also find health claims confusing. FSA-funded research13
concluded that
“health claims made on food labels often leave consumers confused or unclear about
the properties of the products”.
2.8 Food labelling can have wider benefits than more informed consumer choice. In New
Zealand, for example, the introduction of labelling logos for healthier foods led many
companies to reformulate their products, leading to large decreases in the salt content
of processed foods.14
2.9 In the UK, the FSA provides general guidance on clear food labelling, with the aim of
encouraging best practice and improving legibility and usability. It also provides advice
for consumers on the use of labels.
2.10 Nutrition labelling is currently only required by law for those products that make
nutrition claims such as “low-fat” or “reduced sugar”. In practice, however, there is a
high level of voluntary nutrition labelling in the UK market. Rules on nutrition labelling
are made by the European Union (EU) and are under review with a planned EU
Commission proposal expected in 2004. In its latest discussion paper, the EU
Commission suggests compulsory nutrition labelling on all pre-packed foods, which
could be used to make clear whether foods contain low, medium or high levels of
salt, fat and sugar. A proposal for a harmonised EU approach to nutrition and health
claims, to avoid confusing or misleading consumers, is currently being debated in the
European Parliament and Council.
2.11 During the development of the 5 A DAY logo, consumers reported that they wanted
a logo that they could trust. They did not want it to go on products that provided less
that one portion of fruit and vegetables per serving, and they did not want the logo
on products that were high in fat, sugar or salt.
A logo and portion indicator have been developed to help consumers identify
what counts towards 5 A DAY. These are being used for promotional materials
and on food packaging to show consumers at a glance whether the food counts
as one portion towards their 5 A DAY target. As of April 2004, over 340
organisations have applied to use the logo. It can be found, for example, on
frozen vegetables sold in ASDA, Boots’ fruit packets and Minute Maid fruit juice
sold in McDonald’s restaurants.

Food promotion
2.12 Food promotion can influence consumer choice and may also influence consumers’
understanding of key nutrition messages.
2.13 An FSA-funded review15
of evidence on the promotion of food to children indicated
that food promotion does affect children’s food preferences, food behaviour and
consumption and that the influence is not just confined to brand switching.
The Advertising Association’s follow-up paper, on advertising and food choice,16
concluded that food marketing is one of a large number of influences on food
choice among children.
2.14 Although the FSA review found that the balance of foods advertised to children is at
odds with recommendations on dietary balance, there is potential for promotional
techniques to be used to promote healthier choices. For example, an experimental
study17
found that promotional signage on vending machines significantly increased
sales of low-fat snacks in secondary schools, independent of pricing.
2.15 The FSA published a consultation on 29 March 2004 on an Action Plan to improve
the balance of promotions aimed at children, containing recommendations to a range
of potential options. Details can be found on the FSA’s website.18
2.16 The Office of Communications (Ofcom) is also reviewing the relevant rules in the
broadcast advertising code. It is analysing children’s viewing patterns, and gathering
relevant independent research data, as well as collecting the views of children, parents
and teachers on the impact of food adverts.

Improving Food Production and
Manufacture
3.1 Increasing demand for healthy food options through better information needs to go
hand in hand with increasing the supply of healthy choices.
Primary Producers
3.2 Primary producers have a key role in providing healthier food products to consumers.
Several initiatives have clearly demonstrated their capability to respond positively to
changes in consumer demand. For example, livestock producers have achieved
significant reductions in the fat content of carcass meat over the last 15-20 years
(see Case Study 3) and promoted the naturally lower-fat meats, like poultry.
3.3 There is likely to be scope to stimulate demand for healthier products still further, for
example through promotional activity for fruit and vegetables in response to the 5 A
DAY Programme, including the National School Fruit Scheme.
Case Study 3: Fat Content of Carcass Meat
Over recent years, there have been improvements in breeding and management
that have brought down the fat content of pig, sheep and cattle carcasses. The
clearest example is pigs where the reduction in the key indicator fat depth has
been 45% over the period 1982 to 2002. Modern butchery techniques can
remove much of the remainder.
The work of the meat and livestock industry to reduce the fat content of meat has
contributed to the decline in total fat consumption in the UK.
Proposed key goals for improving the availability of healthy choices
in food:
● Reducing salt, total and saturated fat and added sugar in food products where
appropriate.
● Increasing fruit and vegetables, and fibre in food products, where appropriate.
What are the priorities for producers and manufacturers in stimulating demand
and increasing availability of healthy choices in food? including:
● reduce salt in processed foods;
● reduce total and saturated fat;
● reduce added sugar in food and drinks, particularly those for infants and
children;
● increase availability of fruit and vegetables and higher fibre products; and
● promote healthier portion sizes?
3

