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Public Services

Fit for the Future: A Fair Deal on Food for a Healthier Britain


Paper15th July 2023

Our Future of Britain initiative sets out a policy agenda for a new era of invention and innovation, based on radical-yet-practical ideas and genuine reforms that embrace the tech revolution. The solutions developed by our experts will transform public services and deliver a greener, healthier, more prosperous UK.


Chapter 1

Foreword

When I think about the future of Britain, I think about the 600,000 kids that every year leave school and go out into the world. How do we make sure they are as happy and healthy as they can possibly be? How can we ensure they’re on the path to becoming productive citizens who make the world go round?

The true power of a democracy is measured by the way we treat those most at risk. We need economic growth, and to maximise that growth we simply can’t leave anyone behind. It’s a scandal that today the health of one in three children is at risk due to the food they eat. 

Free school meals for children is the fourth emergency service. If we give the 800,000 children who need one a free school meal, it will boost the economy by £8.9 billion over 20 years because well-fed children thrive at school.

We know that poor diet is a risk factor for some horrendous conditions, including 13 types of cancer. Why should those living in deprived areas be even more likely to suffer because nutritious food isn’t accessible or affordable for them?

It should be easy to be healthy, but it isn’t, especially when we’re faced with a flood of sugar on our supermarket shelves and ultra-processed food clogging up our high streets. And for people with limited time and money, it’s even harder.

Food companies are also trapped in this system: they need to sell us more and more to keep their investors happy. And there’s fierce competition – they’re all vying to sell us foods that are cheap to make and sold for the biggest profit margins. But these are the same foods that are making us unwell. We need to redesign the food system so it allows businesses AND kids to flourish.

This is why I launched my Ministry of Food – to try and put this agenda at the heart of government, and why I’m delighted that the Tony Blair Institute is entering the arena to work alongside me to help shape the policy agenda for the country.

We’re asking for proper provision of free school meals for those who need it, proper food education at school, proper protection from the relentless flood of junk food and proper food leadership in government. And delicious, nutritious food available at affordable prices.

This paper is the beginning of that. It charts a course for homes, high streets and supermarkets having accessible and affordable healthy options for everyone.

Every time I come home from a trip abroad, I’m proud of our mighty little island. Let’s not sell ourselves short: we have so much to be proud of. We’ve worked so hard to ensure Britishness is synonymous with trust, quality and high standards. We have achieved so much. 

What we need now is political leaders to make sure the Future of Britain is a future we can all be proud of.

Jamie Oliver, MBE Food campaigner, author and chef


Chapter 2

Executive Summary

Britain needs a fair deal between the food industry, the government and the people to prevent and treat obesity and create a generation that is Fit for the Future.

Over the past 70 years, obesity rates have risen to record levels in the United Kingdom. Pre-packaged, convenient and ultra-processed food now makes up 57 per cent of the average UK diet[_] and the dominance of this food is making people sick. Today, nearly one-third of children aged 2 to 15 have overweight or obesity,[_] the UK has the third-highest rate of adult obesity in Europe[_] and obesity-related deaths have surpassed those caused by smoking.

For the sake of the nation’s future, government must act – the health of a generation and our economic growth and prosperity depend on it.

The current government approach is underpinned by personal responsibility – namely, that people can and must take sole responsibility for their health and the choices they make. But people cannot easily change if they live in an environment that makes that change difficult or even impossible. Twenty years ago, it was reasonable to believe that obesity could be dealt with this way; we had only just started to understand and address the issue. Today, it is inexcusable that the government still relies on the same tired ideas that have proved not to work.

To truly support people to be healthy they first need to be living in a healthy environment. If governments fail to accept this simple truth, they will be doomed to repeat the failures of the past.

We need transformative change to shift the obesity conversation from individuals to the commercial food environment. Our high streets, supermarket shelves and school canteens are flooded with fast food and unhealthy options, and millions of pounds are spent marketing them to us.

We know this shift is possible because it has been done before. Until 1999, when the government’s ban on tobacco advertising recognised the impact of marketing on choice and addiction, smoking was largely viewed as a personal choice. For years, governments had ploughed millions into education campaigns to encourage behavioural change with limited effect. Then the narrative shifted to focus not on individuals but on tobacco itself as a harmful product and the corporate practices that drove its production, retail and promotion.

