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Economic austerity, food poverty, and health
Editorial
A century ago, the Scottish physician John Boyd-Orr saw first-hand how poverty and malnutrition lay at the heart of appalling health, especially among children in the slums of Glasgow, many of whom had rickets—the subject of a Seminar by Charlotte Elder and Nicholas Bishop in today’s Lancet, which details how this disease of the past is increasing in some parts of the UK. Later, Boyd-Orr’s vision and activism for improved population health through the delivery of equitable nutrition programmes helped establish the UK’s food policy during the austere years of World War 2 and beyond. Boyd-Orr would doubtless have put his name to the open letter to UK Prime Minister David Cameron, along with the 170 signatories from the UK Faculty of Public Health, published in today’s Correspondence section. The letter should serve as a stark warning of a growing public health crisis in the country. Adding to letters of concern about growing food poverty from religious leaders and charities, such as The Trussell Trust and Oxfam, the Faculty’s letter calls for the UK Government to create an independent body to become the instrument of scientific analysis to help shape future government policy on nutrition and health. The Faculty of Public Health highlights the welldocumented increase in use of food banks in the UK as an indication of extreme food poverty, but rightly broadens its concerns to the more widespread problem of social inequity, which is fuelling poor population nutrition. They argue that the relative increase in the cost of food by 12% since 2007, combined with an average 6·7% reduction in workers’ incomes during the same period, is a fundamental reason why poorer working families have no choice other than to buy cheap food and drink that is often high in fat, sugar, and salt. Relevant to the food poverty debate, a new report— The Weigh-In—from the UK Academy of Royal Medical Colleges marks a year since it launched Measuring Up: the Medical Profession’s Prescription for the Nation’s Obesity Crisis, and rates progress on the ten recommendations made in the 2013 report. Five of the recommendations have a red mark against them, indicating causes for concern: weight management services (mirrored on smoking cessation programmes); nutrition in schools (2 million children in private or Academy schools in www.thelancet.com Vol 383 May 10, 2014
the UK not being targeted by nutrition programmes); junk food advertising (no progress made); the piloting of a 20% sugary drinks tax (no progress made); and the built environment (no guidance yet issued from Public Health England on how to integrate public health into environmental programmes). Progress (green labels) are attributed to just three initiatives: food labelling, nutrition training for new parents, and training for health professionals. At the very least, the independent advisory board being called for by the Faculty of Public Health is needed. But beyond this must surely come a fundamental shift in Britain’s attitude to food and food policy. At school, children need to learn about the benefits of inexpensive healthy food, learn how to prepare it, and to become aware of the hazards of junk food and of its excessive promotion. At a political level, public health must influence food policy so that crucial upstream measures are taken—such as the introduction of a 20% sugary drink tax to subsidise the cost of healthier food, including fruit and vegetables. Such measures will counteract the food industry’s influence in its lobbying for self-regulation and involvement in downstream measures such as healthy eating leaflets and the rhetoric of personal choice in food decisions. The predicament of social inequity and food poverty is not a public health crisis facing the UK alone, as many other nations struggle to deal with the double hit of draconian austerity measures and rising food prices. Food policy is integral to the global work on noncommunicable diseases, championed by this journal; scientists concluded unequivocally in a 2013 Lancet Series paper, that, concerning the food and beverage industries, there should be “no more industry selfregulation, with no evidence for benefit from publicprivate partnerships concerning food and drink policy on public health”. The reality is, be it at a national or international level, that we have the knowledge and know the solutions, as did John Boyd-Orr. What we need is bold action from our politicians to resist the often pernicious influence of industry. Our governments must create a platform where equitable food policy becomes central to the global fight against undernutrition, malnutrition, and non-communicable diseases. n The Lancet
Guy Corbishley/Demotix/Corbis
Economic austerity, food poverty, and health
See Correspondence page 1631 See Seminar page 1665
For the Academy of Royal Medical Colleges report see http://www.aomrc.org.uk/ general-news/annual-weigh-inleading-medics-say-uk-in-needof-urgent-referral-as-countrystruggles-to-get-to-grips-withobesity-crisis.html For the 2013 Lancet Series paper see Lancet 2013; 381: 670–79
