Food, Health and Neighbourhood Renewal

The national policy requirement for dietary improvement is identified in Health and Neighbourhood Renewal Guidance from the Department of Health and the Neighbourhood Renewal Unit, 2002[1]. It states:

The objective of healthy eating advice is to promote the consumption of a balanced diet by everyone in the community. The Balance of Good Health summarises the desired balance of foods in the diet and provides a basis for the presentation of dietary advice. Neighbourhood renewal offers good opportunities to develop programmes to support people changing their diet. Programmes are particularly effective where local people are involved in running the schemes. Examples of programmes that have been shown to work include fresh food co-ops, boosting sales of fresh fruit and vegetables through local retailers, food growing schemes, cooking skill development and community lunches. (p. 57)

A typical example of the public health challenges that lie immediately behind such an objective is the London Borough of Newham. Newham’s own snapshot of “big killers” related to diet is as follows:

• Death rates in Newham from circulatory disease and coronary heart disease (CHD) are falling, but remain higher than London and England; this difference is getting larger
• Mortality rates in Newham from hypertensive disease tend to be higher than in London and England, especially in younger people
• Death rates from stroke are also higher and appear to be increasing while in London and England they are falling
• The overall death rate from diabetes has been higher in Newham than in London and England, but this rate has fallen recently to the London and England average.[2]

The Guidance identifies the key linkage between diet and risk of chronic disease, focusing on the adult population in general, and school age children. It also makes frequent reference to its “Five A Day” mechanism for promoting a more balanced diet. In this context (slightly surprisingly) it addresses two other key issues, food access barriers and obesity prevention.

 In respect of meeting the needs of children, the Guidance states as priorities:

Promoting a healthy diet rich in cereals, fruit and vegetables; and increasing access to those foods, for example through the provision of community transport or support for local co-ops. The National Fruit Scheme was launched last year. 80,000 children in 27 areas and over 500 schools now receive a free piece of fruit each school day. The scheme will be rolled out on a region by region basis over the next two years to reach all school children aged between four and six years old. The first region to benefit will be West Midlands where around 250,000 children in nearly 2000 schools will receive fruit from summer term 2002.

Somewhat surprisingly, while the Guidance references the Food Access Score, it neither defines nor sets particular metrics for FAS improvements in given neighbourhoods, despite its commitment to a SMART methodology of project management, which includes measurable targets as a key objective.

In the absence of such objective setting, Community Food Enterprise  has in effect defined its own metrics. In a period of a little over one year, starting in August 2004 in Newham, CFE achieved: 

•  200,620 pieces of fruit consumed by key stage 2 pupils
• 42,758 meals served at Breakfast Clubs
• 113,600 pieces of fruit delivered to toddlers groups
•  59,200 pieces of fruit delivered to fruit tuck shops
•  40,000 meals served at Breakfast Clubs
•  28,000 meals consumed by children attending After School Clubs
•  200 bags of mixed fruit &vegetables delivered to families with children under 5 years old
•  3,100 vouchers redeemed by families with children under 5 years old.

The Guidance states:

The national Five-a-day programme will target action to improve one of the most important aspects of diet – the amount of fruit and vegetables people eat. The programme has piloted Five-a-day community initiatives in deprived areas. These pilots included partnerships with schools. £10 million was made available from the New Opportunities Fund to support 66 more community initiatives in areas where consumption of fruit and vegetables tends to be lowest, and where rates of cancer and heart disease are highest.

The Programme has five main strands:

1. The National School Fruit Scheme: will entitle every child aged 4-6 in infant schools to a free piece of fruit each school day as a national campaign to improve the diet of children.
2. Five-a-day community initiatives: to improve people’s access to and awareness of fruit and vegetables to make it easier for them to eat more.
3. Communications programme: to increase awareness of health benefits of fruit and vegetables.
4. Work with food industry: to improve people’s access to fruit and vegetables.
5. Evaluation and monitoring: each element of the programme will be evaluated and monitored so the key lessons can be learned and acted on. (p.58)

 Removing Barriers to Food Access

Unhelpfully buried in the section of the Guidance on Five a Day is a short allusion to the issue of food access, which merits a section in the Guidance in its own right. The document observes:

People living in deprived areas where public transport is poor and few own cars have most difficulty reaching shops which sell a range of affordable foods to make up a healthy and balanced diet. Shopping in small independent corner shops can be as much as 24% more expensive than a supermarket. A food access mapping study was carried out by the Five-a-day pilot team in Sandwell. This identified large networks of streets and estates where there are no shops selling fresh fruit and/or vegetables or where the fruit and vegetables that are available in local shops are more expensive. p.58

The very origins of London community enterprises such as  CFE lie in a spontaneous confirmation of the Sandwell study, through Eric Samuel’s observation as a resident of the Cranberry Lane Estate that it experienced similar conditions to those mapped in Sandwell – “no shops selling fresh fruit and/or vegetables”. No organisation in the UK has achieved a more comprehensive approach to tackling food access barriers than CFE with its balance of fixed and mobile outlets and its partnering strategy with other stakeholders.

Tackling Obesity

The Guidance document makes reference to obesity as a key challenge, while recognising how complex and possibly intractable an issue it is:

The NHS Plan makes a commitment to wide ranging action that includes local programmes to tackle obesity and physical inactivity (including the abovementioned initiatives). Obesity has proven very difficult to treat. Prevention may be a better long term approach; this is why much of cross-Government work has been focused on children. Cross-government working on physical activity is increasing with DH involved as a key player on groups involving sport, education or transport, and a new pilot on exercise based in neighbourhood renewal areas. p.58

 In London, which is slightly below the national average, an estimated 23.5% of women and 21% of men are classified as obese, a rise from a 1980 baseline of only 8%. (London Food Strategy May 2006, p.56). Clearly while food is only one of the factors influencing obesity, it is impossible for the food sector to ignore this emerging challenge affecting not just public health objectives, but in some respects existential dilemmas for society as a whole.

[1] Health and Neighbourhood Renewal (2002) Guidance from the Department of Health and the Neighbourhood Renewal Unit

[2] Health Inequalities in Newham, Annual Public Health Report 2004/2005, Newham Primary Care Trust, slide 103