Manufacturers
3.4 Reducing the amount of total and saturated fat, salt and added sugar and increasing
fruit and vegetables and fibre in manufactured and processed foods would contribute
greatly to improvements in our diets. Some manufacturers have already adjusted the
composition of their products towards healthier alternatives. Many consumers have
already demonstrated preferences towards lower-fat foods such as semi-skimmed and
skimmed milk products and lower-fat meat products.
3.5 People’s taste for a particular content of fat, sugar or salt in foods is not fixed.
Palatability can be influenced by habitual exposure, offering the opportunity to
change through gradual alterations in food composition. Reducing the sweetness of
infant foods might, for example, help preferences for less sweet products to become
the norm, both in childhood and later life.
3.6 75% of salt in the diet comes from processed food19
. The main contributors to total
and saturated fat intakes are meat and meat products, cereal and cereal products and
milk and milk products. The following table sets out the main food sources for total
and saturated fat, salt and added sugar in the average diet.
Table summarising the percentage contribution of food types to average daily intakes
of total fat, saturated fat, added sugar and salt in the diet of British adults.
3.7 Altering the nutritional content of products without changing taste can still have a
significant impact on dietary intakes. A Health Education Authority (HEA) review20
found that passively changing the composition of food decreased the fat content of
catered meals between 6 and 12% of energy intake.
3.8 The recent trend of increasing product portion sizes may lead to passive over-
consumption and excess weight gain. In the USA, there is evidence that portion sizes
increased in parallel to trends in obesity. While the increase in portion size occurred
both inside and outside the home, the largest portions consumed were at fast food
establishments. The sizes of the increases were substantial: between 1977 and 1998
Total Saturated Sodium Added
fat fat (salt) sugars
Meat and meat products* 23% 22% 26% –
Dairy foods (excluding butter) 14% 24% – –
Cereal and cereal products 19% 18% 35% 19%
Fat spreads (including butter) 12% 11% – –
Soups, sauces and condiments – – 9% –
Sugars, preserves, confectionery – – – 32%
Drinks (including soft and alcoholic) – – – 37%
*Lean meat generally has much lower percentages than meat products

salty snacks increased by 93 kcals, soft drinks by 49 kcals, hamburgers by 97 kcals
and French fries by 68 kcals21
.
3.9 Programmes are in place for shared funding to develop the science needed to
produce healthier foods that also have consumer appeal. There is scope for industry,
Government and the research community to work together on these issues.
3.10 Industry is already doing much to improve the production of a wider range of
healthier foods, often in response to increasing consumer demand. Many
manufacturers are introducing “healthier” ranges of foods. Case studies 4, 5 and 6
show how they are reducing salt and fat content in manufactured foods.
Case Study 4: Action by Manufacturers and Retailers on Salt
The food industry has played a vital role in enabling consumers to improve their
health by reducing the levels of salt in processed food and by providing more
“reduced salt” and “low-salt” options.
● the Food and Drink Federation’s Project Neptune, which comprises ten member
companies, including Heinz and Baxters, agreed to make a 10% reduction in
salt (sodium) for branded and ambient soups and sauces by the end of 2003
and has since announced its intention to make further similar reductions in
2004 and 2005;
● the Federation of Bakers announced an additional 5% reduction in the salt
used in sliced and wrapped bread by the end of 2004; and
● the British Retail Consortium, whose members include most of the major food
retailers, such as Tesco, Sainsbury’s and Asda, has set upper level targets for
reductions in salt in nine key product categories, including baked beans and
pizza. It hopes this will lead to overall reductions in salt of 10 to 25% in food
bought.
At the request of Melanie Johnson, Public Health Minister, food manufacturers
and retailers produced, by February 2004, a variety of plans – currently being
analysed – for reducing levels of salt in a range of foods.
The FSA and Health Departments will continue to hold discussions with industry to
examine how reductions can be made. Additionally, the FSA will monitor the levels
of salt in different food categories through a series of surveys.

Case Study 6: Innovation in Milk and Milk Products
Semi-skimmed milk accounts for 5% of saturated fat in the diet.
In March 2004, Robert Wiseman Dairies launched a new product containing 1%
fat compared with the 1.7% fat that is normal in semi-skimmed milk. In focus
groups not one person said that the new product tasted like anything other than
semi-skimmed milk. The company is investing £2million in the venture and other
dairies are expected to follow suit.
Case Study 5: Reduction of Fat Intake in the UK
The fall in average fat intakes in the UK population over the last two decades
demonstrates the significant impact that industry, and other stakeholders, can
have on dietary intakes.
Total fat intakes in the UK have fallen from a mean of 40% energy in 1986-87 to
35.3% energy in 2000-01. Saturated fat intakes have also fallen in that period,
from 16% to 13% energy. Changes in total fat intake have largely been due to a
reduction in the consumption of whole milk, butter, other spreads and meat and
meat products, and a reduction in the fat content of fat spreads and meat and
meat products.
Some of the factors that are likely to have led to these changes include:
● technological developments to enhance the taste and keeping quality of
healthier foods (e.g. lower-fat margarines);
● increasing incomes and the affordability of a wider range of foods;
● a decreased price differential between full-fat and lower-fat products;
● greater availability of lower-fat products and increased consumer demand;
● more advertising of low-fat options, e.g. the advertising of lower-fat spreads
has generally exceeded that of butter; and
● better health education, for example, the Unilever “Flora Project for Heart
Disease Protection” and the Health Education Authority “Look After Your
Heart” Programme.

