Healthy Eating, Active Living: An action plan to improve diet, increase physical activity and tackle obesity (2008-2011)

4 The Action Plan

This section details the specific actions we will take over the next three years to support people to make healthier choices in what they eat, to build more physical activity into their everyday lives and to maintain or achieve a healthy weight. New actions are clustered according to the population groups at which they are targeted. In addition to these new initiatives, we have highlighted just a few of the exemplar projects and programmes that have been developed over recent years. We will continue to support these projects in this new funding period and, in many cases, we have been able to increase our level of support. Many of the projects highlighted in this chapter are led by stakeholders outwith the health sector. These initiatives across sectors and disciplines begin to expose the far-reaching nature of action needed to tackle the causes of overweight and obesity in the long-run.

4.1 Early Years

We want to ensure that we create the best environment that promotes a mother's and child's health. We want to improve their nutritional status, to help mothers understand that the future health of their child is dependent on their diet and lifestyle, and to encourage parents to have the confidence to play with their child to assist their social and physical development.

The nutrition of women of childbearing age and pregnant women is important as dietary intake before and during pregnancy has been shown to have positive impacts on women's health during pregnancy, on pregnancy outcome, and later health of the baby.

Available evidence on tackling inequalities suggests the need to improve nutritional outcomes in lower-income groups across the early years, and this points to key areas of intervention including pregnancy, breastfeeding, weaning and diet in early childhood.

We have considered our manifesto commitment to provide free fruit to pregnant women and children in pre school establishments. We have concluded that to best improve maternal and infant nutrition this commitment should be broadened out to include maternal and infant nutrition generally. We will provide NHS Health Boards with broad parameters within which to work with their partners, but intend that they will have flexibility within this to consider a range of interventions which best meet their local population's needs. These will include new and existing practice, including Healthy Start as mentioned below.

• We will make £19m available over the period 2008-2011 to improve nutrition of women of childbearing age, pregnant women and children under five in disadvantaged areas.

The existing Healthy Start scheme, established in 2006 to replace the Welfare Foods scheme, is targeted at pregnant women on certain benefits. It offers vouchers which can be exchanged for fresh fruit, fresh vegetables and milk (including infant formula) from over 3,700 participating shops across Scotland. Currently we estimate that 48,000 are eligible to receive Healthy Start vouchers in Scotland and that the uptake rate for the UK is around 87%. We want to increase the uptake rate of Healthy Start through NHS Health Boards, working in partnership with other key bodies, while at the same time supporting the delivery of a range of actions to promote maternal and infant nutrition.

Key actions will include direct support for recipients of Healthy Start vouchers to assist them with lifestyle behaviours including breastfeeding, nutrition during and after pregnancy, cooking skills and general healthy living advice.

A condition of the support available to NHS Health Boards will be that they work in partnership with local authorities, Community Food and Health Scotland ( CFHS), local community food initiatives, and other relevant stakeholders to ensure optimum opportunity for interventions.

• We will focus efforts to increase the uptake of Healthy Start.

Currently the range of foods that can be purchased using Healthy Start vouchers is limited. We believe there may be a case for expanding the range of produce to include, for example, frozen or tinned fruit and vegetables, with the goal of improving nutrition.

• We will seek advice from the FSA(S) and NHS Health Scotland on extending the range of produce that can be purchased with Healthy Start vouchers.

In recognition of the importance we place on the best possible start, we have recently appointed an Infant Nutrition Co-ordinator for Scotland whose role is to lead the development and implementation of the infant nutrition strategy for Scotland, providing advice and support to Ministers, NHS Health Boards and all those involved in infant nutrition. This post supports a major strand of maternal and child health policy and wider policy to promote health and tackle health inequalities. The development of this strategy will also provide an opportunity to explore in greater depth indications from existing evidence that there may be important links between infant nutrition and low levels of breastfeeding and increased risk of overweight or obesity later in childhood ¹⁶. The importance of breastfeeding in improving and maintaining health and in establishing healthy eating patterns in infancy will also be emphasised and will contribute to the support for NHS Health Boards on improving breastfeeding rates ¹⁷.

Scotland leads the way in the UK in terms of breastfeeding support. The Breastfeeding etc (Scotland) Act 2005 is the first of its kind in the UK, making it an offence to stop or prevent a person feeding milk to an infant in a public place where the infant is legally entitled to be. We are taking steps to promote breastfeeding and there is now evidence that women in Scotland are more comfortable breastfeeding in public than those elsewhere in the UK.

