Food for thought: how the UK food strategy is trying to revolutionise the way we think about and access food

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Research has shown that healthy food choices are three times more expensive than unhealthy ones, food bank use is at it highest ever level and the NHS is anticipating significant struggles in long term treatment of people with conditions linked to obesity and unhealthy lifestyles, like cancer, diabetes and heart disease.

A forecast published in a report by the Food Foundation showed that if we continue at our current rate and type of food consumption 22% of children born in 2020 will be overweight or obese by age 5, rising to 46% by the time they reach age 21.

But the impact doesn’t stop there. The food system – agriculture, food production, distribution and retail combined – releases more greenhouse gases than any other sector apart from energy. In the UK, the food system accounts for a fifth of domestic emissions – but that figure rises to around 30% if we factor in the emissions produced by all the food we import.

The food we eat – and the way we produce it – is doing damage to both the environment and our health and the government is now trying to take steps to mitigate the damage, and improve our health and wellbeing in the process through the roll out of a national food strategy.

Fixing a broken system

Figures from the Trussell Trust show that between April 2020 and March 2021, a record 2.5 million emergency food parcels were given to people in crisis. The increasing use of foodbanks shows just how deeply entwined inequality, food and health are, and how important it is for a robust and equitable food strategy to be rolled out.

The Broken Plate 2021 report from the Food foundation provides an overview of the food system in the UK, looking across four main themes:

  • making healthier options more appealing;
  • making healthier options more affordable;
  • making healthier and more sustainable options more available; and
  • addressing inequalities in food so that everyone can have the chance to live longer, healthier lives.

In July 2021 the UK government published a review into how the food system in the UK works and the interventions that could be brought in to prevent the harms from what we eat and the way we eat. The plan sets out recommendations and a strategy for the future which focuses on food being equitable, accessible, healthier, and sustainable.

The recommendations cover a number of key themes:

  • escape the “junk food cycle”, including introducing a Salt and Sugar Reformulation Tax;
  • reduce diet-related inequality, including extending eligibility for free school meals;
  • make the best use of our land – including guaranteeing agricultural payments to help farmers transition to more sustainable land use; and
  • create a long term shift in food culture, including the development of a robust system of data collection and reporting to help monitor long term progress.

Inequality exacerbated by unequal access to food

One of the most pressing issues around food is its availability and its ability to exacerbate existing inequalities, particularly among disadvantaged groups. We have already seen that food bank use is high (disproportionately so among lower income groups) and that eating healthier food is more expensive than unhealthy food.

The shelf life of more unhealthy and highly processed food is also often longer, so it is easier to store, and food can be spread out and eaten across multiple days more easily. Processed foods, which are often higher in sugar, salt and trans fats (unhealthy fats) also often require less cooking (both in terms of heat energy required to cook them and knowledge of how to prepare them) which for people with reduced access to kitchens, experience of fuel poverty or limited knowledge of preparing food can be more convenient. Research consistently shows that people who fall into these groups are significantly more likely to come from lower socioeconomic backgrounds and have experience of poverty.

Steps are being taken to try and improve access to healthier food for people living on lower incomes, including free school meals and (with a bit of persuasion from Marcus Rashford) a wider roll out to also offer meals during school holidays. The government also runs a voucher system for new parents to help them get access to fresh food like fruit and vegetables.

More recently there has also been discussion about the roll out of “food on prescription” services, both for those people on lower incomes and for those people who are at risk of medical complications or disease as a result of being overweight or obese.

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Sustainable as well as healthy

As has been made clear in the reports, food systems don’t just impact on us as individuals, they also have a significant impact on the environment. The changing climate is at the forefront of everyone’s mind, including multiple extreme weather events, the publication of an IPCC report on climate change, and the run up to COP26, due to be held in Glasgow. So the way we grow and process our food, and how this negatively impacts our environment is coming under greater scrutiny.

Currently, many practices are having a negative and detrimental impact on our environment across a number of areas including carbon emissions, water pollution, reduction in soil health, loss of biodiversity, land use/deforestation.

And commentators are now emphasising that our food system as well as being healthy and accessible should also be sustainable, with programmes developed to reduce food waste, support community-based agriculture schemes, help farmers to transition to more sustainable ways to farm and use land and stimulate demand for in season, sustainably grown, locally sourced food.

Final Thoughts

Food, and our relationship with it is becoming increasingly important, not only for our own personal health and wellbeing, but also for the health of communities more generally, and the health of our planet.

Sustainable, healthy and equitable food systems help to promote healthier choices and reduce our impact on the planet. And food can also play its part in helping to relieve other pressures on society, like food poverty, inequality and the rising use of food banks. Food on prescription services can help support people to make better choices and reduce the risk of diseases like cancer, heart disease, stroke and obesity.

In short, food is not just vital for life, but also for living well.


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Creating sustainability in health and social care

The question of the sustainability of funding for health and social care services has been in the spotlight recently. The Conservative Party manifesto contained proposals around making individuals pay for more of their social care costs, to deal with the “challenges of an ageing society”. Meanwhile, figures suggest that NHS Trusts in England overspent by £770m last year despite a focus on efficiency savings.