This changed the conversation and created political space for policies that protect people, especially children, enabling politicians to act. Smoking rates fell dramatically and stayed there.[_] Politicians left a positive legacy; today with obesity, they have this same opportunity.

To tackle obesity, the government must act to:

  1. Create a commercial food environment that provides accessible and affordable healthy options for people.

  2. Embed healthier food across all government entities such as the National Health Service (NHS) and schools to promote long-term health – particularly for children and the vulnerable.

  3. Actively adopt new research, technologies and treatments to improve the prevention and treatment of obesity.

These goals must rise above political differences to achieve a cross-party consensus that can survive any change of government.

In the long run, creating a fair deal on obesity means the state can spend less money on treatment and instead invest in other essential services across the country. Britain’s state can be smaller, its economic productivity higher and its capacity to tackle other pressing challenges greater.


Chapter 3

Politicians Have an Opportunity to Create a Healthier, More Prosperous Britain

Britain can be a country with a fair and healthy food system. A system that improves rather than hurts our health, that protects children, that supports rather than hinders the NHS and that unleashes the innovative power of British business to create healthy products for all.

Sadly, we are a long way from achieving this vision.

Instead, health outcomes in the UK are falling behind. If current trends continue, almost 40 per cent of the UK population will have obesity by 2040,[_] which comes with growing risks of cancer, diabetes, cardiovascular disease, musculoskeletal conditions and poor mental health.[_]

The personal costs to families living in a food environment that is rigged against them are immeasurable. However, the cost to the taxpayer is not. It is estimated that the societal cost of obesity is between £29 billion and £58 billion per year, which is 1 per cent to 3 per cent of GDP.[_] In England, research shows that areas with the highest rates of overweight and obesity also have the lowest rates of productivity.[_]

Increasing rates of obesity pose a threat to the longevity of our health system, with the responsibility for treating obesity-related conditions falling on the NHS. Data show that obesity costs the NHS £6 billion annually, set to rise to over £9.7 billion by 2050.[_]

Every government since 1992 has missed targets to reduce obesity, despite publishing 14 strategies and implementing almost 700 policies. The status quo is not working; we must tackle the causes of obesity.

Figure 1

Obesity rates in England from 1992 to 2020, and government policies in place during this period

Source: NHS Health Survey for England. % not overweight is the inverse of % overweight including obesity

As when they came together behind the anti-smoking cause, politicians must demonstrate political will and ambition by establishing an aspirational cross-party agenda that will create a safer food environment for the health and prosperity of the country.


Chapter 4

A Fair Deal that Saves Lives, Costs Less and Protects the NHS

The current approach to obesity policy is unsustainable.

It is characterised by an expectation that individuals can navigate a commercial food environment of expensive healthy options and an increasing share of unhealthy, cheap and widely available foods. Meanwhile, the food industry actively markets these products and makes huge profits, while the government and taxpayers foot the health bill.

Previous governments have tried – and failed – to tackle obesity by focusing on personal responsibility and behavioural change such as exercise and education. It’s no longer excusable to rely on this same failed approach.

Even when a government has taken steps in the right direction, caution against overreach and commercial interests have stoked fears of “nanny-statism” and politicians back down. For example, the government delayed the introduction of bans on TV and online advertising of unhealthy food and drinks as well as plans to ban multibuy promotions on unhealthy products, even though polling shows that most people support these policies.[_] To explain this choice, the government cited the cost-of-living crisis – despite multibuy promotions actually driving consumers to spend more than they originally intend.[_]

The biggest challenge to tackling obesity is political.

Politicians and policymakers are vastly out of step with public-opinion research that shows broad support for strong government intervention to create a healthier food environment. The Health Foundation says that fewer than one in five people think the government is working effectively to improve diets,[_] and a 2020 study by the Obesity Health Alliance found that 74 per cent of the public supports government action to address obesity.[_]

This is not to say that preventing obesity should fall solely on the shoulders of government and industry. Individuals still have a critical role to play. However, the belief that individuals can maintain health while the system works against them is not only ineffective but increasingly damaging. To truly support people to be healthy they first need to be living in a healthy environment.