Improving Food Supplied by Retailers,
Caterers and the Workplace
4.1 As discussed in chapter 2, consumer demand drives the food chain. However, retailers
and caterers can help consumers make healthier choices through simple techniques,
both in terms of increasing awareness and influencing consumption through the
composition of foods.
4.2 Retailers and caterers are well placed to influence eating habits. More than 9 out of
10 consumers do most of their shopping at a supermarket. Half the country’s food is
now sold from just 1,000 large stores.22
Eating outside the home is increasingly
common too, whether in the workplace, in the high street or in a setting where food
is provided by the public sector. 25% of respondents to the FSA Consumer Attitudes
Survey 20038
said that they regularly used some form of fast food or takeaway outlet.
Evidence suggests that food eaten outside the home is higher in fat than food eaten
in. Responses to a recent survey of diets and eating habits carried out by the Institute
of Grocery Distribution showed 74% of teenagers eating out at least twice a month
and 43% once a week or more.
Proposed key goals for improving food supplied by retailers, caterers and
the workplace:
● Food retailers, including fast food shops and caterers reducing the salt, total
and saturated fat and sugar content of food and providing better access to
fruit and vegetables and higher fibre products.
● Employers who have catering facilities providing greater access to fruit,
vegetables, higher fibre products and a wider range of foods lower in salt, total
and saturated fat and added sugar.
What are the priorities for retailers, caterers and the workplace for improving food
supplied, in particular:
● reducing salt, added sugar, total and saturated fat and increasing fruit and
vegetables and fibre in processed and convenience food, and catered meals;
● access to fruit, vegetables and higher fibre foods;
● promoting healthier portion sizes;
● improving the availability of affordable healthy foods;
● marketing and promoting healthier, affordable food; and
● providing access to nutrition training for caterers?
4

4.3 The 1997 HEA review20
on the effectiveness of different interventions on healthy
eating found that the most effective actions in supermarkets and catering settings
involved simple menu or shelf signs identifying healthier choices, reinforced or
accompanied by more detailed leaflets and local promotion. The promotion of
healthier items at the point-of-sale (e.g. signs or stickers) resulted in increased sales
of 2 to 12% of total market share while the notices were in place.
4.4 In North Karelia, Finland, the reported consumption of vegetables doubled between
1979 and 1994 during which time a combination of measures were introduced,
including free salad with catered meals and improved availability of vegetables.6
4.5 Price can have an important impact on consumer demand. In Norway, fiscal and
regulatory strategies designed to affect prices of “healthy” foods contributed to a
30% increase in the consumption of vegetables, 17% increase in fruit consumption
and a 13% decrease in total fat intake between 1970 and 1993.23
Retailers and caterers
4.6 Retailers and caterers are already doing much to improve the supply of healthier food,
including:
● introducing healthier ranges of foods, with reduced levels of fat, salt or added
sugar and providing increased access to fruit and vegetables;
● offering a range of healthier foods in many convenience format stores in city
centre locations and more petrol station forecourt convenience stores in areas
often remote from a major supermarket;
● developing a more responsible approach to promotion of foods to certain target
groups and within certain settings. Some retailers have introduced a policy of not
displaying confectionery at the checkout, in response to consumer demand;
● using “Catering for Health”, a practical guide to healthier catering practice for
lecturers, to help improve the range of healthier options in food provided.
Workplace
4.7 The majority of adults spend a significant part of their daily lives at work. Health
promotion interventions in the workplace have been shown to be effective. For
example, the Heartbeat Award scheme had a positive impact on the use of healthier
catering practices, with increased sales of some healthier products, greater provision
of healthier options and a commitment to healthy eating principles by the caterers.24
4.8 In general, the most effective activities in workplaces include:24
● education programmes and/or environmental changes; and
● the delivery of “individualised” information, effective in a range of interventions.
Engaging “eager” employees into wellness programmes was easy if programmes
were provided on-site; engaging “reluctant” employees required one-to-one
approaches.