However, creating and maintaining sustainability in health and social care is much broader than financial sustainability. It means considering other factors, including environmental, training and project management issues. This takes planning, commitment and an understanding of the aims and expectations of staff and senior management.

A research symposium earlier this year (hosted by Healthcare Improvement Scotland and partners) explored these issues further, looking at the evidence underpinning ways to create sustainable health and care systems.

Environmental sustainability

Environmental sustainability is something which all organisations are being asked to address and improve. The issue of climate change has led to a focus on behaviour change and a more sustainable use of resources.

  • Buildings – This includes the planning of new healthcare buildings, as well as adaptations to existing structures to make them more energy-efficient. Alternative building materials and designs have been used in new projects to improve energy efficiency, with some buildings even incorporating wind turbines, solar panels and geothermal capture centres. Reducing waste water and improving temperature regulation through heat capture and insulation techniques are also being adopted. While these may be costly initial spends for many, the long-term cost savings are also significant, as well as ensuring that the buildings meet minimum national requirements for energy efficiency and contribute to emissions reduction targets.
  • Resource, waste and recycling management – In many offices and clinical centres, individuals are encouraged to be personally responsible for their own reduction in waste and improved use of recycling facilities; however, this must also be facilitated at an organisational level. Clearly labelled recycling bins, promoting reduction in of the use of disposable water and coffee cups, and encouraging employees to use less paper when report writing (printing double sided for example, or going paperless where possible) are all simple ways in which environmental sustainability can be promoted in health and social care settings. Innovative techniques such as reusing water in internal plumbing, or creating bespoke recycling facilities to help reduce the amount of clinical waste incinerated, are being developed.
  • Remote monitoring and the use of technology – There have been major advances in the use of remote technology to host meetings, video-conferences, follow up appointments and assessments for those in receipt of reablement care via tele-health. Remote monitoring of patients, as well as the use of tele-health and other digital platforms can allow consultations and routine check-ups to take place without either party having to leave the house or office, thereby reducing vehicle emissions used in transport. In social care, remote meetings and cloud-based reporting can allow front-line social workers to remain out on visits instead of having to return to the office to fill out reports, again reducing vehicle emissions.

Sustainable resource management

In the face of more limited funding, joint working between health and social care is being heralded as a new way of cost saving, making the most of ever-depleting resources in the face of ever-greater demands. Being efficient with resources, through effective planning and management is one of the key ways to ensure resource sustainability in the long term, especially for the NHS and local authority social care teams.

Approaches include:

  • Making full use of the entire health and care ecosystem – This means using the entirety of the health and social care ecosystem, its capacity, expertise, resources and the end-to-end care it can provide. It means engaging carers, GPs, nurses, and pharmacists to improve efficiency, make better use of resources, spread the workload and improve satisfaction levels and outcomes for service users.
  • Using careful and well-managed commissioning models  This means making good decisions about commissioning and outsourcing to make best use of funding and other available resources. It also means allocating to appropriate projects, being mindful of the possible consequences of payment by result frameworks, and getting the best value possible.

Sustainability in practice

The final level of sustainability in relation to health and social care practice involves the sustainable implementation of programmes. This means finding ways to ensure that implementation is carried out in ways that ensure long term success and positive outcomes. It involves understanding context, and the culture of the organisation and makes reference to something discussed previously in our blog on implementation science.

Ensuring sustainability in practice requires multiple efforts including:

  • Making sure that practice becomes embedded into everyday work
  • Sharing best practice
  • Maintaining motivation among your workforce
  • Using robust, local evidence in a way that is clear and concise.

Understanding what kind of evidence leads to sustainable programme implementation is also important: economists prefer cost-based strategies, chief executives want one-page summaries, professionals want examples of other organisational based programmes and what was required to implement effectively, and councillors want case studies based around the positive impact on services users. Case studies can at times actually be the least helpful because even in a failing programme there is usually one example you can use to find positives.

Another issue with evidence is the reluctance to report on issues or challenges, or failed projects, when actually some of the greatest insight can be gained from this. All of the learning that can be gained from failures could be useful when trying to make programmes more resilient so they can be more sustainable.



Final thoughts

The concept of sustainability in health and social care cuts across many areas of organisational management and personal practice and behaviour. Encouraging and participating in sustainable practice can mean anything from being more environmentally friendly by digitising reports, recycling paper or changing to energy saving lightbulbs to promoting sustainability of resources through efficient and effective management, utilising the skills, expertise and resources of the entire health and social care ecosystem.

These approaches to sustainability should not only help health and social care as a profession to be less impactful on the environment but will also allow organisations to save money, improve efficiency and ultimately improve outcomes for patients and service users as a result.


* The 5th Annual Research Symposium: Evidence for sustainability – exploring the current evidence underpinning ways to create sustainable health and care systems was held on 16 March 2017. It was jointly hosted by Healthcare Improvement Scotland, Health Services Research Unit and the Health Economics Research Unit at the University of Aberdeen, and the Nursing, Midwifery and Allied Health Professions Research Unit at the Chief Scientist Office.

If you enjoyed this blog, you may also be interested in other articles on implementation theory and commissioning in health and social care.

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