Breastfeeding

Breastfeeding rates vary according to deprivation. We have targeted NHS Health Boards via their HEAT target to increase the proportion of newborn children who are exclusively breastfed at 6-8 weeks from 26.2% in 2006-07 to 32.7% in 2010-11.

Early years establishments, e.g. nurseries, childminders, playgroups etc play a crucial role in shaping children's eating and physical activity patterns. The Nutritional Guidance for Early Years (2006) ¹⁸ set out the nutritional requirements for children aged 1 to 5 and we will build on the work currently underway by local authorities and health boards.

• We will implement a comprehensive programme of education, training and support for health professionals on maternal and infant nutrition to ensure that all pregnant women and mothers have access to the best quality care and advice about how they feed themselves and their child.
• We will continue to raise awareness of the importance of folic acid supplementation at preconception and in the early weeks of pregnancy while awaiting definitive advice from the FSA regarding fortification of bread or flour.
• We also wish to help encourage mothers and families to help their child's physical development and body awareness. Play@home is a programme that encourages recognition of the fact that all movement in babies can be exercise and health related. Through a programme of physical activity for children over three stages, from birth to five years, Play@home provides parents with guidance on safe and beneficial ways of handling an infant to improve family emotional ties, stimulate child development and promote a stimulating, nurturing environment within the home for the child's early years.
• We will support the roll out of Play@home across Scotland.

4.2 Schools and School Age Children

Our aspiration for all our young people is that they are successful learners, confident individuals, responsible citizens and effective contributors. Schools have an important role to play in developing in young people qualities of resilience and adaptability so that they are able to make informed choices to enhance their own and their families' health and wellbeing. This is now supported by a legislative duty on Scottish Ministers, local authorities and managers of grant-aided schools to ensure that schools are health promoting.

The review of the curriculum from 3 to 18 has as its aim to help prepare all young people in Scotland to take their place in a modern society and economy which will include the promotion of active and healthy lifestyles and skills for work. On 13 May 2008, draft experiences and outcomes for health and wellbeing from 3 to 15 within Curriculum for Excellence were released ¹⁹ together with guidance for local authorities and schools ²⁰ on the Schools (Health Promotion and Nutrition) (Scotland) Act 2007. In addition, Building The Curriculum 3, A Framework For Learning and Teaching which the Cabinet Secretary for Education and Lifelong Learning published on 10 June, provides guidance for those involved in planning the curriculum for children and young people.

The framework for learning and teaching includes entitlements for every child and young person to have a broad general education to the end of S3 which will include all of the experiences and outcomes across all curriculum areas, including health and wellbeing to the third level. From S4 to S6, young people will have an entitlement to a senior phase where they can obtain qualifications. There will continue to be an emphasis on health and wellbeing, including the relationship between food, health and wellbeing. Taken together these documents describe the Scottish Government's expectations for promoting the health and wellbeing of children in school. It is the responsibility of schools and their partners to bring the experiences and outcomes together and apply the national entitlements to produce programmes for learning.

Active Schools

The Active Schools ²¹ programme is responsible for providing high quality opportunities for children to be active in and around the school day and incorporates programmes such as the Youth Sport Trust's TOP Play and TOP Sport programmes (aimed at primary aged children), the Out of School Hours Learning, Sporting Champions, the NHS Health Scotland Class Moves programme, Sustrans Safe Routes to Schools programme and a wide range of sport and physical activities into a comprehensive whole school approach. Instrumental to delivering Active Schools is the development of a staffing network of 630 co-ordinators and 32 managers who are responsible for putting in place and driving forward a range of planned activities in both school and community settings.

As part of Curriculum for Excellence, the Scottish Government expects schools to continue to work towards the provision of two hours of good quality physical education for each child every week. This commitment is reflected in the draft experiences and outcomes for health and wellbeing. There are also draft experiences and outcomes for physical activity and sport. These will take place in addition to planned PE.

In addition to the work above we are also continuing to support a variety of initiatives aimed at promoting active and healthy living.

As figure 5 indicated in section 3, unlike young boys, physical activity declines steeply as young girls move into adolescence. For this reason we are funding three national programmes directly targeting physical activity promotion in young girls; "Fit for Girls", "Dance for Girls" and "Girls on the Move".

