Wednesday 29 April 2015

A blether with Scotland’s fast food vendors

Guest post by Michelle Estrade, Scottish Collaboration for Public Health Research and Policy (SCPHRP)

In June 2014 the Scottish Government published a voluntary framework, entitled Supporting Healthy Choices, which encourages the food industry to take action towards offering healthier food choices to consumers. The recommendations include guidance on promotional activities, healthier cooking practices, and types and portion sizes of foods offered. Just after the recommendations were drafted, I sat down with owners of independent fast food shops in lower-income neighbourhoods across Scotland to discuss how they felt about offering healthier menu options. They shared many thoughts on tradition, customer demand, and the deprived neighbourhood context, suggesting that food vendors in disadvantaged areas would need additional incentives and assistance in order to implement healthy menu guidelines and ensure that their customers don’t miss out on the potential benefits.

The shop owners I talked to took pride in their menus, using words like “traditional” and “proper” to describe the foods they sold. Because they felt food was being prepared the proper way, there was a sense of reluctance to change cooking methods. One example was the use of traditional beef dripping for frying, rather than healthier oil alternatives. During our conversation, the food vendor I was interviewing looked at me quizzically and asked: “I mean, how can we say we’re traditional if we’re cooking in palm oil or rapeseed oil?”

Most places I visited had a well-developed sense of niche, which was a common reason for offering only certain types of foods and not others. When I asked about the possibility of adding other [healthier] options, a fish and chip shop manager gave me a cheeky smile and quipped: “…they’re not coming here because they want fruit.” Again and again, the food vendors I talked to explained that they needed to respond to customer demand in order to keep their clients; competition was described as “cut-throat”, and the fear of losing business was palpable.

Indeed, price was viewed as a major barrier to offering healthier options to current clientele. The owner of a sandwich shop shared a personal example of the dilemma: “I don’t allow my kids to have fizzy juice, so I dinnae really like having it. I’d like to buy fresh juice, but it’s so expensive, you wouldn’t make any money. With the price you would have to charge, they wouldnae want to buy it.” Another told me: “We’re barely making a profit just now. If we were anywhere else we’d be able to charge more, but in [this neighbourhood], most of our customers are on a limited budget...”

I went into this project assuming that the major problem I would uncover would be a lack of awareness and knowledge about healthy eating. All we would need to do is help food vendors realise how important it is to get people to make healthier food choices, and they would be eager to jump on board with guidelines like Supporting Healthy Choices. What I found though was a much more complex set of circumstances at play – a constant struggle to cope with economic pressures, intertwined with the enduring characteristics of the neighbourhoods in which these people did business. Reflection on this has helped me realise that perhaps what needed uncovering was my own lack of awareness about the pivotal role of environment and context. Too often, I think, researchers are eager to jump into intervention mode and change what is happening without first thoroughly understanding why it’s happening.

Michelle is presenting at the Fuse Quarterly Research Meeting - More than enough on our plates: tackling the takeaway food diet at source tomorrow (Thursday 30 April).

Tuesday 28 April 2015

Whipping town planners into shape

Guest post by Michael Chang, Town & Country Planning Association

Obesity is climbing up the national and local government agenda, and following two previous seminal publications – the Foresight Report on reducing obesity in 2007 and the Marmot Review of health inequalities in 2010 – one of the many spotlights has now firmly fixed on town planners and the planning system.

So all eyes will be on town planners at the Fuse event – More than enough on our plates: tackling the takeaway food diet at source – on Thursday (30 April).

This blog will attempt to shed some light on what planning can, must, should and could do. Coming from a non-academic background and admittedly a town planner, I take a pragmatic but liberal view of the planning system. This is not surprising as I work for a charitable organisation which essentially championed good planning for healthy outcomes for people in the Victorian times through the building of two garden cities in Letchworth and Welwyn.

