82. The Acheson report noted that the percentage of expenditure spent on food is usually higher in low-income households than among the better off. The result is that higher food prices have the greatest impact on the least able to bear them, leading to ‘food poverty’ among the most disadvantaged groups. The report drew attention to the multiple effects that the Common Agricultural Policy (CAP) has in improving the nutritional position of the less well-off and achieving public health goals. It highlighted four main areas for further government action to reduce inequalities, including:
• reviewing the impact of CAP on health and health inequalities
• promoting the accessibility and availability of food to supply an adequate and
affordable diet, including improving retail provision for disadvantaged groups
• reducing sodium in processed foods.
Policy response
Common Agricultural Policy
83. The CAP is primarily a set of financial and economic instruments designed to influence food production, and is directed at producers and processors, not customers. It is at best a very blunt and inexact instrument for promoting nutrition policy. The operation of the CAP disproportionately affects poorer households as they devote a higher proportion of their disposable income to purchasing food. Government policy is to continue to move the CAP away from this approach in order to ensure healthy and fair competition across the food supply chain and to reduce the EU import tariffs that keep prices high.
84. Using the CAP to influence what farmers produce (through supporting market prices) has been very costly and has led to a wide range of serious problems, especially affecting poorer households as they devote a higher proportion of their disposable income to purchasing food. Government policy is to continue to move the CAP away from such market manipulation and to connect farmers more fully to market demand, ensuring healthy and fair competition across the food supply chain (including in production and distribution) with consumers receiving the benefits of that competition.
85. The UK has not participated in the CAP surplus food scheme to improve the nutritional policy of the less well-off. This is because it considers the policy to be ill thought out and believes that more effective ways of targeting disadvantaged groups and areas lie in programmes like Healthy Start and 5 A DAY.
Promoting accessibility and availability of food – Healthy Start
86. The importance of nutritional advice and support to disadvantaged families, particularly those with children, is at the heart of the Healthy Start scheme. This statutory scheme succeeded the Welfare Foods Scheme (introduced in 1940) and it was rolled out across the country by November 2006. It provides nutritional support to pregnant women and young children under the age of four in some of the most disadvantaged families.
87. Large and small retailers are crucial to the scheme’s delivery, as they accept Healthy Start vouchers for milk, fresh fruit, fresh vegetables and infant formula milk to ensure that those on the scheme have access to these basic foodstuffs. The scheme also encourages breastfeeding and healthy food choices among families taking part, with midwives and health visitors routinely offering advice and support on these issues to applicants for the scheme. Their involvement in supporting applications also provides a mechanism for health professionals to identify clients who may be in greatest need of support, and an opportunity to encourage them to take part in locally available initiatives such as breastfeeding support groups and cooking skills classes. 5 A DAY
88. The 5 A DAY programme was introduced in 2002 and has made considerable progress in increasing awareness and understanding of the importance of consuming five portions per day of fresh fruit and vegetables – as shown by the Food Standards Agency’s Consumer Attitudes Survey. Covering 66 PCTs and funded with £10 million from the National Lottery, 5 A DAY community initiatives have been established to help families on low incomes secure access to fruit and vegetables. An evaluation of the scheme showed that the most significant increase in fruit and vegetable consumption was among those from the most socially disadvantaged groups.51
An evaluation of these initiatives, published in 2005, is available on the Big Lottery Fund website. 89. Funding for community food initiatives in all PCTs has been provided since April 2006 as
part of the Choosing Health allocation, focusing on people and families living in deprived communities. In 2008, the Healthy Weight, Healthy Lives cross-government strategy52
highlighted increased fruit and vegetable consumption as a priority area for improving diet.
51 See: www.biglotteryfund.org.uk/er_eval_schoolfruits-final_report-uk.
Reducing salt in processed food
90. Work started in 2003 to reduce the UK’s salt intake and has been taken forward in three main areas:
• setting voluntary salt reduction targets and working with all sectors of the food industry to
reduce the levels of salt present in food
• running a public awareness campaign to make consumers aware of the health risks associated
with consuming a high level of salt and what they can do to reduce their intake
• encouraging the use of front-of-pack signpost labelling by retailers and manufacturers to
enable consumers to quickly identify those foods that have lower salt levels.
91. Average population intake has dropped from 9.5g in 2000/2001 to 8.6g in the first quarter of 2008, with reductions in salt levels of between 25 per cent and 50 per cent in many of the foods that contribute most to salt intake. There has been a tenfold increase in awareness of the 6g a day message; the number of consumers cutting down on salt has increased by around one-third; and the number of consumers trying to cut down on salt by checking labels has doubled.