• We will support the national delivery of "Fit for Girls". This project is a joint collaboration between the Youth Sport Trust and Sportscotland and will offer training and support to key stakeholders on the barriers and potential solutions to providing access to high-quality activities for school-aged girls together with financial support for those initiating girls only projects. It will be made available in every local authority.

Dance in Schools

The YDance initiative ²² was a three year programme designed to develop and provide resources to enhance the delivery of dance education in schools. Successful pilots in Midlothian and Inverclyde in 2005 led to the programme being rolled out across Scotland with workshops and in service training delivered. The programme has been delivered in 320 schools, to over 57,600 children (aged 5-17) and over 720 primary and PE teachers.

• We will build on the successful YDance programme. The focus will be on providing dance workshops out with the school curriculum and strengthening links and pathways to local opportunity and provision in three targeted Scottish localities.
• We will continue to provide support for national delivery of Girls on the Move ²³ in partnership with the Robertson Trust. ²⁴ This is a community based programme that promotes physical activity through participation and leadership programmes and focuses on girls and young women from hard to reach groups.
• We will continue to support Scottish Sports Futures ²⁵ develop and deliver the jump2it programmes. This innovative programme uses the Scottish Rocks Basketball team to take healthy living messages directly into schools.
• We will introduce Scotland's first Cooking Bus in 2008 as a means of highlighting the importance of food and nutrition for children, teachers and communities. This will provide links to a better understanding on how food can affect health, especially in light of the changes to food provision in schools resulting from Hungry for Success and Curriculum for Excellence.

Hungry for Success

School meals in Scotland have undergone a transformation due to the Hungry for Success initiative. The Schools (Health Promotion and Nutrition) (Scotland) Act 2007 builds on Hungry for Success and will require local authorities and managers of grant-aided schools to ensure that food and drink provided in schools comply with the nutritional requirements specified by Scottish Ministers in regulations. These regulations will apply to all food that is sold or served in local authority and grant-aided schools, including tuck-shops and vending machines.

NHS Health Boards will deliver child healthy weight intervention programmes to meet the new target mentioned earlier. The essential features of the approved interventions will be that they engage children in participatory and educational sessions over a specified period of time. These sessions will offer multi-stranded support addressing dietary, physical inactivity, social and behavioural causes of weight gain and, crucially, they will engage parents and carers to create the foundations for sustainable results. NHS Health Scotland has developed guidance to establish these basic requirements and will provide further support to NHS Health Boards in planning and delivering these services.

These healthy weight services will be locally procured and there will be scope for variation in how individual NHS Health Boards choose to implement the guidance. This diversity in approach will be important in enriching our understanding of what works. It is anticipated that 20,000 children will benefit from these interventions by 2011.

Provision of broader health checks to school age children will be based on the assessed need of the most disadvantaged children in each region and the recommendations from Hall 4. ²⁶ The Scottish Government has developed proposals for a community based integrated school health team that will increase the nursing and other healthcare capacity to schools.

This model supports a multi-disciplinary approach to meeting the health challenges of school children and their families using a range of skills. Examples will be determined by the identified health needs of individual schools and may include: mental health nursing, dieticians and sexual health workers who will work in partnership with teachers and the local community to meet those needs. It aims to provide opportunities for teachers and school staff to be proactive in identifying those who are particularly vulnerable or have complex needs.

• We will support and monitor the delivery of family focused, multi-stranded childhood healthy weight intervention programmes in each NHS Health Board area.
• We will continue to support national development officers for physical activity and food based within Learning and Teaching Scotland. The posts will support schools deliver relevant Curriculum for Excellence outcomes and relevant guidance on the Schools (Health Promotion and Nutrition) (Scotland) Act 2007.
• We will develop a team, skills based approach to increase the healthcare capacity in schools beginning in our most deprived communities.

In recognition of the need to work in partnership in securing healthy environments beyond the school environment we commissioned the Scottish Consumer Council to produce guidance on commercial sponsorship in the public sector. This covers public sector settings beyond schools, and outlines the considerations and risk assessment that can help ensure that decisions on sponsorship in the wider public sector provide continuity on health improvement messages and settings.

• We will with the Scottish Consumer Council publish guidance on commercial sponsorship in the public sector.

In addition, there are a number of other areas where the public sector can help create healthier environments. Guidance for local authorities is being developed with the Association of Public Service Excellence ( APSE) and others, to capture examples of the ways that policies and practices on both food and physical activity can help contribute to better health outcomes called "Beyond the School Gate". This work will support the development and delivery of Single Outcome Agreements.