4.9 An American study concluded that worksite interventions involving family members
appeared to be a promising strategy for influencing workers’ dietary habits, increasing
fruit and vegetable consumption by 19%.25
Role of the public sector
4.10 Public sector bodies, including the NHS, central Government, local authorities, the
education system, prisons and the armed forces, cater for many people in their
workforces and within their charge, including some of the more vulnerable in society.
The way the public sector purchases, prepares and serves food is likely to have an
important influence of the health of individuals and communities (see Case Study 7).
4.11 Defra is leading a Public Sector Sustainable Food Procurement Initiative which offers
guidance and tools for public sector buyers to ensure they make healthy and
nutritious food a priority, while also contributing to wider environmental and
sustainability goals.
Case Study 7: Procurement in the NHS
The NHS is the largest public procurer of food, spending £500 million on food per
year and serving 800,000 meals a day in hospitals. Consequently, the NHS is in a
good position to help change people’s eating habits by promoting a balanced diet.
Serving and making available nutritious and value-for-money food can improve
patient recovery times, staff morale and staff health. The choice of retail outlets or
vending machines in NHS buildings sends strong messages that can reinforce or
undermine the principles of healthy eating.

Improving Nutrition in Pregnancy
and the Early Years
5.1 Before and during pregnancy, good nutrition is essential for both the mother and
unborn child. Nutrition in the early years of life is a major determinant of growth and
development and also influences adult health. The diets of young children are
determined wholly by their parents or other carers.
5.2 Breastfeeding has both short and long term health benefits, and makes an important
contribution to reducing death and disease in infants and, in that way, tackling health
inequalities. Breastfed babies are five times less likely to be admitted to hospital with
infections, such as gastroenteritis, and are less likely to become obese in later
childhood. Mothers least likely to choose to breastfeed are the young, less well
educated and those from disadvantaged groups.
Proposed key goals for improving nutrition in pregnancy and early years:
● All relevant stakeholders promoting and providing practical support for
exclusive breastfeeding to 6 months.
● Health professionals, other local health and childcare workers promoting
greater access to, and information about, nutrition and health for mother and
child.
● Low income and other disadvantaged groups effectively targeted through
programmes such as Sure Start local programmes, children centres, and
Healthy Start activities.
● Development of a coherent approach to healthy eating in early years settings.
● communicate the benefits of breastfeeding particularly in the most
disadvantaged groups;
● provide families on low income with financial assistance to buy milk, infant
formula, fresh fruit and vegetables;
● develop and implement guidance and training packages for health
professionals and Sure Start local practitioners to support the delivery of diet
and nutrition advice and information to parents and expectant mothers;
● develop guidance on improving access to healthy food and drink in early
years settings; and
● develop mechanisms for sharing the learning from nutrition focused
innovative practice?
5

5.3 A report evaluating 79 breastfeeding best practice projects found that many
interventions were effective in increasing breastfeeding rates among low-income
groups.26
Peer support programmes in particular were found to be effective in
increasing continuation of breastfeeding and targeted education of health
professionals also had a beneficial effect on breastfeeding mothers.
5.4 Mothers need to eat an appropriate diet themselves as well as introduce healthy
eating practices to their children. Good eating habits in childhood can help establish
healthy lifetime eating patterns and ultimately reduce the risk of chronic disease later
in life. Studies promoting healthier eating in pre-school children have demonstrated a
positive effect on nutrition knowledge.27
5.5 Action focusing on good nutrition in early life is already in place in a range of settings,
including Sure Start, nurseries, playgroups, mother and toddler groups and the home.
Current programmes include the Welfare Food Scheme, which provides tokens to low
income families to buy a pint of milk each day for pregnant women and children under
five (or 900 grams of infant formula for infants who are not breastfed). All children in
pre-school day-care can get a 1/3 pint of milk a day regardless of income. Healthy Start
proposals to reform the Welfare Food Scheme will provide greater access and greater
choice to mothers over what foods they buy, and will help promote breastfeeding.
5.6 Sure Start programmes – including Local Programmes, Children’s Centres, Early
Excellence Centres and Neighbourhood Nurseries – offer a range of services and
provide guidance and support to young disadvantaged families on infant feeding,
weaning, healthy eating nutrition and cookery clubs and activities to promote
awareness of healthy eating amongst young children28
.
5.7 The NHS, in various settings, delivers maternity services and post-natal care, including:
● the promotion of, and support for, breastfeeding initiation within maternity services,
supported by the 2003-06 NHS Priorities and Planning Framework target to increase
breastfeeding initiation by 2% per year, focused on disadvantaged groups;
● local advice, guidance and peer support programmes to encourage breastfeeding
initiation and duration; and
● the promotion of breastfeeding, infant feeding and weaning advice through National
Breastfeeding Awareness Week and Department of Health promotion materials.
Case Study 8: Breastfeeding
A health visitor in North Hull introduced an antenatal visit to discuss breastfeeding
with mothers on two outer urban council estates. Over the six months of the
project, breastfeeding initiation rates increased from 14% to 34%.
In another project, midwives looking after women in Holloway prison arranged
breastfeeding workshops for mothers, and training for prison officers in working
with mothers and babies. As a result, breastfeeding initiation rates increased from
57% to 78%.

