Reducing health harms of foods high in fat, sugar, or salt: consultation analysis

Executive Summary 

Introduction

1. From 2^nd October 2018 to 9^th January 2019, the Scottish Government undertook a public consultation to invite views on its proposed approach for restricting the promotion and marketing of targeted foods that are high in fat, sugar or salt (HFSS) where they are sold to the public.^[1] 

2. The aim of the consultation was to gain some sense of the balance of opinion among respondents towards the proposals, whilst also attempting to come to a clear realisation about the breadth and detail of arguments put forward both for and against the proposals. It should be noted that respondents to the consultation are a self-selecting group and their views cannot be claimed to be representative of the wider population.

The respondents

3. The consultation received 728 responses, including one duplicate and one blank response. Of the 726 responses analysed, 632 were from individuals (87%) and 94 were from organisations (13%) – comprising 55 (59%) from non-industry organisations (public sector, third sector and other) and 39 (41%) from industry organisations (manufacturers, industry representative bodies, retailers and Out of Home sector). 

Overview of findings

4. In general, there was support for the aim to reduce the public health harms associated with the excessive consumption of calories, fat, sugar and salt and diet-related conditions. However, views were mixed as to whether the restrictions proposed were the most appropriate way to achieve this.

5. Across the consultation, distinct viewpoints emerged by respondent type. Many respondents from non-industry organisations felt the proposed approach was necessary in light of the scale of the public health challenge, purchasing patterns and the shortcomings of other approaches. However, some thought the approach did not go far enough: that it should encompass more types of HFSS foods, more types of promotions and not permit exemptions. It was suggested that the approach should be undertaken in combination with other approaches to educate and encourage healthier eating and lifestyles and should not widen health inequalities particularly in regard to those on a low income.

6. Many respondents from industry either disagreed with the approach or did not indicate a specific view but raised concerns and suggested alternative approaches. In effect, support for the specific proposals, where they were restrictive, was low and, where they were not restrictive or allowed exemptions, was higher. Key concerns from industry organisation respondents included: (i) the potential negative impact on businesses generally and specifically on smaller and specialist businesses that may be disproportionately disadvantaged; (ii) concern about conflict with and the undermining of a number of existing approaches and requirements (such as reformulation), and (iii) a view that other approaches to better inform customers of the contents of HFSS foods and nudge them towards healthier choices might be more effective than the proposed restrictions.

7. Individual respondents were fairly split in their view. Support for the approach was more common overall, generally acknowledging the problem of obesity in Scotland and that the proposed restrictions would reduce the likelihood of people buying and consuming excessive amounts of unhealthy foods. However some disagreement was also present across the questions. The most common reason individuals disagreed was due to a view that restrictions of this nature imposed by the Scottish Government affect democratic freedom of choice for the public and it was felt it was inappropriate for a Government to act in this way.

Headline findings for each question group

Whether to introduce mandatory measures to restrict promotion and marketing of discretionary foods (Question 1)

8. Most respondents from non-industry organisations (over four-fifths) and over half of the individuals agreed with the introduction of mandatory measures. Those in agreement generally acknowledged (i) the problem of obesity in Scotland, (ii) the link between promotions and sales, (iii) the idea that the proposed approach would reduce the likelihood of individuals buying and consuming excessive amounts of unhealthy foods, and (iv) the limitation of other approaches such as relying on voluntary approaches by industry or improving education levels among the population.

9. Nearly half of the respondents from industry organisations and over a third of individuals disagreed with the introduction of mandatory measures. Concerns included: (i) a potential negative impact on businesses, (ii) a lack of evidence regarding the effectiveness of legislation to restrict food and drink promotions, (iii) that alternatives may be more appropriate such as promoting healthier options or educating the population on healthy lifestyles, and (iv) a belief – particularly among individuals that citizens should have unrestricted control/choice of the purchases that they make and that the proposed restrictions would deny this.

Identifying categories of food and drink to target (Questions 2-4)

10. Views were wide-ranging on which food categories to target. A fifth of organisations and a quarter of individuals agreed with targeting ‘discretionary’ foods predominantly on the basis that the proposals focused on foods that lack nutritional benefits and are therefore most relevant to target. More than a quarter of organisations and nearly a third of individuals felt that there are ‘additional categories that should be targeted’. Reasons included: (i) while a focus on discretionary foods was good, it was not sufficient given the scale of the public health issues, and (ii) the categorising of foods as discretionary or non-discretionary was arbitrary and could provide potential loopholes. Over a tenth of organisations and nearly a third of individuals indicated that ‘no foods should be targeted’ predominantly due to disagreement with the proposal to introduce mandatory measures altogether.

