Health inequalities in Scotland are not new. They have been a significant issue for decades but it is in the last few years in particular that we’ve seen a further worsening of the gradient between the most and least deprived. Progress on life expectancy has been made but this has now been interrupted by austerity, with life expectancy stalling, along with a widening gap in healthy life expectancy between our most and least deprived communities. The pandemic has made matters worse and the current cost of living crisis will only add to this.
One of the main determinants of a healthy population is a healthy diet. Healthy food is something we all have a right to and something we all need but unfortunately, we are not all able to access this equally. Significant inequalities exist with regards to the affordability and availability of healthy food, which has been exacerbated by both the Covid-19 pandemic and the cost of living crisis.
Inflationary pressure on food is rising with some staple foods increasing in price by more than 13% in the year to August 2022 – milk, cheese and eggs have seen the largest increases, with prices of less healthy options rising less sharply. Data from The Food Foundation shows that that the average cost of healthy food is £8.51 per 1,000kcal, compared to £3.25 for less healthy foods, and over the last year, healthier foods have increased in price by twice as much as less healthy foods. When broken down by EatWell Guide food categories, fruit and vegetables are the most expensive category by a significant margin at £10.56 per 1,000 kcal, compared to an average of just £4.50 per 1,000 kcal in discretionary high fat, salt and sugar (HFSS) products.
This inflationary pressure is not experienced equally and is contributing to a worsening of inequality between the most and least well off in our society. The poorest fifth of households in the UK would need to spend almost half – 47% – of their disposable income on food to meet the EatWell recommendations for a healthy diet, compared to just 11% for the richest fifth. This is only likely to get worse as the cost of living crisis deepens.
What does this mean for health and healthy weight outcomes?
Scotland continues to face a significant challenge from overweight and obesity, with just under two-thirds of adults having overweight and obesity, and 29% of children at risk of developing overweight and obesity. This is clearly patterned by deprivation, with the most deprived significantly more likely to have overweight and obesity than the least deprived. For children, the trend is no different, with clear evidence of persistent and worsening inequalities – 24% of the most deprived children are at risk of developing obesity, compared to only 9% of the least deprived.
The full impact of the pandemic and the cost of living crisis on obesity is not yet fully known but indications from post-pandemic surveys shows there has been an impact on health determinants. At OAS, we were keen to better understand this impact on food consumption behaviours and so commissioned a poll to find out. This polling was carried out in May 2020 and repeated again in March 2021 to monitor the ongoing impact of the pandemic on consumption patterns.
The results indicate there has been a clear shift in eating patterns. More than half (52%) of participants reported they ate more out of boredom since the start of the pandemic, with large increases in consumption of takeaways, sugary foods, and ready meals, and this was particularly pronounced in households with children.
The health consequences associated with obesity are well evidenced and include a range of non-communicable diseases and increased Covid-19 severity. In a recently published report, from University of Glasgow and Glasgow Centre for Population Health (GCPH), obesity has been identified as a potential contributing factor to the recently seen stalling in life expectancy.
Addressing inequality and delivering an affordable healthy diet for all
Action needs to be focused on population level public health interventions which help to address the underlying causes of these inequalities. One of these interventions is to restrict price and location promotions of HFSS products, which was recently consulted on by the Scottish Government.
Such measures have been criticised by the food industry as being inappropriate during a cost of living crisis, arguing they will increase food costs for individuals and families. However, evidence shows this is clearly not the case. Promotions encourage increased spending and consumption. Research from the Money Advice Service has shown that price promotions cause individuals to spend an average of £1,300 per year more than they intended, and consumers on average purchase around 20% more. The majority of promotions are also on unhealthy, HFSS products. Crucially, restrictions on promotions have to be introduced alongside actions that make healthier food more affordable – with promotions targeted at healthy and staple foods.
We believe good health is undoubtedly something we shouldn’t compromise on, regardless of the circumstances. Encouragingly, this is something many people in Scotland appear to agree on. We conducted polling with a sample of over 1,000 adults in Scotland in August this year on public policy interventions designed to help more people in Scotland to access and afford healthy food. The polling found high levels of support across all interventions. Most notably, 87% supported interventions to ensure special offers and promotions are applied to healthy foods and everyday essentials.
This year’s Scottish Government Programme for Government outlined a commitment to introduce a Public Health (Restriction of Price Promotions) Bill by the end of this parliamentary year. Regulation of price and location promotions of HFSS products is urgently required to rebalance the food environment to one which promotes and prioritises healthy, affordable food for all.
Jennifer Forsyth, Policy and Evidence Manager, Obesity Action Scotland