Improving Nutrition in Schools
6.1 Alongside parents and carers, schools have a role in shaping the habits and eating
behaviour of children and young people. They are in a good position to encourage
and provide opportunities for healthy eating, as well as to equip children with the
skills and information they need for continued healthy eating.
6.2 Partnerships between schools, parents, governors, local health and education
authorities, caterers and other sectors of the food industry can help maximise and
sustain the impact of initiatives led by schools.
6.3 There is substantial evidence that schools and other educational establishments can
positively influence the eating habits of children and young people. Action in schools
may have wider ranging benefits for families and communities. For example, a
National Opinion Poll survey showed that the National School Fruit Scheme is having
beneficial effects on the whole family:
● over a quarter of parents reported that their children and families ate more fruit
at home as a result of the scheme;
● nearly half of all parents questioned thought the scheme had made them more
aware of the importance of fruit for a healthy diet; and
● the scheme had the most positive impact on parents from lower socio-economic
groups – they learned more than the other parents about the importance of
eating fruit and vegetables and reported the highest increases in their
consumption at home.
Proposed key goals for improving nutrition in schools is to:
Develop a more coherent whole school approach to healthy eating in the schools
setting, in particular:
● With relevant stakeholders, to supply the range of foods children need for
a healthy diet.
● Giving children the information and skills they need for a lifetime of
healthy eating.
● help schools develop a coherent whole school approach to healthy eating?
● ensure that children have access to a range of healthy foods whilst at school?
● provide children with information and advice on healthy eating?
6

6.4 Action in schools can impact on key health outcomes. For example, a 2003 Health
Development Agency review29
demonstrated the effectiveness of school-based
interventions to reduce obesity and overweight in schoolchildren, particularly girls.
These interventions included nutrition education, behavioural therapy, teacher
training, curricular material and the modification of school meals and tuckshops.
6.5 There is a range of activities within schools aimed to improve diet and nutrition,
including:
National Healthy Schools Standard
Healthy eating is one strand of the Government’s National Healthy Schools Standard
(NHSS), led by DH and the Department for Education and Skills (DfES), which
promotes a whole school approach to the health of schoolchildren, teachers and
parents. About 4,000 schools – half of those engaged in the NHSS – are involved in
promoting healthy eating.
Food in Schools Programme
The joint DH/DfES Food in Schools (FiS) Programme aims to build the healthy eating
strand of the NHSS. The programme comprises eight pilot projects that follow the
child through the school day – healthier breakfast clubs, tuck shops, vending
machines, lunch boxes and cookery clubs, as well as water provision, growing clubs
and the dining room environment.
The programme also focuses on teaching and learning within the National
Curriculum. FiS provides curriculum and school resources (such as the food audit tool,
which assists schools in developing a whole school food approach) and training and
support. Expert food technology teachers train and support their primary colleagues
to assist practical food education in the classroom, working towards the NHSS.
National Curriculum
Aspects of healthy eating are taught throughout the National Curriculum. Children
learn about different types of food, in the context of a balanced diet, nutrition, safety
and hygiene. Food technology is studied by all primary pupils and offered at Key
Stage 3 by around 90% of schools. Opportunities to teach about food, nutrition and
healthy eating and cooking are provided within Science, Design and Technology, and
the benefit of a healthy lifestyle through Personal, Social and Health Education.
The DfES Growing Schools programme encourages schools to use the “outdoor
classroom” with an emphasis on fruit and vegetable growing and farming and the
countryside as a resource across the curriculum.
The Government works with industry to quality assure food education resources.
For example, DfES supports the whole school approach of Sainsburys’ “Taste of
Success” Food Awards, which are based around diet, nutrition, cooking, food safety
and hygiene. Over 1,100 food technology teachers are registered on the scheme, and
115,000 pupils have been awarded certificates for excellence in practical food
activities since it began in 2000.

