Intended for healthcare professionals


A system-wide challenge for UK food policy

BMJ 2012; 344 doi: (Published 15 May 2012) Cite this as: BMJ 2012;344:e3414
  1. Susan A Jebb, head of diet and population health
  1. 1MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK
  1. susan.jebb{at}

Single issue solutions won’t prevent diet related diseases with complex causes

Diet related disease leads to about 70 000 premature deaths in the United Kingdom.1 The rising prevalence of obesity is a signal that the food system is out of kilter with public health priorities. Ahead of the World Health Assembly (21-26 May in Geneva), which will discuss the World Health Organization’s progress on strengthening action for preventing non-communicable diseases, Mytton and colleagues (doi:10.1136/bmj.e2931) consider the evidence for specific food taxes to improve health,2 while Hawkes (doi:10.1136/bmj.e2801) makes the case that global health policies should be embedded within the wider food economy.3

Under successive governments, UK policies on diet have relied heavily on more and better education for consumers to make healthy choices, based on the notion that consumer behaviour will shape markets. More recently, basic information campaigns have given way to a social marketing approach, epitomised by Change4Life, a campaign run by the Department of Health in England that offers encouragement and support to achieve a healthier lifestyle. It is well known that putting knowledge into practice needs clear nutritional labelling, although the plethora of current schemes limits the opportunity to deliver consistent messages to consumers. Several “health by stealth” initiatives also exist, including reformulation to reduce salt and remove artificial trans fats. Increasingly, the UK government is accepting that consumer behaviour is shaped by people’s life experiences and environments,4 which suggests the need for a broader food policy.

The challenge for government is that food policy cuts across departmental boundaries. The Foresight report on obesity highlighted that although the Department of Health picks up most of the costs of obesity, many of the policy levers for change lie outside its jurisdiction.5 The same holds true for other diet related diseases. In the UK we now have a cabinet subcommittee on public health, which should help realise the potential of government-wide action to reform the food system along the lines previously set out in the Cabinet Office report Food Matters.1

The UK has been at the forefront of international efforts to introduce new policies to change dietary habits, and we need to use this experience to shape future actions to tackle problems in the entire food system. For example, introducing nutritional standards for school meals was successful because it stimulated broader changes across the whole of school food policies and encouraged the food industry to improve recipes. Through related activities, such as cooking and gardening clubs, the message has spread to families and communities, and this has encouraged a public debate about food.6

In contrast, narrow policies such as restrictions on TV food advertising have led to only limited reductions in the exposure of children to the promotion of foods of low nutritional quality, with marketing spend shifting beyond children’s programmes to other outlets, including digital media.7 TV advertising may be iconic, but it is only the tip of the iceberg in marketing power. As evidence accumulates of a direct effect of food branding on eating behaviour in children,8 and public concerns about the commercialisation of childhood increase, it is time to revisit this issue to seek a wider societal shift in the balance of food promotions.

As we strive to change the food system local government also has a role to play. The latest draft guidance on obesity from the National Institute for Health and Clinical Excellence, now out for consultation, focuses on working with local communities to transform local food (and physical activity) environments to prevent obesity.9 In the new public health system local authorities will need to seize the opportunities to link local policies, from procurement of food by public institutions, through work with local food businesses and planners, to interventions by health professionals.

We all find it easier to think of isolated actions—they provide a succinct rallying cry for lobby groups, a neat testable hypothesis for academics, and a clear target for policy makers—but there is an intellectual inconsistency in accepting poor diets as the product of a complex web of determinants while advocating single issue solutions. The Nuffield Council set out a useful “ladder of intervention” to frame public health actions,10 but a systems approach is not so much a ladder as an intricate climbing frame, where a whole series of initiatives need to be enacted in concert.

Food policy is a matter for everyone and needs partnerships and alliances at all levels to drive change—individuals making choices for themselves and their families, communities and local government taking action, businesses acting responsibly, and government leading and coordinating action across departments and sectors. The Responsibility Deal Food Network, a government scheme that asks organisations to sign up to encourage and enable people to achieve a healthier diet, represents a new commitment to this way of working in England. The task for the World Health Assembly next week is to build an international coalition that accelerates and unites the whole range of national actions to rebalance the food system and reduce the burden of diet related disease.


Cite this as: BMJ 2012;344:e3414


  • Analysis, doi:10.1136/bmj.e2931
  • Analysis, doi:10.1136/bmj.e2801
  • Competing interests: The author has completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; she is a science adviser to the Department of Health obesity team and chair of the Public Health Responsibility Deal Food Network.

  • Provenance and peer review: Commissioned; not externally peer reviewed.


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