4.3 Adults and Workplaces

A great deal of daily life is spent at work, or getting to and from work. We want to work with employers and employees to maximise the opportunity to be active and to eat healthily. The Government believes that the public sector should be an exemplar in the provision of healthy choices for those who use its services and for those who work within it. We have already produced nutritional standards for schools and hospitals, and intend to support a range of programmes for the workforce to help deliver healthy eating and physical activity in workplaces.

• We will support the Scottish Centre for Healthy Working Lives ( SCHWL) in their activities to help local workforces deliver quality physical activity programmes as part of the national Healthy Working Lives Award.
• We will continue to fund the national Institute for Sport, Parks and Leisure ( ISPAL) physical activity accreditation award. The ISPAL programme uses six pre-set criteria to assess the performance of an organisation in relation to physical activity promotion in the population. To date seven organisations have gained the award and six are in progress.
• We will identify the gaps around healthy catering training with Education colleagues and with scientific advice from Food Standards Agency Scotland and NHS Health Scotland.
• We will create a role that will support the food sector to drive forward and support positive changes within industry and ensure that health objectives are integrated. Although large food businesses have the resources to reformulate (reduce fat, saturated fat, salt and sugar) products and innovate, that is not always the case for small to medium sized enterprises ( SMEs). Our aim is to work with SMEs to identify the interventions that can have the biggest impact and we will identify the best use of this resource in partnership with key partners.
• We will ensure that the NHS fully implement existing NHS Quality Improvement Scotland Clinical Standards for Food, Fluid and Nutritional Care in Hospitals, through an integrated programme supported by NHS Quality Improvement Scotland, Health Facilities Scotland and NHS Education Scotland.
• We will develop and pilot interactive tools ( e.g. through workplace intranet sites) for use in the workplace to allow employees to keep a track of any changes in their own weight and to help them understand what health consequences there may be associated with an increasing weight. The programme will prompt individuals to make those connections and provide appropriate advice.

Keep Well

The Keep Well ²⁷ programme addresses health inequalities by strengthening and enhancing primary care services in the most deprived areas of Scotland. It attempts to counter the inverse care law which recognises that those who need health care most are least likely to get it, and has a particular focus on cardiovascular disease and its contributory risk factors, including smoking, diet and physical inactivity, and alcohol. The aim is to engage those communities/individuals who have previously not made full use of the medical care available to them. People are screened to identify potential/existing health risk and offered appropriate medical treatments and referral to a range of health, local authority or voluntary agencies to support health behaviour change, designed to improve their health and prevent future ill health.

One of the programmes that we have made available to GP practices delivering Keep Well is Counterweight. ²⁸ Counterweight is an evidence-based approach to managing weight in primary care that helps obese patients achieve a healthier lifestyle and lose some weight. Counterweight is based on specialist Weight Management Advisers working across health board areas and training local dieticians and other primary care staff about obesity and the delivery of Counterweight. The programme for each patient lasts a year with continuing follow up. Since the programme started in Scotland, 1000 patients have enrolled across 62 GP practices.

• We will, in addition to supporting the roll out of Counterweight in wave 2 of Keep Well, support the roll out of Counterweight to NHS Highland, NHS Borders, NHS Forth Valley, NHS Dumfries and Galloway, NHS Western Isles, NHS Shetland and NHS Orkney from 2008.

It is also recognised that GP exercise referral schemes, if properly managed and supported, can provide an opportunity to address inequalities in healthcare and disease prevention. We wish to build on the lessons learned from Keep Well about how we support patients through their treatment programme and the intensity of that support. The Scottish Government is taking a phased approach to the promotion of physical activity in primary care, which includes advice about "exercise on referral". The first phase, which will be complete this August, is to develop material to help raise awareness of physical activity in the primary care setting which is underway. This will be followed by the identification of suitable tools that can be used to assess patients' physical activity levels which will conclude in December 2008. The final phase will focus on identifying suitable and effective interventions that can be used to get patients more active and will conclude in 2010.

• We will support the development of guidance and promotion of physical activity in primary care settings by developing material to help raise awareness and identifying suitable assessment tools by the end of 2008, and identifying suitable and effective interventions by 2010.