1609
A century ago, the Scottish physician John Boyd-Orr saw first-hand how poverty and malnutrition lay at the heart of appalling health, especially among children in the slums of Glasgow, many of whom had rickets—the subject of a Seminar by Charlotte Elder and Nicholas Bishop in today’s Lancet, which details how this disease of the past is increasing in some parts of the UK. Later, Boyd-Orr’s vision and activism for improved population health through the delivery of equitable nutrition programmes helped establish the UK’s food policy during the austere years of World War 2 and beyond. Boyd-Orr would doubtless have put his name to the open letter to UK Prime Minister David Cameron, along with the 170 signatories from the UK Faculty of Public Health, published in today’s Correspondence section. The letter should serve as a stark warning of a growing public health crisis in the country. Adding to letters of concern about growing food poverty from religious leaders and charities, such as The Trussell Trust and Oxfam, the Faculty’s letter calls for the UK Government to create an independent body to become the instrument of scientific analysis to help shape future government policy on nutrition and health. The Faculty of Public Health highlights the welldocumented increase in use of food banks in the UK as an indication of extreme food poverty, but rightly broadens its concerns to the more widespread problem of social inequity, which is fuelling poor population nutrition. They argue that the relative increase in the cost of food by 12% since 2007, combined with an average 6·7% reduction in workers’ incomes during the same period, is a fundamental reason why poorer working families have no choice other than to buy cheap food and drink that is often high in fat, sugar, and salt. Relevant to the food poverty debate, a new report— The Weigh-In—from the UK Academy of Royal Medical Colleges marks a year since it launched Measuring Up: the Medical Profession’s Prescription for the Nation’s Obesity Crisis, and rates progress on the ten recommendations made in the 2013 report. Five of the recommendations have a red mark against them, indicating causes for concern: weight management services (mirrored on smoking cessation programmes); nutrition in schools (2 million children in private or Academy schools in www.thelancet.com Vol 383 May 10, 2014
the UK not being targeted by nutrition programmes); junk food advertising (no progress made); the piloting of a 20% sugary drinks tax (no progress made); and the built environment (no guidance yet issued from Public Health England on how to integrate public health into environmental programmes). Progress (green labels) are attributed to just three initiatives: food labelling, nutrition training for new parents, and training for health professionals. At the very least, the independent advisory board being called for by the Faculty of Public Health is needed. But beyond this must surely come a fundamental shift in Britain’s attitude to food and food policy. At school, children need to learn about the benefits of inexpensive healthy food, learn how to prepare it, and to become aware of the hazards of junk food and of its excessive promotion. At a political level, public health must influence food policy so that crucial upstream measures are taken—such as the introduction of a 20% sugary drink tax to subsidise the cost of healthier food, including fruit and vegetables. Such measures will counteract the food industry’s influence in its lobbying for self-regulation and involvement in downstream measures such as healthy eating leaflets and the rhetoric of personal choice in food decisions. The predicament of social inequity and food poverty is not a public health crisis facing the UK alone, as many other nations struggle to deal with the double hit of draconian austerity measures and rising food prices. Food policy is integral to the global work on noncommunicable diseases, championed by this journal; scientists concluded unequivocally in a 2013 Lancet Series paper, that, concerning the food and beverage industries, there should be “no more industry selfregulation, with no evidence for benefit from publicprivate partnerships concerning food and drink policy on public health”. The reality is, be it at a national or international level, that we have the knowledge and know the solutions, as did John Boyd-Orr. What we need is bold action from our politicians to resist the often pernicious influence of industry. Our governments must create a platform where equitable food policy becomes central to the global fight against undernutrition, malnutrition, and non-communicable diseases. n The Lancet
Guy Corbishley/Demotix/Corbis
Economic austerity, food poverty, and health
See Correspondence page 1631 See Seminar page 1665
For the Academy of Royal Medical Colleges report see http://www.aomrc.org.uk/ general-news/annual-weigh-inleading-medics-say-uk-in-needof-urgent-referral-as-countrystruggles-to-get-to-grips-withobesity-crisis.html For the 2013 Lancet Series paper see Lancet 2013; 381: 670–79
1609