Meeting 2: The cost of food-related ill-health
Thames Valley University/Sustain: AgriFood Network meeting 29 April 2002
Liz Dowler - Warwick University
Chizom Eke - National Consumer Council
Sue Fowler - Aberystwyth University
Vicki Hird - Sustain
David Hughes - Imperial College
Mike Joffe - Imperial College
Debbie Johnson - Wildlife and Countryside Link
Tim Lang - Centre for Food Policy, Thames Valley University and
Tim Lobstein - Food Commission
Jeanette Longfield - Sustain
Karen Lock - London School of Hygiene and Tropical Medicine
Eric Millstone - Science Policy Research Unit, Sussex University
Geraldine Oliver - Coronary Prevention Group
Karen Peploe - Health Development Agency
Mike Rayner - British Heart Foundation Health Promotion Research Group
Sarah Watson - Foundation for local Food Initiatives
The theme of the second meeting was the cost of food-related ill-health.
A wide-ranging discussion was initiated by the paper circulated before the meeting:
- Mike Rayner (BHFHPRG): 'The burden of food-related ill-health in the UK'
Download as PDF - 59kb
And by the notes tabled at the meeting (and circulated after it):
- Tim Lang (Centre for Food Policy, TVU): 'The relationship between science and policy'
Download as PDF - 16kb
Mike spoke very briefly to his paper, as it had already been circulated. He noted that new figures from the Wanless report  attributed a similar magnitude of costs to the same diseases highlighted by Mike, and in a similar ranking. This is despite the difficulties inherent in such calculations, and the fact that both sets of figures had been undertaken independently and for different reasons. Forthcoming statistics from the World Health Organization are also likely to be broadly comparable. This increases confidence in the robustness of the approach.
Barrie Margetts (Southampton University) could not be present but had sent comments to Mike noting the importance of the unequal distribution of the burden of costs. This issue is explored in more detail in the summary below.
Tim, in outlining the main arguments in his paper, compared the Department of Health (DH) with the fate of the Ministry of Agriculture Fisheries and Food (MAFF). In the case of the latter, the link between science and policy had, alongside other pressures, led to MAFF's abolition and its replacement with the Food Standards Agency and Department for Environment Food and Rural Affairs (DEFRA). This is despite the fact that food poisoning statistics show falling incidence due to some pathogens, no clear trends for others, and rising rates for only some pathogens. DH, by contrast, remains a largely unreformed ministry focusing mainly on how to improve the efficiency of the National Health Service in treating ill-health.
Summary of discussion around the presentations.
Some themes arose in the discussions following the two presentations, as follows:
Many echoed the point made by Barrie Margetts that the costs of food-related ill-health fell disproportionately on poor people. However, traditional cost-benefit analysis would appear to reduce this effect, since higher costs would be attributed to the premature death of a wealthy young man, than of a poor older woman.
The economics of health
In arguing the limitations of cost-benefit studies and other traditional economic techniques, it would be helpful to have links with some friendly economists. In general, those interested in promoting public health are not experienced in economic analyses. As a result, economic arguments are used (as their political importance is recognised) but the arguments are sometime lost on a "technicality".
It was also noted that given current funding regimes (favouring private sector, near-market research over public interest research), very little funding was available to assess the relative costs and benefits of more radical policy options. These are the options usually generated by non-government organisations (NGOs) and other public interest actors.
Invisibility of health
Partly as a result of this imbalance in research funding, policies to promote health have a low political profile. Even within DH, health promotion has a low status and, therefore, a small budget. Outside health departments, in the UK and elsewhere, health promoting policies are largely invisible. In particular, Common Agricultural Policy (CAP) reform rarely acknowledged the impact of agriculture on health, apart from in relation to food safety issues such as BSE/vCJD and dioxin contamination.
In assessing the impact of any given policy on sustainable development, health considerations should be included. However, too often, impact assessments focus solely on environmental effects. For example, it is now a legal requirement, at European Union (EU) level that major programmes and projects should undergo a Strategic Environmental Assessment (with smaller projects having an Environmental Impact Assessment - EIA). However, these tend not to include health and, in any case, apply only to programmes and projects, and not policies (such as the CAP).
There are some encouraging signs, albeit modest, that health could be integrated into EIAs, alongside social justice considerations, with DEFRA arguing this case for a forthcoming UN conference in Kiev 2004. However, the case is rarely made at UK level that food-related health is an holistic concept beginning with soil quality, which affects plant health and, in turn animal health, with the quality of both plants and animals affecting human health.
Integrating health and environment
It was suggested that, although intellectually defensible, linking human and environmental health into a single notion risked alienating some people, confusing others and debasing the language. Others argued that research shows "ordinary" people make these links anyway and that the way policies are presented will, in any case, differ for different audiences, making any disagreements on this point largely irrelevant.
The culture of food
The dominance of "junk" food ads, coupled with well-known social and educational trends, has produced a population largely (apparently) unwilling or unable to prepare meals from basic ingredients. This is particularly problematic when trying to increase vegetable consumption. Increasing fruit consumption is difficult enough but, since most vegetables have to be prepared, this is an additional barrier.
Cost is also a barrier, particularly for poor consumers, but even marginal increases in consumption could be important for health. They should also be important for fruit and veg producers but, since this industry largely lacks the opportunities for "value-adding" available in other parts of the food industry, insufficient profits are generated to capitalise on these market opportunities.
The DH Free Fruit for Schools scheme was thought to be a helpful step in the right direction of market creation but was flawed in several important respects, since it:
- excludes vegetables (some argue that at least half of the five daily portions should be vegetables);
- excludes meals (fruit is served as a snack), so losing a valuable opportunity to alter the balance of meals;
- specifies only four types of fresh fruit (apples, bananas, pears and satsumas), thereby ruling out producers of frozen, canned, juiced and dried products, all of which can be incorporated into five daily portions;
- centralises buying, so does not encourage the development of local supply chains;
- does not specify important sustainability criteria such as absence of pesticide residues, fair trade standards for overseas produce, or preference for domestic and seasonal supplies to reduce food miles.
- More collaborative research is needed, particularly with economists, to reveal the true costs of inadequate food policy and to allow comparison of figures.
- Any bodies commenting on nutrition initiatives e.g. free fruit in schools, should encourage the government to consider environmental issues including local supplies and absence of agri-chemical residues.
- Similarly, organisations should be encouraged to include health when lobbying on environmental issues.
- In general, the policy minefields need to be explored and thought through carefully.
- Members of AFN can circulate new references via the email group e.g. on Sustainability Impact Assessments, WHO reports, and CAP health impact assessments.
1] Wanless D (2002) Securing our future health: taking a long-. term view. HM Trearury: London