Planning is a legal mechanism tasked with a land use function and exists to ensure the sustainable use of a scarce resource that is the land and the natural environment. What we do is grounded in what planning law, dating back to the 1990s, allows us to do and what national policy in the National Planning Policy Framework (NPPF) published in 2012 requires us to do. Why do I emphasise these dates? Simple. Laws change and policies evolve. Of all the planning laws and policies we have had, there has never been an explicit reference or requirement to consider access to fresh healthy food. That is, until 2014 with the online Planning Practice Guidance which the government hailed as a triumph in condensing thousands of guidance into an accessible and evolving online guidance, and which supports the NPPF. In addition to having a section on health and wellbeing, it states:
The range of issues that could be considered through the plan-making and decision-making processes, in respect of health and healthcare infrastructure, include how: opportunities for healthy lifestyles have been considered (e.g. planning for an environment that …promotes access to healthier food).
Healthier food is of course not defined but at least planners are now strongly encouraged to consider food in planning.

Laws and policy frameworks haven’t stopped some enlightened local planning authorities in doing what they think is right for their local areas to use current planning powers to improve access to healthy food or rather, to restrict the proliferation of unhealthy land uses. We know there are dozens of councils now pursuing planning policies to prevent burgeoning shops serving unhealthy foods, albeit meeting increasing resistance from the food industry and also from within different sections of the planning profession. Actions in planning also take time: five years between the publication of Foresight (2007) to the first Supplementary Planning Document (SPD) on takeaways in 2009 and the Greater London Authority’s takeaways toolkit in 2012. Also there are more than 350 local planning authorities across England, so we still have a long way to go.

The Town and Country Planning Association (TCPA) published the Planning Healthy Weight Environments resource in 2014 which highlighted the following considerations regarding food in planning:
  • Development avoids overconcentration of hot-food takeaways (A5 class use for the sale of hot food for consumption off the premises) in existing town centres or high streets, and restricts their proximity to schools or other facilities for children and young people and families.
  • Shops/markets that sell a diverse offer of food choices are easy to get to by walking, cycling or public transport.
  • Leisure centres, workplaces, schools and hospitals with catering facilities have a healthier food offer for staff, students, and/or customers.
  • Opportunities for supporting innovative approaches to healthy eating through temporary changes of use have been explored.
  • Development maintains or enhances existing opportunities for food-growing, and prevents the loss of food-growing spaces.
  • Opportunities are provided for households to own or have access to space to grow food – for example roof or communal gardens, or allotments.
So the key message of this blog is: there is actually no legal, or professional, basis that stops town planners from taking appropriate policy actions to promote healthier communities through the provision and access to fresh healthy food. Much of what is needed is a cultural change within the profession, more active support of colleagues in public health in the planning process, continuing advocacy by national organisations, and last but not least (especially where Fuse is concerned), translating valuable evidence from academia to a format planners can use.

Tuesday 14 April 2015

Have we been had?

Guest post by Jean Adams, Centre for Diet and Activity Research (CEDAR)

Parents don’t like sweets at supermarket checkouts. The ‘guilt lane’, as it’s been called, seems designed to attract children in a place where they are a captive audience – you can’t just move away from the checkout when you have a trolley full of shopping that you need to pay for.

This consumer concern is what seems to have prompted many supermarkets to impose total, or partial, bans on checkout confectionary.

It was certainly a healthy dose of parental curiosity that prompted our recent study on food at checkouts in non-food stores. The lead author was in Primark with her pre-schoolers, noticed a LOT of sweets by the till, and started to wonder how pervasive a phenomenon this was.

We felt food at checkouts in non-food stores was a worthwhile thing to study for two reasons. Firstly, these are places where we assumed most people aren’t naturally thinking about food. Buying confectionary at a supermarket is, perhaps, appropriate. But at a clothes shop? Presumably most people don’t go into Primark to buy some energy-dense, nutrient-poor snacks. So any purchases they do make are unplanned and prompted entirely by the display, rather than, say, hunger. Secondly, a lot of campaigning attention has been devoted to #junkfreecheckouts in supermarkets. To some good effect. But if the problem has just shifted to other types of shops, then any war is not yet won.

So we enlisted the help of two medical students, who were keen to get some hands-on experience of public health research, and did a survey of all the non-food stores in the MetroCentre - which has the dubious accolade of being the second largest shopping centre in the UK (I’m sure it was the largest in Europe at some point).

Of 205 non-food stores in the MetroCentre, 32 of them, or 16%, had food within arm’s reach of the checkout queuing area. All these stores stocked less healthy checkout food, although about half of them also had foods that were not specifically identified as less healthy. This was mostly bottled water or chewing gum – so not exactly healthful! Overall more than four-fifths of checkout food was less healthy and would not be allowed to be advertised on children’s TV in the UK.