The Food Standards Agency (FSA) is leading a cross-Government group that has
identified the food-related knowledge and skills (competencies) needed by young
people to be able to feed themselves safely and healthily when they leave school.
Food provided in school
Statutory Nutritional Standards for school lunches, led by DfES, outline the minimum
requirement of foods from the four main food groups (starch foods, fruit and
vegetables, milk and dairy foods, and meat, fish and alternative sources of protein) to
be available on a daily basis in schools at lunchtime. Guidance is provided to caterers
on implementing the standards. In partnership with DfES, the FSA is carrying out
research to assess whether food provided at school lunches in secondary schools in
England complies with statutory nutritional standards.
The Government also provides free food to schoolchildren at different times of the
day. The National School Fruit Scheme, led by DH as part of the 5 A DAY programme,
will entitle every 4 to 6 year old in local education authority schools to a free piece of
fruit each school day. This programme will reach out to 2.2 million children, in over
16,000 primary schools, by the end of 2004. Vegetable provision is being piloted, as
part of an expansion of the scheme.
Under the EU school milk subsidy scheme, nursery and primary schools may claim the
payment of an EU subsidy, topped up by a national subsidy, for the provision of
school milk. Where milk is provided, it must be given free to those children who –
or whose families – are in receipt of certain welfare benefits.
The Food Standards Agency has carried out a joint survey of food related best practice
in primary schools and early year settings with the Office of Standards in Education
(Ofsted) and has piloted and evaluated economically viable healthier drinks vending
in secondary schools.

Improving Nutrition in the National
Health Service
7.1 The NHS has an important role to play in the delivery of the nutritional priorities.
This role will be enhanced through the involvement of Primary Care Trusts (PCTs) and
in Local Strategic Partnerships (LSPs) with key organisations, such as local authorities,
employers, schools, catering outlets and the media. Within these partnerships, the
key nutritional messages can be focussed on local people and targeted effectively
amongst key population group.
7.2 The NHS – in particular, primary care – can promote good nutrition by providing
information on healthier eating, especially to target groups. Dr Foster’s survey of
obesity services30
found that 57% of Primary Care Trusts provided advice on healthy
shopping and virtually all were promoting national initiatives, such as 5 A DAY.
7.3 The NHS employs, and provides occupational health services to, over a million staff,
and serves some 300 million meals per year to staff, patients and visitors. This
contributes to people’s diets and also sends a message about healthier food that may
influence both the individual and, through sustainable procurement, the food chain.
Proposed key goals for improving nutrition in the NHS:
● NHS bodies strengthening their present initiatives on diet and nutrition,
working in closer partnership with others in their local communities.
● The NHS:
– promoting better nutrition through its role in delivering health improvement;
– supply a wide range of healthier foods needed for a healthy diet to both
patients and workforce; and
– ensure they have fully trained workforce to deliver action to improve diet
and nutrition to the population it serves as well as individuals.
● supply healthier food, for example through improving public sector
procurement of food and extension of the Better Hospital Food Initiative;
● provide dietary advice to patients, both routinely and opportunistically; and
● ensure health care professionals, are appropriately trained to provide advice on
diet and nutrition.
7

7.4 Brief nutritional interventions provided in GP surgeries, hospitals and care homes have
been shown to be effective. For example:
● following a brief intervention of behavioural or nutrition education counselling in
primary care31
an increase in fruit and vegetable consumption of 0.9 to 1.5
portions per day was found;
● a recent randomised control trial found that behavioural counselling on fruit and
vegetable intake lowered blood pressure;32
● an HEA review20
found that nurse-administered health checks in general practices
resulted in dietary changes and a reduction in blood cholesterol of 2 to 3 % in
large populations; and
● the FSA Family Food and Health Project33
found that a positive message e.g. “eat
more starchy foods” may be effective in lowering fat intake.
7.5 Patients diagnosed as being at high risk of cardiovascular disease, diabetes and some
cancers may be particularly receptive to healthy eating messages. A recent study in
Finland found that intense nutritional advice and exercise regime resulted in a 58%
reduction in the cumulative risk of diabetes over a six year follow-up34
An HEA
review20
also found that the provision of more intensive intervention for those at
increased risk was associated with sustained reductions in blood cholesterol levels.
7.6 Current action in the NHS includes the following:
Catering
● The NHS Plan commitment – Better Hospital Food – aims to address standards of
food in hospital, including nutrition and the contribution of food to the overall
patient experience. Participation varies across the country, for example, only 60%
of London hospitals participate.
Advice and support on nutrition and diet
● advice for health professionals on diet, especially to patients on “at risk registers”
for Coronary Heart Disease and diabetes as part of the NHS Priorities and
Planning Framework;
● the Health Development Agency (HDA) review on effective interventions in
obesity and overweight;
● National Institute for Clinical Excellence (NICE) guidance on prescribing obesity
drugs, highlighting the importance of providing advice and support on diet,
activity and behavioural strategies;
● NICE, in collaboration with the HDA, developing guidance on prevention and
management of obesity and overweight (to be available 2006);
● as part of the new GP contract, practices will be required to offer consultation
for chronic disease and related health problems (such as obesity), provide relevant
health promotion advice to patients and refer patients to other treatment, as
necessary;
● the DH-funded British Dietetic Association “Weightwise” website provides
expert, unbiased advice for health professionals and consumers on sensible and
effective ways to prevent and manage obesity;

