A healthier future - action and ambitions on diet, activity, and healthy weight: consultation

1. Transforming the Food Environment

Minister for Public Health & Sport

1.1 Many of us find it challenging to make healthy choices, particularly when food and drink high in fat, salt and sugar is cheap, widely available, and heavily promoted. As a consequence, we are consuming significantly more calories than we need, with around 20% of all calories and fat, and 50% of sugar coming from so-called 'discretionary foods' ^[1] .

1.2 Poor diet is associated with significant harms to public health and wider socioeconomic performance. Much of that harm is driven by overconsumption leading to people becoming overweight and obese. A good diet and healthy weight significantly reduces the risks of developing type 2 diabetes, 13 types of cancer, and other diseases including cardiovascular disease and depression ^{[2] , [3]} .

Obesity Harms Health

Source: Public Health England

1.3 The food and drink industry has a pivotal role to play in leading, enabling and supporting healthier purchasing. We know that marketing boosts purchasing of foods high in fat, salt and sugar, which are already over-consumed ^[3] .

1.4 Significant work is already well established in Scotland – such as the Healthyliving Award and the Scottish Grocers Federation Healthy Living Programme which help caterers and small retailers to offer healthier choices. These voluntary schemes have informed the development of Scotland's mandatory Healthcare Retail Standard which sets strict criteria for hospital food and drink provision and in-store promotions.

1.5 There is growing recognition across industry of the need to support healthier diets. Some progress has been made through voluntary action – such as front of pack labelling and removal of confectionery from some checkouts. However, we want to enable industry to go further so we can deliver the scale and pace of change needed.

1.6 In 15 years, progress towards meeting the Scottish Dietary Goals has remained stubbornly challenging. Furthermore, action is inconsistent across the food and drink sector, leading some to call for a level playing field across retail, catering and manufacturing. There is clearly no single solution, rather a wide range of regulatory and other action is required to create a food environment that better supports healthier purchasing.

Promotions

1.7 Promotions are a key strand of marketing activity designed to encourage consumers to purchase products more quickly, more frequently and in greater quantities than in the absence of the promotion. In Scotland latest figures ^[4] show that 35% of all food and drink purchased was on price promotion, with food high in fat, salt and sugar more likely to be purchased on promotion than healthier alternatives (around 50% compared to around 30% respectively).

50% of the sugar we consume comes from discretionary foods

Source: Food Standard Scotland

1.8 We have engaged the food and drink industry on voluntary action to support healthier diets, most recently through our Supporting Healthy Choices Voluntary Framework. Despite constructive engagement with the food and drink industry, this approach has not delivered sufficient commitment to action, particularly in relation to promotions. We therefore believe that more specific targeted action is required to improve the balance of promotional activity towards healthier options.

1.9 We will therefore take forward measures to restrict the promotion of food and drink high in fat, sugar and salt.

1.10 The primary aim is to reduce the public health harm associated with poor diet and the excessive consumption of food and drink high in fat, salt and sugar, including the risks of developing type 2 diabetes, 13 types of cancer and other conditions such as cardiovascular disease and depression.

1.11 In developing our approach, it is important that we clearly define both the types of foods and the types of promotions to be targeted for maximum benefit to public health. We are currently considering how we approach this.

The Scottish Government is minded to act to restrict price promotion on food and drink products which are high in fat, salt and sugar. This could include:

• multi-buy;
• X for Y;
• temporary price promotions.

1.12 Food and drink products high in fat, salt and sugar could be defined by:

• the existing nutrient profiling model ^[5] ; or
• a specific nutrient e.g. sugar and saturated fat; or
• foods that contribute the most calories to the diet.

Question 1

Are there any other types of price promotion that should be considered in addition to those listed above?

Please explain your answer.

Question 2

How do we most efficiently and effectively define the types of food and drink that we will target with these measures?

Please explain your answer.

1.13 We are in the early stages of developing our proposals for legislative action. Your feedback will inform our approach and we will engage with stakeholders on our final proposals in early 2018.

1.14 We will also continue to engage with industry on opportunities to increase the promotion and availability of healthy food, building on work already underway – in particular the Scottish Grocers Federation Healthy Living Programme, which seeks to increase the range of healthier products on offer in convenience stores in low income areas. We will also work with retailers to promote uptake of the Healthy Start Programme and implement the industry-led Fruit, Vegetables and Potatoes Action Plan for increasing the consumption of Scottish produce.

Advertising

1.15 Promotions and advertising are significant drivers of behavioural change. Promotions influence consumer decisions at the point of purchase, with complementary messaging through advertising in the wider environment. Advertisements appear in a variety of media, with out of home advertising accounting for 66% of an individual's total exposure to marketing in any day ^[6] . We equally recognise that advertising can also be a powerful force for positive messaging on healthy eating.

1.16 While we welcome recent ASA measures to limit junk food and drink advertising aimed at children, they do not go far enough. We believe there is scope to further strengthen current restrictions for both broadcast and non-broadcast advertising of food and drink high in fat, salt and sugar, to encourage healthier purchasing particularly in relation to children.

Scottish Health Survey 2016: Children's diets

Overall, children in Scotland tended to consume foods and drinks high in fat and/or sugar more often than adults

Source: Scottish Health Survey 2017

1.17 A positive change in this area would be to extend current restrictions on the advertising of food and drink high in fat, salt and sugar to all programmes before the 9pm watershed. As broadcast advertising is currently reserved, we will strongly press the UK Government to ban the broadcast advertising of foods high in fat, salt and sugar before the 9pm watershed. If they will not act, we will request these powers are devolved to the Scottish Parliament.

