4. Good food for healthy and flourishing communities

Whilst farming, growing and countryside matters might seem distant to urban dwellers, everyone eats food. What we eat, how we eat, and where our food comes from generates heated debate, particularly when it comes to our health and wellbeing.

The issues we want to tackle

One of the intractable issues at the intersection of food, farming and the public’s health, is that the rapid increase in diet-related ill health is a result of over-consumption of calories, largely from food of poor nutritional quality. We live in an obesogenic environment: one which encourages us, through marketing and promotion, to buy and eat more than necessary. Many of these calories come from the sorts of food which sector specialists call ‘value added’. It may be time to ask the question: “value added for whom?”

This requires leadership as well as a step change in thinking. Currently, we are ramping up production by growing ever more commodities in more specialised systems to provide low cost components for a global processing system. Instead, we should focus on changing both the methods of production and our patterns of consumption.

Type 2 diabetes — almost entirely diet-related — costs the NHS £12 billion a year, with a further £15 billion (for all types of diabetes) due to absenteeism, early retirement and benefits. And it costs individuals their health, wellbeing and even their limbs. How food is produced also affects our health. Certain forms of livestock production pollute water, air, and increase antimicrobial resistance, one of the biggest risks facing the planet. Our food system is a major contributor to greenhouse gas emissions, and agro-chemicals can cause illness and disease.

These negative impacts of food production and consumption are unequally distributed throughout society.

Today there are an estimated 8.4m people in the UK who can’t afford to buy enough nutritious food, and there has been a dramatic rise in the UK of emergency food banks in the last few years, as well as gradual rise in malnutrition and obesity — all of which hits the poorest in society the hardest:

“Obesity prevalence for children living in the most deprived areas was more than double that of those living in the least deprived areas.” Source

“A boy born in one of the most advantaged 20 percent of neighbourhoods in 2015 can now expect to outlive his counterpart, born in one of the least advantaged 20 percent of neighbourhoods, by 8.4 years.” Source

It is widely acknowledged that social and economic circumstances (including income, education, employment, housing and early childhood development) have a huge influence on health outcomes. The picture is getting worse. Around 4 million adults in the UK struggle to put food on the table. Around 10 percent of children in the UK are living in households affected by severe food insecurity.

“Routine practice is to sanction people and signpost to the food bank at the same time. It’s outrageous. That is the state imposing hunger. It is a public health issue. We get people in temporary accommodation with no cooking facilities. We have kettles we give out, can openers. We’ll reach more people by doing this at food banks and social eating clubs.” Community Worker, Derbyshire.

Why this has been so intractable

These issues derive from another false assumption: that the way to deal with poverty and inequality is to promote unhealthy food to the poorest parts of our society through the chimera of ‘affordability’.

This is one of the most problematic consequences of our generation’s modern food system: in an under-scrutinised food and farming system, businesses can profit while damaging people and planet, with the most vulnerable bearing the brunt. This cannot be remedied by relying on constrained consumer choice: governments and businesses together must take responsibility for making sure that minimum standards are not only met, but that the bar is raised.

“My uncle took a load of lambs to market, sold them and bought a tractor; these days that wouldn’t be possible. The price of everything has gone up, except for food. This is what triggers off an unhealthy nation — people expect cheap food and find it everywhere. Only it’s rubbish food.” Sheep Farmer, Denbighshire

This is more than just a moral and healthcare crisis: it is an industrial crisis. As the UK’s largest industry, the food and drink sector is not only responsible for this situation but also exposed to its consequences, for example through days lost to work and reduced productivity. These problems are exacerbated by a low wage food and farming system. Research shows that low paid workers in the four big supermarkets (Tesco, Asda, Sainsbury’s and Morrisons) require the taxpayer to top up wages by around £1 billion a year in tax credits and extra benefits payments.

Towards more comprehensive solutions

Our proposals look at some ways to intervene now, but we are also suggesting more fundamental methods of providing incentives for a system of farming for health.

Similarly to the sugar tax, taxes on other ingredients could encourage healthier and more sustainable behaviour by the public and businesses, and taxes on certain inputs in food production, such as a nitrogen fertiliser, may help to recoup some of the hidden costs of the food production system. These proposals require the public’s health to be placed at the centre of the UK’s industrial strategy for farming, food and drink.

Next Steps

Invest in social prescribing and green care

In another illustration of the false choices that limit us, debates about whether the public’s health and wellbeing are best led from the NHS, or from local government, or from other service providers often get stuck in the scarcity mindset. ‘Social prescriptions’ which guarantee access to schemes for better health and wellbeing, can range from exercise and healthy eating support, to access to green care and intergenerational befriending schemes.

It is encouraging to see support for social prescribing in the £4.5m pledge towards social prescribing schemes such as gardening or arts clubs made by the health secretary Matt Hancock in July 2018, is welcome, though more can still be done. But we know doctors are already overwhelmed, and we’re not suggesting medicalising social needs. Instead, the role of health and wellbeing services can be to support citizens and their communities to discover and mobilise community assets which benefit them; this makes doctors ‘participation advocates’ who collaborate with patients rather than simply prescribing medicine and social activities.

This kind of work can be done through other professions; community pharmacists, or ‘health champions’, an idea in GP practices which began in Yorkshire and has now spread nationwide, or by utilising the community pharmacist networks.