● the DH-funded “Weight Concern” work to develop the “Shape Up” toolkit and
training for health professionals to manage obesity in group settings; and
● DH contributions to the funding of a family-based therapy study for obesity in
children. This will roll out guidance for clinicians to undertake family-based
behavioural treatment for childhood obesity, targeting diet, inactivity and
sedentary lifestyles.
Community initiatives (see also Chapter 8, on improving local
communities)
● the Lottery-funded Healthy Living Centres and 5 A DAY PCT-led community
initiatives targeting the most disadvantaged in society. Many of the projects cover
diet and nutrition; and
● the Healthy Communities Collaborative, for which dietary improvement is a focus.
Sharing best practice
● NHS Beacon Programme supports the modernisation of the NHS by encouraging
“beacons” to share their innovations in meeting specific healthcare needs.
There are four beacons that relate to diet and nutrition; and
● Primary Care and Coronary Heart Disease (CHD) Collaboratives, informing
primary prevention generally and the use of CHD “at risk registers.”

Improving Nutrition in Local
Communities
8.1 The need for the engagement of local communities in improving nutrition and health
has been recognised in many areas. In 2003, for example, about 40% of Healthy
Living Centres provided dietary advice, ran food co-operatives or offered cookery
classes, and some provided all three, complementing national plans to combat
Coronary Heart Disease. Free healthier school meal initiatives and breakfast clubs in
schools are further examples of successful approaches to address unhealthy diets.
8.2 However, more could be done to promote understanding and increase access to
healthier food. Major employers in a community have a role to play in providing
healthier meals for their staff and those in their care. Local Strategic Partnerships
(LSPs) are well placed to ensure that a co-ordinated approach is taken to improving
nutrition and health within a community.
8.3 As an agent, a local authority can influence healthy eating and improve access to
healthier food, particularly in deprived areas, through its own services and functions,
such as planning, housing and transport, and through a leadership role for its
community. Its powers are matched by a statutory responsibility to promote wellbeing.
While the Department of Health has a Public Service Agreement to reduce health
inequalities, it is clear that local authorities are a key partner in this agenda.
Proposed key goals for improving nutrition in communities, including:
● Improving access to a wider range of the foods needed for a healthy diet in
local communities and the public sector workforce.
● Ensuring that consumers get the information they need to make choices about
what they eat and develop the skills and understanding to use that information
effectively.
● support and sustain local community and retailer initiatives focusing
on improving access to healthier foods eg free bus services where they exist;
● extend 5 A DAY opportunities; and
● support Local Authorities and other public sector partners to address food and
health issues strategically.
8

8.4 A review for the FSA of existing initiatives explored the complex nature of food
poverty and the problems faced by low-income consumers across the UK. It outlined
the links between different organisations and the ways in which food poverty is
tackled in each country, and made recommendations on how Government could take
this work forward. The FSA is running a consultation (available at the FSA website35
),
ending 10 May 2004, on the review and its findings.
8.5 There is evidence that community interventions can influence access, awareness and
consumption. For example, pilots to assess the feasibility of implementing an area-
wide approach to increasing fruit and vegetable consumption targeted one million
people across five areas in England for 12 months, from June 2000.
8.6 The key findings were:
● overall, the interventions had a positive effect on people with the lowest intakes,
important for addressing health inequalities;
● frequency of intake was an important determinant of total fruit and vegetable
consumption;
● at follow up, 35% of people living in the intervention areas reported that their
access to fruit and vegetables had improved, compared to only 21% of people in
control areas; and
● there was a 17% increase in the proportion of people who were aware of the 5
a day optimal fruit and vegetable intake, compared to 8% in the control group.
8.7 Examples of community actions include:
● local initiatives to improve access to healthier food especially in disadvantaged
areas through PCT-led community initiatives and in Healthy Living Centres.
● improved access to food retailers, for example, through planning and local
transport policies, as set out in Case Study 9;
● “Foodvision” helps develop and run projects promoting safe, sustainable and
nutritious food in communities;
● FSA research on food deserts and their effects on diet; and
● work to regenerate allotments.