4.4 Older People

Good nutrition and being physically active plays a vital part in the well-being and health of older people contributing to reducing the risk or delaying disease. We will consider both the needs of free living older people and those in long term care establishments e.g. hospitals and care homes. At the same time we will support the development of skills in all physical activity-related professionals working with older people and training staff in residential care and similar settings in how to support residents to benefit from physical activity. We have commissioned research, jointly with SPARColl, to identify effective interventions to improve nutrition for older people living in the community and to map current relevant practice in Scotland.

• We will work with COSLA to develop nutritional standards for the vulnerable elderly in care settings.
• We will implement appropriate interventions based on the research.

Active for Later Life

Keeping active is acknowledged to be a key factor in maintaining health and well-being in later life. Active for Later Life aims to help all those involved in developing physical activity programmes for older people of all ages and abilities. The Active for Later Life resource provides practical guidance documents for practitioners, summaries of evidence and recommendations, policy and strategic connections, and a series of working papers that support health, social care and public service planning colleagues.

• We will support the introduction of the new British Heart Foundation/ NHS Health Scotland 'Active for Later Life' ²⁹ guidance for the physical activity workforce.

4.5 Communities

The shape and character of the communities in which we live and the ways they are connected to the places where we work and play have an undeniable impact on how much physical activity we are likely to build into our everyday lives. This in turn has consequences for the amount of contact we have with others in our communities with corollary benefits in terms of positive mental wellbeing. Opportunities for being physically active in groups and with our friends provide essential developmental lessons in early years and valuable social contact in later life.

The Foresight Report places particular emphasis on the role our physical living environment plays in affecting the choices we make in our everyday life; choices that result in almost inevitable incremental weight gain across the course of our lives. Evidence is emerging that people who live in more walkable neighbourhoods and areas with higher levels of mixed land-use are more active and have somewhat lower body weights than those in areas less conducive to walking or cycling as part of their everyday routine.

Greenspace Scotland

Greenspace Scotland ³⁰ is supported by the Scottish Government to promote the goal of everyone living and working in urban Scotland having easy access to quality green space which meets local needs and improves their quality of life by enabling delivery and embedding action within local authorities, community planning partnerships and other local delivery bodies.

We know from Scottish research ³¹ that those living in more deprived communities are more likely to report a lack of appealing outdoor environments in their neighbourhoods in which to walk or play with their families and that this also correlates with poorer self-reported health status and lower indicators of social cohesion. Further evidence is needed to understand whether there are parallel patterns linking the design of communities and the built environment with healthier food choices. However, the Foresight Report serves to highlight the potentially important foundations that more sustainable places may provide for healthier, more confident and resilient communities.

Protection and use of open spaces for recreation and sport

Scottish Planning Policy Guidance ( SPP) 11 'Physical Activity and Open Space' ³² was published in November 2007. It emphasises the importance of quality open spaces and sets out national planning policy on the provision and protection of open space within and on the edges of settlements and on sports and recreation facilities in urban and rural settings. It requires all local authorities to prepare an open space audit and strategy.

As part of our work within communities we plan to pilot Healthy Weight Community Projects in partnership with local authorities in one or more locations across Scotland. The projects are inspired by the EPODE³³ model developed in France and will be tailored to suit Scottish circumstances. The aim is to develop community-wide awareness of the importance of healthy weight and establish this as a common thread across all opportunities available in these communities to make healthier food choices and build more physical activity into everyday life. These opportunities will encompass many of the programmes and initiatives already listed here in this action plan. Local stakeholders across all sectors will be engaged to create leading examples of environments and initiatives that support healthy living and healthy weight in an interconnected and cross-sectoral way. Local leadership and a strong sense of community ownership will be central to the success of these projects.

Case Study

Ensemble, Prévenons l'Obésité des Enfants ( EPODE - 'Let's Prevent Childhood Obesity Together') - is a programme designed to tackle rising obesity levels in France. Ten towns in diverse regions across France have participated in this programme since its launch in 2004. Since then uptake of the programme has spread to additional towns in France and wider to Spain and Belgium. A variety of community initiatives involving schools, local businesses and others are delivered in these towns to improve healthy eating and physical activity awareness and habits amongst primary school aged children and their families. This programme was based on findings from two towns in Northern France where earlier community nutritional initiatives were found to have had positive impacts on children's eating habits, benefits for other family members, and an apparent freezing of childhood obesity rates while those in comparable non-participating communities rose.

• We will introduce pilot Healthy Weight Community Projects in selected locations across Scotland in partnership with Local Authorities, NHS Health Boards and other key partners.