“Supporting people to create pathways towards a good life is not about prescriptions or referrals, it is about walking alongside people in their life’s journey. A doctor can’t do that alone, but they can advocate for greater participation and ensure that social issues are not medicalised, and community efforts are not devalued.” Source

Forest schools, and similar programmes, are important vehicles to connect children and young people with green space. Farmers, themselves can and should also be more directly involved in green care. The Let Nature Feed Your Senses (LNFYS) project and the growth in care farming has captured huge enthusiasm from both farmers and the thousands of people who have benefitted from access to the countryside and farming. An evaluation of the project showed that farmers who had participated felt appreciated by non-farming people as doing something positive for society. Care farming (a broad category of therapeutic activities in the outdoors), farm visits like LEAF’s ‘Open Farm Sunday’, but also direct sales, break out of this disconnected model and give producers a direct connection with the positive impacts of what they do for other people, helping them to feel more valued.

“She told me before she came she was planning on taking her own life. She told me this garden literally saved her.” Care Farm, Norfolk.

Finally, the benefits of being in nature and the countryside requires green spaces to be easier to reach by public transport, so that more people can benefit. Extending green corridors into towns and cities brings the countryside closer to where more people are. The countryside is integral to Britain’s sense of identity. It must be easily accessible to more of us.

Broaden membership of industry bodies to include representatives of the ‘health community’

One example of how an apparently simple change could have far-reaching effects, is to increase transparency and public participation in the food value chain. For instance, bringing public interest representatives onto the Food and Drink Sector Council, first announced in the government’s Industrial Strategy white paper should include people from health, consumer and environmental groups. This will enable public health bodies to be involved in the transformation in food manufacturing, retail and catering needed to meet public health objectives, backed up by a clear regulatory timetable. Alongside a ten-year plan for more sustainable agricultural systems, progressive improvements in food standards in parallel, over a ten-year period, allows businesses and investors time to adjust in step, ensure that ‘hidden’ costs are fairly and equitably accounted for, without pushing up the price of food too quickly. The industry must change shape and the Council should lead that change.

Incentivise farming for health

This means recognising and promoting the relationship between food, farming, nutrition, health and wellbeing. It means ‘farming for health’ in the wider sense of the word, rather than over-supplying a food system with cheap calories and all its associated health and environmental impacts.

In this complex territory, there are many potential routes to beneficial impacts. We could incentivise ecologically intensive production systems like agroforestry, and fruit and vegetable production, though this alone will not solve the problem of diet related ill-health. We could look at the other ways of stimulating the market — for example with procurement contracts that stipulate that UK fruit and vegetables should be sourced. But more fruits and vegetables are far from enough in a food supply system that is overloaded with calories.

“£2.50 for a three-course meal, 50p for kids: liver and onions, mushroom soup, chicken dinner, lamb roast, veg curry. We call it ‘good food’ not ‘healthy food’ — which puts people off. Getting a meal is more important than the nutritional value, and hunger is a serious issue around here.” Community Worker, Derbyshire

What is needed is a ‘whole food chain’ approach to driving out excessive calorie consumption, particularly in the form of sugar and highly processed foods and reducing meat and dairy consumption. Current strategies, using nudges or conditional approaches to get processors and supermarkets, to take more responsibility for their impact on the public’s health (as we suggest above) may still work, but more substantial drivers may yet be needed to move at pace. Another possibility might be to mobilise shareholder action through pension funds and investors, who are now turning their attention towards their power to drive change within the food system, by supporting initiatives such as FAIRR.

The relationship between food, nutrition, health and wellbeing — across all kinds of social spaces — has to find a new standing in these debates. As we’ve said elsewhere, when we frame people as consumers, and reduce everything to choices made on price, we neglect the social and cultural aspects of a thriving and healthy food system. Commentators as diverse as food activist Michael Pollan, poet Darren McGarvey and chef Tom Hunt argue that the social role that food plays in our lives is being eroded and lost. We know that buying local food has a positive multiplier effect in rural economies. We know provenance also matters to people — it’s why supermarkets have been known to use faux farm names to brand their groceries. Asking better questions about where our food comes from, and how it gets to be on our plates, reveals much more clearly the hidden impacts that the food systems plays in our lives. This otherwise neglected dimension must be folded into this debate.

“In recruiting members, we always thought that people would join for the veg boxes. But when we surveyed our members we found that people actually value the social aspects and opportunities to be outdoors more. This is what our members value most.” Community Farmer, Essex

So, as citizens, we have wider interests at stake than price alone. As citizens we have a right to ask questions about the role that food could and should play in our health and wellbeing — in schools, hospitals and public institutions, as well as all the social settings which are essential to a flourishing society — the restaurants, cafes, pubs and times at home, where people gather over food. When government is also addressing the problem of loneliness and isolation — in urban as well as rural settings — it is time to ask whether the increased atomisation and individuation of social spaces (the meals for one, the bedsits, the increasing attachment to pastimes which requires no actual human contact) are good for us. We realise that this is not simple or easy, so it makes no sense to be prescriptive — but it means opening up this debate, setting a broader context for policy and putting more resources into successful ideas that are already working. In the next stage of our work, we will be inviting participation from people from across this system, to help us frame the right research to address this.