Most people know what a healthy diet looks like, but healthy and nutritious foods are more difficult to access, especially for those in disadvantaged areas. The Food Foundation says that more than one in four places to buy food on our high streets are fast-food outlets and that eating healthily costs nearly three times as much per calorie than less healthy foods.[_] The UK food industry spends hundreds of millions of pounds annually advertising unhealthy foods while the government spends only £5 million[_] on its healthy-eating campaign.

There are ways to ensure that the building blocks of a healthy food environment are strong across the country. The NHS is one of the largest providers of food and drink services, serving more than 199 million meals a year for patients, staff and visitors.[_] Meanwhile, nearly 2 million schoolchildren are currently eligible for free school meals, and many more parents pay for them. [_] Yet many of these food options are unhealthy and of poor quality with little choice. The government has an opportunity to lead by example by embedding healthier food options across all government entities.

Finally, while prevention is a priority, some individuals remain at higher risk of obesity. There are an increasing number of technology and treatment options to address obesity and the government must ensure that those who develop obesity receive the most clinically and cost-effective care. Crucially, support must continue as patients become healthier. It doesn’t make sense to provide individuals with cutting-edge treatments and surgery only for them to continue to live in a food environment flooded with the unhealthy food that increased their risk of obesity in the first place.


Chapter 5

A Step Change in the Governments Approach to Obesity

We need a strategic approach to tackling obesity. The food system is stacked against individuals’ health and needs to be transformed. This means the government must intervene to create a healthier commercial food environment that will finally support better choices and healthier lives. People cannot be expected to make good choices when faced with a range of bad options.

Ongoing failure to act will continue to damage the country for decades to come – making us less healthy, less productive and less competitive.

Many policies have been proposed, for instance in the National Food Strategy[_] and by the Obesity Health Alliance.[_] A coherent plan is needed to reform the food environment, lead by example through government procurement of healthy and nutritious food, and explore new methods of preventing and treating obesity.

1. Create a Commercial Food Environment That Provides Accessible and Affordable Healthy Options

A healthier commercial food environment is fundamental to a fairer deal to preventing and treating obesity. Today’s commercial food environment is flooded with cheap, unhealthy and easily accessible food that is marketed aggressively and sometimes deceptively.

Through a combination of regulation and incentives, the government can transform the commercial food environment to be healthier. These kinds of interventions have proved effective. The Soft Drinks Industry Levy (SDIL), which came into effect in 2018, led to a 35 per cent reduction in the total sugar sold in soft drinks by retailers and manufacturers.[_] Fears that extending the SDIL could have an adverse impact on consumers during the cost-of-living crisis have not materialised. Since the SDIL was implemented, sales of affected products have remained stable,[_] with industry opting to reformulate products to include less sugar.

Priority areas include:

  • Legislation to restrict marketing of products deemed to be high in fat, salt and sugar in shops, online, on TV and radio, and in sports sponsorship and the wider environment

  • Fiscal levers like the SDIL to incentivise reformulation of products high in sugar and salt

  • Planning laws to allow local authorities to reduce the prevalence of unhealthy food outlets, particularly around schools, and to tackle unhealthy food and drink marketing

  • Incentives for retailers to sell healthier food and drink

  • Initiatives that prescribe or subsidise fruit and vegetables to low-income individuals and families to increase the affordability of healthy food, such as Healthy Start, and adopt a proactive public-service model to expand coverage, as outlined in the paper What Are Proactive Public Services and Why Do We Need Them?

2. Embed Healthier Food Across All Government Entities

Politicians must intervene to show they're serious about tackling obesity and creating a fair deal. This should start with a commitment to clean up government food provision in schools, the NHS and army canteens, for example. As mentioned above, millions of people consume government-procured food in these institutions every day – the potential for population-level impact is enormous.