11. Non-industry organisations were generally in favour (three-fifths) of ice-cream and dairy desserts being included among the foods targeted. Industry respondents tended not to express a specific view (over two-fifths), but where they did they were generally against their inclusion (a third). More individuals were against (nearly half) than in favour (over two-fifths). Reasons for support (across respondent types) included: (i) these foods are HFSS, and (ii) these foods are discretionary in the sense that they are not essential to a healthy diet. Reasons against targeting these foods included: (i) they have some nutritional value, and (ii) they are more likely to be eaten as part of a meal rather than as a snack. 

12. Non-industry organisations were generally more supportive of the overall approach to defining categories (two-thirds) than industry, who tended not to express a specific view (close to half), but where they did they would generally indicate disagreement (over a quarter). Individuals more commonly indicated disagreement (close to half) than agreement (nearly a third). Respondents that agreed tended to simply state that they agreed or that the approach was sensible or reasonable. Concerns, generally from industry, included: (i) it was difficult to categorise products in the way outlined and the approach was too complex, (ii) there was a need for an expert technical group to identify which foods are subject to regulation, and (iii) there were potential alternative methods for categorisation – such as defining specific levels of fat, sugar and salt to determine inclusion/exclusion. Three-quarters of individuals who disagreed did so based on their position against mandatory measures.

Forms of promotion and marketing to be restricted (Questions 5-6)

13. In respect of the proposals to restrict multi-buys and unlimited amounts for a fixed charge, respondents from non-industry organisations generally agreed (over two-thirds). Industry organisations tended to not express a specific view (over two-fifths), but where they did, more commonly agreed (close to a third) than disagreed (just over a fifth). Individuals were very closely split between agreement (close to half) and disagreement (over two-fifths).

14. In respect of the proposals to not restrict temporary price promotion and not restrict multi-packs, non-industry respondents were more split between agreement (over a quarter for temporary price promotions and a third for multi-packs) and disagreement (over a third). Non-industry views diverged on whether to have a ‘blanket approach’ and avoid exemptions being used as a ‘loophole’ or to allow appropriate exemptions. Close to half of the industry respondents agreed, but similar numbers (over two-fifths) did not give a tick box response. Individuals typically agreed (over half) with the proposals.

15. Reasons for indicating these four promotion types should be restricted included: (i) that these promotions are designed to encourage purchase beyond what is needed, and (ii) that they encourage overconsumption as once bought they are more likely to be consumed in addition to what is needed. Reasons for indicating that these promotion types should not be restricted included: (i) they may be shared among a number of people, (ii) do not necessarily result in overconsumption, (iii) enable people to buy in bulk which aids budgeting, and (iv) offer savings that are needed for those on a low income.

16. When asked for views on the approach to restricting other forms of promotion and marketing, respondents from non-industry organisations generally indicated agreement with the approach (close to three-quarters), while industry tended to either indicate disagreement (half) or not offer a specific view (close to a third) on the approach. Individuals were more likely to indicate agreement with the approach (over two-fifths) than they were to indicate disagreement (over a third). Respondents in favour generally stated that they agreed or thought the approach was sensible or reasonable. Among those who indicated disagreement, reasons included: (i) the approach would not be effective as people would still not know how to make healthier choices, how to cook healthy foods and how to live a healthier lifestyle, (ii) the proposed restrictions may disproportionately affect smaller businesses, which are more likely to use in-store promotion than other forms of marketing, and (iii) that small stores would struggle to implement changes in the approach due to the limitations of existing space/layout.

Places the restrictions would apply (Questions 7-8)

17. Respondents from non-industry (over two-thirds), industry (over two-fifths) and individuals (over half) generally agreed that, if regulations were to be introduced, restrictions should apply to any place where targeted foods are sold to the public, except where this is not in the course of business. Agreement centered on the view that to be effective, the restrictions should apply equally, with some industry respondents voicing that there should be a ‘level playing field’. Among those against, concerns were raised about small independent and specialist shops that may struggle to comply with requirements.

18. Where respondents were asked to comment on whether and to what extent restrictions should be applied online, most respondents from non-industry (more than four-fifths) and industry (more than three-quarters) indicated a view that, if implemented, restrictions should be mirrored online. However, individual respondents were very evenly split between agreement and disagreement (each at over two-fifths) with online restrictions. Reasons for agreement with applying restrictions online focused on the need for consistency between the physical and online environment. Disagreement was predominantly based on overall disagreement with introducing mandatory measures, and to a lesser extent concern was expressed about how online restrictions could be enforced.