1.18 We will monitor and review the implementation and impact, in 2018, of the Committee of Advertising Practice ( CAP) code on non-broadcast advertising of products high in fat, salt and sugar. If we assess this is not sufficient, we will take any necessary steps to embed good practice. We will also continue to press the CAP to adopt the revised nutrient profile model once it is available.

1.19 We will explore the scope to, and commission research to examine, the extension of the current CAP restrictions at, or near, streets or locations commonly used by a high proportion of children (for instance, children's visitor attractions and Safer Routes to Schools). We will also explore opportunities to restrict advertising on buses, trains and transport hubs.

Question 3

To what extent do you agree with the actions we propose on non-broadcast advertising of products high in fat, salt and sugar?

• Strongly agree
• Agree
• Neutral
• Disagree
• Strongly disagree

Please explain your answer.

Out of home sector

1.20 The out of home ^[7] sector – referring to food and drink purchased and consumed outside the home – has the potential to play a significant role in driving improvements to the Scottish diet. In 2015 alone, there were 948 million visits to out of home establishments in Scotland – up 3% on the previous year (compared to only a 1.3% increase in England) ^[8] .

1.21 Evidence suggests that, overall, the food and drink provided out of home is skewed towards less healthy options ^[9] . The sector is very diverse, ranging from multi-nationals and UK companies to local independent outlets – and is still growing. Food and Drink is a growth sector in Scotland and our commitment to becoming a Good Food Nation is part of our efforts to encourage the sector to focus on healthy, fresh and nutritious food. Some work has been done to promote healthy eating in the out of home sector, for example through the Healthyliving Award. But there is scope for the sector to do much more to support healthier food provision.

1.22 Working with Food Standards Scotland, NHS Health Scotland and stakeholders, we will produce Scotland's first sector specific strategy for out of home providers by summer 2018. This will include action on:

• calorie labelling
• portion size and calorie cap options
• promotions and marketing
• advice on healthier processes e.g. cooking methods and reformulation; and
• nutritional standards for public sector procurement.

1.23 The out of home strategy will be relevant for large and small businesses across the public, private and voluntary sectors. We will engage with relevant stakeholders as we develop our strategy.

Question 4

Do you think any further or different action is required for the out of home sector?

Yes / No / Don't know

Please explain your answer.

Planning system and the food environment

1.24 We will research precedent, evidence and good practice on the relationship between the planning system and food environment, including exploring how food outlets in the vicinity of schools can be better controlled, with a view to informing the review of Scottish Planning Policy.

Labelling

1.25 Labelling, with simplified nutrition information, works alongside dietary advice, industry reformulation and other changes to the food environment to make healthier choices easier. It has an important role to play in both retail and out of home settings to help consumers make informed food and drink choices. It can also encourage food manufacturers to reformulate their food products to gain a more positive nutrient profile.

1.26 The UK-wide voluntary Front of Pack (FoP) colour coded nutrition labelling scheme was introduced in 2013 following extensive consultation with businesses, consumer groups and public health professionals. It has good uptake, with around two thirds of pre-packed foods and drinks in the UK displaying a FoP label, and is popular with consumers. Around 80% of people say they look at the label when shopping and those that do tend to have a healthier shopping basket with fewer calories, less sugar, fat and salt and higher fibre content ^[10] .

1.27 We will explore how we can strengthen the current labelling arrangements and improve the way in which we communicate important information to families. In doing so, we will consider the effectiveness and impact of other labelling approaches.

Question 5

Do you think current labelling arrangements could be strengthened?

Yes / No / Don't know

Please explain your answer.

Reformulation and innovation

1.28 Changing consumer preferences, as well as the influence of initiatives such as the UKG's Soft Drinks Industry Levy and Public Health England's ( PHE) reformulation programmes, are creating incentives for manufacturers to produce healthier food.

1.29 This, in turn, is creating important opportunities for Scottish businesses. Ambition 2030 recognises the opportunities that come with a greater demand for healthier food in helping to grow the Scottish food and drink sector. Large food and drink businesses are more likely to have the resources needed to invest in product reformulation and innovation, such as research and development and technical capacity. For many small and medium enterprises ( SME), it is more challenging. As 98% of Scottish food businesses are SMEs, we must ensure that they have the support they need to compete in this area and enhance Scotland's reputation for healthier food products.

1.30 We will invest an initial £200,000 over the next 3 years to help Scottish SMEs reformulate their products. With Food and Drink Federation Scotland and Food Standards Scotland, we will develop a wider package of support including access to practical advice, academic and technical expertise and knowledge exchange, as well as promoting other relevant initiatives such as the recently launched Make Innovation Happen service.

Question 6

What specific support do Scottish food and drink SMEs need most to reformulate and innovate to make their products healthier?

Food and drink levies

1.31 We support the introduction of the UK Government Soft Drinks Industry Levy from April 2018. The significant levels of reformulation that companies have already undertaken in response are encouraging. Notwithstanding the important role this can have in supporting our endeavours, we are concerned at the lack of transparency of the existing soft drinks levy and the way in which it is allocated to Scotland.

1.32 To that end we will be engaging with the UK Government to seek more transparency on how the soft drinks levy is distributed.

1.33 However, the scope of the levy should be extended to include sugary milk-based drinks containing less than 95% milk, consistent with advice from Food Standards Scotland. The current threshold of 75% is much too low, allowing milk to be used as a carrier of added sugars into children's diets with some drinks exceeding more than 8g/100ml ^[11] . We think that threshold should also apply to dissolvable powders for milk-based drinks such as milkshakes or hot chocolate since their added sugar levels are comparable and feature in products aimed at children.

1.34 We will call for the UK Government to extend the Soft Drinks Industry Levy to include sugary milk-based drinks, including dissolvable powders, containing less than 95% milk.