Case Study 9: Transport and Land Use Planning
There is an important relationship between transport and land-use planning.
Planning policies can help reduce the need to travel and the length of journeys,
and achieve, among other things, easier access to facilities such as shops, by
public transport, walking and cycling.
Local transport authorities will be expected to pay greater attention to accessibility
in their second Local Transport Plans, to be submitted July 2005, which will cover
2006-07 to 2010-11. “Accessibility planning” is being introduced as a result of
the Social Exclusion Unit (SEU) report “Making the Connections”, which sets out
the relationship between social exclusion, transport and the location of services.
Access to food was highlighted in the SEU report as one of the four most
important opportunities for reducing social exclusion. This will be highlighted in
the guidance on accessibility planning that the Department for Transport will issue
to local transport authorities in the summer of 2004.

The process of consultation and
how to contribute
How to respond
When should you submit your contributions by?
9.1 Ideas and proposals should reach the project team at the latest by 30 June 2004.
9.2 It is important that consultees have sufficient time to respond to this consultation
document. But equally the outcome of this consultation informs the Choosing Health?
consultation (which ends on 28 May) and the subsequent White Paper. This
consultation will therefore run for a period of 8 weeks, rather than the 12 weeks
recommended by the Cabinet Office. Code of Practice on Consultation (see Annex B).
The Department of Health would welcome contributions as early as possible in the
consultation process.
Where should you submit your contribution?
By e-mail to: fahap@doh.gsi.gov.uk
By post to: Choosing a Better Diet Consultation
Health Improvement and Prevention
Department of Health
Area 704, Wellington House
133-135 Waterloo Road
London SE1 8UG
Via the website: www.dh.gov.uk/consultations/liveconsultations
9.3 When responding, please state whether you are responding as an individual or
representing the views of a larger organisation. If responding on behalf of a larger
organisation, please make it clear who that organisation represents. If responding
as an individual, please mention your own interest.
9.4 Please note that responses may be made public unless confidentiality is specifically
asked for. We may also publish your responses in a summary of responses to the
consultation unless you specifically include a request to the contrary. If you are replying
by e-mail or via the website, unless you specifically include a request to the contrary in
the main text of your submission to us, we will assume your consent overrides any
confidentiality disclaimer that is generated by your organisation’s IT system.
9.5 The Department of Health will be drawing up a Regulatory Impact Assessment for
the food and health action plan. We would welcome your views on the impact of
any proposals.
9

Further information and copies of the consultation document
9.6 Further information about this consultation and copies of the consultation document
are available from:
E-mail: fahap@doh.gsi.gov.uk
On the web at: www.dh.gov.uk/consultations/liveconsultations
Phone: 020 7972 1305
9.7 This consultation forms part of the wider consultation on Choosing Health?
a consultation on action to improve people’s health. For further information on
Choosing Health? please contact:
E-mail: choosing.health.consultation@doh.gsi.gov.uk
On the web at: www.dh.gov.uk/consultations/liveconsultations
Phone: 020 7210 5343

Annex A: List of abbreviations used
in this document
CHD Coronary Heart Disease
COMA Committee on Medical Aspects of Food and Nutrition Policy
Defra Department for Environment, Food and Rural Affairs
DfES Department for Education and Skills
DH Department of Health
EU European Union
FiS Food in Schools Programme
FSA Food Standards Agency
GP General Practitioner
HDA Health Development Agency
HEA Health Education Authority
LSP Local Strategic Partnership
NDNS National Diet and Nutrition Survey
NHS National Health Service
NHSS National Healthy Schools Standard
NICE National Institute for Clinical Excellence
NMES Non-milk extrinsic sugars
NSP Non-starch polysaccharides
ODPM Office of the Deputy Prime Minister
Ofcom Office of Communications
Ofsted Office for Standards in Education
ONS Office of National Statistics
PCT Primary Care Trust
PPF NHS Priorities and Planning Framework
SACN Scientific Advisory Committee on Nutrition
SEU Social Exclusion Unit, Office of the Deputy Prime Minister
WHO World Health Organization
A

Annex B: The Cabinet Office: Code
of practice on written consultation
The consultation criteria
1. Timing of consultation should be built into the planning process for a policy (including
legislation) or service from the start, so that it has the best prospect of improving the
proposals concerned, and so that sufficient time is left for it at each stage
2. It should be clear who is being consulted, about what questions, in what timescale
and for what purpose
3. A consultation document should be as simple and concise as possible. It should
include a summary, in two pages at most, of the main questions it seeks views on. It
should make it as easy as possible for readers to respond, make contact or complain
4. Documents should be made widely available, with the fullest use of electronic means
(though not to the exclusion of others), and effectively drawn to the attention of all
interested groups and individuals
5. Sufficient time should be allowed for considered responses from all groups with an
interest. Twelve weeks should be the standard minimum period for a consultation
6. Responses should be carefully and open-mindedly analysed, and the results made
widely available, with an account of the views expressed, and reasons for decisions
finally taken
7. Departments should monitor and evaluate consultations, designating a consultation
co-ordinator who will ensure the lessons are disseminated
B

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