Exemptions to restrictions (Questions 9-11)

19. The consultation invited comment on a number of possible exemptions to restrictions: (i) positioning restrictions (in relation to display at end of aisle, checkouts etc.) when there is no reasonable alternative to displaying foods elsewhere, (ii) close to expiry food exemptions (in order to prevent food waste), and (iii) whether any other exemptions to restrictions should be considered.  Non-industry organisations were relatively split regarding the suggested exemptions to restrictions; while the logic for the exemptions was acknowledged by some, others felt exemptions would create loopholes that may undermine the policy. Industry were generally in agreement with exemptions,^[2] highlighting their relevance: (i) to take account of the practicalities of store operations, and (ii) if restrictions on close to expiry food were put in place, they would undermine other schemes to reduce food and drink waste. Individuals were split in their views on exemptions although overall more agreed than disagreed.

20. Suggestions for other exemptions included: small businesses, seasonal stock, items for special dietary needs, local products, items beneficial for controlling medical issues and specialist shops.

Enforcement and implementation (Question 12)

21. Respondents from non-industry organisations generally indicated agreement (over four-fifths) with the proposals for enforcement of restrictions, typically acknowledging that the local authority already has appropriate knowledge, legal status and relationships with businesses to enable enforcement. Industry generally did not give an overall indication (more than two-fifths) or indicated agreement (over a third). Overall more individual respondents indicated disagreement (two-fifths) than agreement (close to a third). Respondents indicating disagreement expressed a number of views that included: (i) belief that other organisations would be better suited to enforce restrictions, (ii) local authorities are already overstretched, and (iii) general disagreement on the basis of their overall stance against mandatory restrictions.

22. Overall, on the subject of enforcement, respondents expressed a number of views that included: (i) concern about the potential burden that enforcement would place on local authority teams and suggestions that separate funding would be required for this function, (ii) concern that sufficient lead-in time would be needed to implement the changes, and (iii) concern about the use of penalties as described.

Legislative framework (Question 13)

23. Most non-industry organisation respondents (over four-fifths) and close to half of individuals indicated agreement with the flexible approach to legislation, most of which did not further clarify their reasoning. Close to half of the industry organisations indicated disagreement with the approach or gave no overall indication (over a third). Among industry organisations concern was expressed that: (i) allowing revisions to the approach via secondary legislation would lack the democratic scrutiny that primary legislation is subject to, and (ii) that it would be unfair to businesses to have to keep making changes as requirements are changed. 

24. In general, there were a few respondents (individuals and organisations) who felt that the proposals for legislation were relatively vague and that they would need more detail on what the legislation would look like to be able to comment fully.

Impact and support (Questions 14-16)

25. Respondents from industry organisations generally noted that the introduction of the proposed measures would have a significant impact on the way the industry operates, and that they are coming at an exceptionally challenging time for the industry. A number of concerns were raised including: (i) negative impact on turnover and possible redundancies, (ii) impeding the introduction of new products to the market, (iii) costs attributable to a lack of a joined up approach across the UK for example holding dual stock, (iv) costs attributable to making the changes needed to comply with restrictions, (v) competitive disadvantage for smaller businesses that rely on the types of promotions included in the proposed restrictions, (vi) competitive disadvantage for Scottish businesses, and (vii) reduced incentive to reformulate products.

26. In respect of the support needed by organisations to implement the restrictions effectively, organisations highlighted a number of considerations including: (i) the importance of ensuring that industry and the public understand the need to implement change, (ii) guidance being needed (and a training and awareness programme being beneficial), (iii) small independent businesses are likely to find implementing changes more challenging and therefore resources should focus on them, and (iv) in addition to the dissemination of resources to Scottish manufacturers and retailers, resources would need to be disseminated to food and drink manufacturers across the UK who supply to Scotland.

27. In relation to how the restrictions would impact the people of Scotland with respect to the determinants of health inequalities, there was recognition among individuals and non-industry organisations of potential positive impacts on health. However, many respondents, across all respondent types, reported potential negative impacts. While various concerns were raised^[3], the restrictions were generally perceived to have the greatest potential impact on people who were already socio-economically disadvantaged. This was on the basis that the impact of the restrictions would be that discretionary foods become more expensive, and since those on a low income are more likely to rely on these promotions as a cheap way of meeting their calorie needs, their food costs would increase. Suggestions to mitigate this centered on education in relation to healthy low-cost eating, and reducing the costs of healthier foods.