The cry from campaigners in the UK is neither government nor industry is doing enough to reduce sugar consumption. Here, Ben Cooper compares the measures proposed in last week's report from Public Health England with what has been advocated by campaign group Action on Sugar and government action and industry engagement as represented by the Public Health Responsibility Deal.
There is widespread concern over the prevalence of overweight, obesity and diet-related health problems such as type 2 diabetes in the UK. As in other countries, the debate over the last couple of years has focused predominantly on the consumption of sugar – and there is fierce debate over how the government and food companies should be responding to the issue.
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The debate intensified further last week when Public Health England, an executive agency within the Department of Health, published an evidence review on sugar consumption and how it might be reduced. The report was commissioned by the department following publication of a draft report on carbohydrates and health from the UK government's Scientific Advisory Committee on Nutrition (SACN) in June last year. The SACN report said sugar should make up no more than 5% of daily calorie intake, a recommendation that was adopted as the government’s official dietary advice in July this year.
Public Health England: Sugar Reduction – The evidence for action
In its report, Public Health England concludes a range of factors is contributing to an increase in sugar consumption but the fact it summarises these as "crucially including" marketing, promotions, advertising and the amount of sugar in manufactured food leaves little room for misinterpretation. What food companies sell and how they sell it is at the epicentre of this issue and Public Health England sees changes in how food companies operate – or how they are compelled to operate – as critical in achieving a meaningful reduction in sugar consumption.
"This is too serious a problem to be solved by approaches that rely only on individuals changing their behaviour in response to health education and marketing, or the better provision of information on our food," the report states. "The environmental drivers of poor diets we face are just too big."
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By GlobalDataThe Public Health England review concludes that "no single action will be effective in reducing sugar intakes". Instead, a "broad, structured programme of parallel measures" aimed at reducing the sugar content of food and drinks and the impact of influences that increase consumption is required.
A successful multi-stranded approach could include the following eight "levers", the agency says:
1. Reduce and rebalance the number and type of price promotions in all retail outlets including supermarkets and convenience stores and the out of home sector
2. Significantly reduce opportunities to market and advertise high sugar food and drink products to children and adults across all media including digital platforms and through sponsorship
3. The setting of a clear definition for high sugar foods to aid with actions one and two.
4. Introduction of a broad, structured and transparently monitored programme of gradual sugar reduction in everyday food and drink products, combined with reductions in portion size
5. Introduction of a price increase of a minimum of 10-20% on high sugar products through the use of a tax or levy such as on full sugar soft drinks, based on the emerging evidence of the impact of such measures in other countries.
6. Adopt, implement and monitor the government buying standards for food and catering services across the public sector.
7. Ensure accredited training in diet and health is routinely delivered to all of those who have opportunities to influence food choices in the catering, fitness and leisure sectors and others within local authorities.
8. Continue to raise awareness of concerns around sugar levels in the diet to the public as well as health professionals, employers, the food industry etc.
Action on Sugar and the Jamie Oliver effect
A significant event in the sugar debate in the UK was the launch of the Action on Sugar campaign in January 2014, spawned from the successful Consensus Action on Salt and Health campaign. Latterly, the campaign agenda has been greatly strengthened by the intervention of celebrity TV chef Jamie Oliver, who has won plaudits by successfully spearheading a campaign to improve the nutritional content of school meals. Celebrities may be inclined to overestimate their popularity and importance but the influence the likes of George Clooney and Angelina Jolie wield on the global political stage speaks to the effect the engagement of well-known personalities can have.
The Jamie Oliver man-of-the-people shtick is also significant. He may over-egg his ability to speak for the people but politicians will be acutely aware his views – particularly in the no-nonsense, shoot-from-the-hip-way he articulates them – will resonate with many ordinary working parents and most certainly heighten public engagement in the debate.
Oliver, Action on Sugar and other campaigners are particularly vehement in their support for a sugar tax or a levy on soft drinks. They are also concerned about issues such as promotions, advertising to children and clearer information on pack.
In July, Action on Sugar called on UK Prime Minister David Cameron to implement sugar reduction targets for food and drinks aimed at a 40% reduction by 2020, cease all advertising and promotion of “unhealthy foods and drinks” to children and adolescents and introduce a 20% duty on sugary drinks.
Looking at Action on Sugar’s most recent statement along with its previous interventions, like the eight-point plan it presented to Health Secretary Jeremy Hunt in June 2014, it is fair to say there is significant common ground with a campaign agenda now galvanised by the involvement of a major celebrity and the recommendations in the Public Health England report.
Where there is markedly less alignment is between the sorts of measures Public Health England is recommending and what has so far been undertaken in this area under Cameron’s governments, namely the Public Health Responsibility Deal.
Current action – Public Health Responsibility Deal
The Public Health Responsibility Deal, aimed at engaging the private sector voluntarily in the pursuit of public health goals, has been much maligned by campaigners as ineffective at best and at worst a sop to industry. Whether that is entirely fair is a matter of debate but owing to its emphasis on voluntary action, the Public Health Responsibility Deal could also be seen as reflecting the level of engagement by industry.
Crucially, it contains no pledges directly related to sugar. Theoretically, the reduction targets called for by Action on Sugar and in the Public Health England report (recommendation 4) could be placed under the auspices of the Public Health Responsibility Deal, which inherited salt reduction targets instituted originally by the Food Standards Agency largely in response to the CASH campaign. It also subsequently added a pledge related to saturated fat reduction.
However, while some have called for a sugar reduction target, at present the only other reduction target the Public Health Responsibility Deal includes is a general calorie reduction pledge. While the Public Health Responsibility Deal does include pledges to back the government's voluntary uniform front-of-pack nutritional labelling scheme and a commitment on trans fats, the Public Health Responsibility Deal approach has failed to yield any voluntary undertakings relating to promotion in spite of hopes from its supporters that this might be possible.
As the policy framework most closely related to the issues the Public Health England report was examining, it is clear the Public Health Responsibility Deal bears no relation in scope or strength to the sort of actions outlined in the Public Health England study – and it is notable its report makes no specific mention of the Deal as a possible vehicle for future initiatives.