As well as making life easier for the parents of young children, there may well be health benefits of #junkfreecheckouts. Around the world, most checkout food really is ‘junk’ – soft drinks, and foods high in energy and salt, and low in vitamins and minerals. Checkout food may prompt impulse purchases and purchasing requests from children, which parents find hard to resist.

But, importantly, I’m not aware of any research that shows that people who see more checkout junk food eat more junk food, or that removing checkout junk food leads to changes in what people buy or eat. This is one of those absence of evidence, rather than evidence of absence situations – we just don’t know what effect checkout confectionary has on what kids eat.

There was an interesting discussion on the Food Programme recently suggesting that sales of confectionary from UK supermarkets were steady, or rising, despite many stores removing it from checkouts. Checkouts aren’t the only way to prompt impulse purchases in supermarkets. Prominent, end-aisle displays, and price promotions seem to be keeping sweets sales buoyant. At least for now.

This wasn’t what we meant: a prominent confectionary display opposite a #junkfreecheckout at my local supermarket (that pizza wasn’t mine!)
Which makes me wonder…have we been had? Have supermarkets taken confectionary off tills because it makes them look responsible and ‘part of the solution’, knowing full well it will have no effect on sales? And what might the consequences of that be for public health? Well, no change on the diet front. But what if supermarkets voluntarily choosing to remove checkout junk food, means that it also closes down a conversation on unhealthy food environments? Could the supermarkets keep referring to this non-change as a way of trumpeting how importantly they take health, and silencing any requests for further, serious, meaningful change?

I find this a bit scary. Some well-intentioned public health campaigning might have made things worse? I don’t know that it has. Maybe it hasn’t. Probably it hasn’t? Hopefully it hasn’t. Probably it’s just made no difference. At the very least, it makes life a bit easier for stressed out parents trying to get the shopping done and their kids to eat a healthy diet?

Thursday 9 April 2015

How hard can it be? Flying over the gap between research and policy

Posted by Peter van der Graaf
A man in a hot air balloon realised he was lost. He reduced altitude and spotted a woman below. He came lower and shouted: “Excuse me, can you help? I promised a friend I would meet him, but I don’t know where I am”. The woman below replied: “You’re in a hot air balloon hovering approximately 30 feet above the ground. You’re between 40 and 41 degrees north latitude and between 59 and 60 degrees west longitude”.

“You must be a researcher,” said the balloonist. “I am,” replied the woman, “how did you know?” "Well,” answered the balloonist, “everything you told me is technically correct, but I’ve no idea what to make of your information, and the fact is I’m still lost. Frankly, you’ve not been much help at all. If anything, you’ve delayed my trip.”

The woman below responded: “You must be a policy maker”. “I am,” replied the balloonist, “but how did you know?” “Well,” said the woman, “you don’t know where you are or where you’re going. You made a promise, which you’ve no idea how to keep, and you expect people beneath you to solve your problems. The fact is you are in exactly the same position you were in before we met, but now, somehow, it’s my fault.”
This story was presented by Professor Roland Bal from Erasmus University in Rotterdam, the Netherlands in his recent Knowledge Exchange Seminar titled: ‘Hybrid management in science-policy practice relations’. You might have heard the story before, as it is adapted from an article by Locock & Boaz in 2004 in Social Policy and Society and also quoted in the PhD thesis of one his students, Rik Wehrens (2013), who studied the Dutch Academic Collaborative Centres for Public Health and how they shaped the co-production of research, policy and practice within this field in the low lands.

In his seminar Roland used the above story to explain that we often fall into the trap of thinking of two communities (ivory tower scientists on the one hand and policy makers at the coalface on the other) with completely different perspectives on the use of research and evidence. He did not deny there were differences between both professions, and gaps to bridge but suggested that we should use these gaps more strategically. By starting from a recognition that all science is a social practice quoting Jasanoff (2004) (“Scientific knowledge [..] both embeds and is embedded in social practices, identities, norms, conventions, discourses, instruments and institutions” (p. 2-3)) he showed how the Dutch Centres have been able to blur the boundaries between the two communities by distinguishing between a front and back stage for their partnerships and performing on these stages at different times in the collaboration process.