Priority areas include:

  • Rules for government procurement that ensure taxpayer money is spent on healthy foods within government entities such as the NHS and schools

  • Extending eligibility for free school meals to the 800,000 children who are from Universal Credit Households and living in poverty

  • Enabling those eligible for free school meals to be proactively enrolled to reach more students

  • Implementing the “Eat and Learn” initiative for schools as outlined in the National Food Strategy

3. Adopt New Research, Technologies and Treatments to Improve the Prevention and Treatment of Obesity

While prevention and the creation of healthy environments is the priority, some people will still be at increased risk of obesity. The government must protect the individual, the NHS and the taxpayer by ensuring that people with obesity receive the most clinically and cost-effective care. And when an individual receives treatment the environment in which they live should be able to support them to easily maintain better health.

The government must harness the potential of new research, technologies and treatments to remain at the cutting edge of obesity prevention and treatment.

Priority areas include:

  • Accelerating research into ultra-processed foods to establish a robust base of evidence that will inform government efforts to support obesity prevention and health promotion

  • Leveraging technological advances such as artificial intelligence – for example, government food procurement could be automated in favour of food with higher nutritional values

  • Conducting further large-scale, real-world trials for modern obesity drugs to understand effectiveness in weight reduction

  • Conducting a full review of weight-management services to identify how to make the best use of new digital tools


Chapter 6

Conclusion

The government – and politicians – have a responsibility to protect the health of their citizens and must be bold in their interventions to address obesity and create genuine choices for individuals to live healthy lives.

This requires a fair deal between the food industry, the government and the people.

Individuals should be able to confidently navigate a food environment with easy access to healthy options, where industry no longer profits from ill health by marketing and selling cheap and unhealthy foods, and where the government boldly leads in creating healthy environments.

The politicians who act will leave legacies to be proud of – having protected the NHS, created a more productive economy and, most importantly, helped us all to live longer, healthier and happier lives.

Footnotes

  1. 1.

    https://bmjopen.bmj.com/content/9/10/e027546

  2. 2.

    https://www.gov.uk/government/publications/health-matters-obesity-and-the-food-environment/health-matters-obesity-and-the-food-environment--2

  3. 3.

    https://www.thetimes.co.uk/article/uk-adult-obesity-is-third-highest-in-europe-59zqx528c

  4. 4.

    https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/bulletins/smokingprevalenceintheukandtheimpactofdatacollectionchanges/2020

  5. 5.

    https://news.cancerresearchuk.org/2022/05/19/new-analysis-estimates-over-21-million-uk-adults-will-be-obese-by-2040/

  6. 6.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884814/

  7. 7.

    https://www.frontier-economics.com/media/5094/the-full-cost-of-obesity-in-the-uk.pdf

  8. 8.

    https://www.theguardian.com/society/2023/jan/31/higher-obesity-levels-linked-to-lower-productivity-in-england-research-shows

  9. 9.

    https://www.gov.uk/government/news/new-obesity-treatments-and-technology-to-save-the-nhs-billions

  10. 10.

    https://www.ipsos.com/sites/default/files/ct/news/documents/2020-09/covid%5Fand%5Fobesity.pdf

  11. 11.

    https://obesityhealthalliance.org.uk/2020/12/11/the-problem-of-unhealthy-multi-buy-promotions-online/

  12. 12.

    https://www.health.org.uk/publications/reports/public-perceptions-of-health-and-social-care-what-government-should-know

  13. 13.

    https://obesityhealthalliance.org.uk/2020/06/03/74-of-the-public-support-government-action-on-obesity-in-the-wake-of-emerging-links-with-covid-19/

  14. 14.

    https://foodfoundation.org.uk/sites/default/files/2023-01/FF%5FBroken%5FPlate%5FReport%202022%5FDIGITAL%5FUPDATED%5F2023.pdf

  15. 15.

    https://cdn2.assets-servd.host/ffcc-uk/production/assets/downloads/FFCC-Our-Future-in-the-Land.pdf

  16. 16.

    https://www.england.nhs.uk/blog/better-hospital-food-on-the-menu/

  17. 17.

    https://www.statista.com/statistics/1182077/free-school-meals-uk/

  18. 18.

    https://www.nationalfoodstrategy.org/

  19. 19.

    https://obesityhealthalliance.org.uk/2023/05/23/manifesto/

  20. 20.

    https://www.instituteforgovernment.org.uk/article/explainer/sugar-tax

  21. 21.

    https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1477-4

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