choosing a better diet consultation

Choosing Health? Choosing a Better DietA 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 EstatesHR / Workforce PerformanceManagement IM & TPlanning FinanceClinical Partnership Working

Document Purpose Consultation/Discussion

ROCR Ref: Gateway Ref: 3143

Title Choosing Health? Choosing a BetterDiet: a consultation on priorities for afood 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, MedicalDirectors, Directors of PH, Directorsof Nursing, NHS Trust Board Chairs,Special HA CEs, Directors of HR,Directors of Finance,Communications Leads

Circulation List Local Authority CEs, VoluntaryOrganisations, Government officefor regions, OGD‘s

Description This is a consultation on a food andhealth action plan for England, acommitment in the Government’sSustainable Farming and FoodStrategy. The consultation, animportant strand of the ChoosingHealth? debate, will run from 6 Mayto 30 June 2004.

Cross Ref Food and Health Action Plan: Foodand Health Problem Analysis forComment. 31 July 2003

Superseded Docs N/A

Action Required NHS views invited on consultation

Timing 30 June 2004 consultationdeadline

Contact Details Choosing a Better Diet – ConsultationHealth Improvement and Prevention,Dept HealthArea 704 Wellington House133-155 Waterloo RoadLondon SE1 8UGNutrition Support – 020 7972 1305www.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 forPublic 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 aBetter 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 toimprove 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 ChoosingHealth? 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 forSustainable 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 overcomebarriers 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 Population1.12 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 FinlandTwo 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 Groups1.15 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 awareness2.2 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 andinfluencing 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 informationeffectively.

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 AwarenessFood Standards Agency’s websiteThe 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 ProgrammeThe 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 andManufacture

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 Producers3.2 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 MeatOver 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 choicesin 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

Manufacturers3.4 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 intakesof 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 SaltThe 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 ProductsSemi-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 UKThe 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 andthe 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 tofruit 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, totaland 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 NHSThe 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 Pregnancyand 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 andchild.

● Low income and other disadvantaged groups effectively targeted throughprogrammes such as Sure Start local programmes, children centres, andHealthy 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: BreastfeedingA 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 schoolssetting, 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 NationalHealth 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 localcommunities)

● 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 LocalCommunities

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 informationeffectively.



● 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 PlanningThere 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 andhow 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: [email protected]

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: [email protected]

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: [email protected]

On the web at: www.dh.gov.uk/consultations/liveconsultations

Phone: 020 7210 5343



Annex A: List of abbreviations usedin 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: Codeof 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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