We are committed to working within our communities to improve the opportunities to access health promoting programmes. In addition we will endeavour to work across policy areas to maximise the impact of joint initiatives for example in establishing links between Smarter Places, Smarter Choices and the Scottish Sustainable Communities Initiative. Smarter Places, Smarter Choices is a cross-Government programme that will support a number of sustainable transport demonstration towns. Scottish Government and COSLA are working in partnership with a selection of local authorities to put in place intensive programmes to reduce car dependence and increase physical activity, to improve health and create sustainable places, while reducing emissions and congestion. Activities may include personalised travel planning, development of travel plans by schools, public buildings, retail centres or work places, improvement of green spaces, road space reallocation, using public spaces to increase opportunities for recreational physical activity and the promotion of opportunities for and benefits of active travel. These projects will evaluate the impact on health outcomes.

• We will support directly the introduction of Smarter Places, Smarter Choices to support a number of sustainable travel demonstration towns.

The Scottish Government is encouraging local authorities and their partners to propose new sustainable communities as part of the solution to meeting housing requirements in their areas. The Scottish Sustainable Communities Initiative will seek proposals that are ambitious and innovative and lead to the creation of sustainable places which will serve as exemplars of good practice in planning and building in Scotland. The location, design and environmental standards of these communities will at the broadest level lead to the creation of healthier places to live, work and play.

In addition to the cross-cutting work designed to help reshape the environment we are also continuing to support a wide range of targeted programmes. These have included support for voluntary groups to encourage walking and jogging, especially in deprived areas and amongst key target groups such as teenage girls.

Paths to Health

Paths to Health ³⁴ is a leading delivery agent for the physical activity strategy whose aim is to develop local walking schemes. Since we began our support of Paths to Health over 200 community based schemes have been supported, over two thirds of which are located in deprived areas, with 1,700 Walk Leaders trained to lead walks in communities and up to 20,000 people participating in led walks every week.

• We will continue to support Paths to Health to develop local schemes in key settings including communities with a focus on disadvantaged areas, as well as workplaces, as an option for onward referral from primary care and in schools through the support and development of their volunteer network.
• We will provide support to JogScotland ³⁵ to develop jogging groups in three key settings: workplaces, communities, and with children and young people.
• We will support Living Streets ³⁶ to continue to campaign for environments conducive to physical activity and to take forward a number of key programmes including practical support for implementation of recent National Institute for Clinical Excellence ( NICE) guidance on physical activity and the environment, ³⁷ national walkability audits and development of a community empowerment toolkit.
• Green Gym

The BTCV³⁸ Green Gym ^® is a scheme that inspires participants to improve their health and the environment at the same time. It offers them the opportunity to 'work out' in the open air through local, practical environmental or gardening work. The Green Gym has: involved approximately 10,000 volunteers in improving over 2,500 green spaces. There are now 95 Green Gyms across the UK with 17 in Scotland.

• We will support the expansion of the BTCV led "Green Gyms" programme across Scotland to increase the number to 56 by 2012.

The Scottish Government is working with a range of stakeholders in the public, private and third sectors to improve access to and take-up of affordable healthier food options, helping to drive forward long-term changes towards a healthier Scottish food culture to the mutual health and economic benefit of suppliers, manufacturers, retailers and consumers.

Scottish Grocers Federation Healthyliving Programme

The Scottish Grocers Federation Healthyliving Programme ³⁹ is improving the supply and provision of healthier food choices, focusing on fresh produce, in local neighbourhood shops particularly in low income areas. Participating stores have registered an average increase in sales of fresh fruit and vegetables of between 20% and 30% since the start of the programme which now boasts 500 stores representing around 1 million transactions per week.

Healthyliving Award

The Healthyliving Award ⁴⁰ is a national award that encourages the food service industry to deliver healthier food across the range of provision. It is run by the Scottish Consumer Council. ⁴¹ The Award recognises and rewards caterers who reduce the amount of fat, salt and sugar in food they provide and make healthy options more easily available. Launched in August 2006 over 300 sites across Scotland have won the award, with around 270,000 customers eating in Healthyliving establishments every day.

• We will with the Scottish Consumer Council, develop a new higher level (Gold) Healthyliving Award for public sector workplaces to ensure an increased range of healthier choices.
• We will work with Community Food and Health (Scotland) to identify activities and opportunities for joined up working across Scotland's community food initiatives, to explore opportunities for improving food supply chain development, achieving better economies of scale and encouraging the sharing of expertise from the wider food sector.