At front stage the academics took the limelight and made all the right noises about scientific rigour by presenting their advisory report to public and policy audiences, complete with imposing lecture theatres. They deliberately emphasised the difference between academics and health professionals to create the impression of ‘science speaking truth to power’. However, the content of the reports and the research behind were intensely debated behind the scenes on various back stages between academics, health professionals and policy makers to ensure that the research objectives and findings were embedded in the wider political context. In other words, collaboration and distinction were highlighted at different times in the process to enable each community to explain and sell their work to their peers: policy makers needed to account for their compromises and shared decisions, and academics needed to manage the expectation around their research.

Two key mechanisms provided crucial in this staging: firstly, dual appointments that enabled health practitioners to take up part-time roles in academia (but surprisingly not the other way round!) and, secondly, scenario approaches that clustered specific interventions into modelled scenarios connected to relevant policy programmes.

What lessons does this hold for Fuse? Are we still trying to bridge the two communities or should we spend more time developing different stages? AskFuse (our responsive research and evaluation service) might be a step in the right direction to create the back stage for initial conversations between policy makers, health professionals and academics but where is our front stage? Are we making enough noise? And how serious are we about dual appointments (researchers in residence?) and linking research on interventions to specific policy programmes?

Thursday 2 April 2015

Hunting down the seasonal calories: an Easter eggs-ercise

Posted by Avril Rhodes

Will you be looking forward to an Easter egg hunt soon? Well, beware, those Easter treats are really loaded with calories, fat, and bizarrely, a little fibre. I’d love to say I’ve spent hours researching this, but I haven’t - just one trip to this weight loss website and I was overwhelmed with results. So, I picked a few favourites.

No Easter eggs were harmed in the writing of this blog (although some may have been consumed)
 Let’s go for some at the top end, weighing in at 1,250.2 calories, 67.7g fat and 4.0g fibre was the Kit Kat Chunky Easter egg from Nestle. Chunky indeed. Another in the heavyweight division for possibly more sophisticated palates, is the After 8 Giant (clue here) Chocolate egg also from Nestle which has 1,072 calories, per shell (possibly the calorie measuring people couldn’t bring themselves to estimate the whole egg). It has 64.6g fat and 16g fibre, which is a consolation but not as good as, say, porridge. How about the dark chocolate Easter egg from Green & Black’s, sneaking in at under 1,000 calories with 960, but 69.5g fat (ouch!) and strangely, 16.6g fibre? I know that Garfield, the cartoon cat, once said he’s never met a calorie he didn’t like, but there are limits to how you might increase your fibre intake. However, with Green & Black’s you are buying Fairtrade chocolate, which can’t be bad, and this also applies to Divine Chocolate.

Ding-ding! Round one goes to this heavyweight contender
And what about the children I hear you cry. The Buttons Easter egg by Cadburys is 858.6 calories per medium egg, (who said medium?) with 48.6g fat and 1.1g fibre. The Cadbury Caramel egg, per 38g egg (so a snack really), is 195 calories; with a mere 10.2g fat and 0.2g fibre. Parents might be tempted by the pack of two (to keep each other company, presumably) Cadbury Caramel bunnies, which come in at 200 calories, 10.8g fat and 0.2g fibre. And I couldn’t write this blog without paying homage to the Cadbury’s Crème egg which is 180 calories per egg with a fat rating of 6.3g. Although, I have overheard gossip about the Crème egg being downsized, bearing in mind that you seem to be able to buy these from December 26th onwards.

And what about the office snacking? More bad news. A single Lindt chocolate mini-egg, a mere 5g, is 30calories, a Malteaster bunny (ahhh) by Maltesers is 157 calories; and each Cadbury’s mini egg is 16 calories.

However, you can earn your calories. The same website that calorie counted the eggs, makes some suggestions that seem blatantly sexist…for example a 40 year old female weighing 12st 7lb who is moderately sedentary, can use 100 calories spending 30 minutes hovering/dusting/mopping floors, or, if you prefer, 20 minutes weeding the garden. What a way to earn about half of a Crème egg! I have no idea what you do with the other half.

Well, have a Happy Easter anyway from all at Fuse. That's all yolks!