20.Before examining the links between the core themes of the inquiry and drawing any conclusions about how to address the issues of food insecurity, diet-related ill health and food sustainability, it was important to consider the food system as a whole, to examine what it produces and what we consume, and the scale of the challenges that are present. The following sections set out a broad overview of the ‘food system’, focused in particular on agriculture, food and drink manufacturing, food and drink retailing, and consumer interaction with the food environment.
21.British food and farming are vitally important to UK industry. The agri-food sector (which DEFRA defines as including: agriculture and fishing; food and drink manufacturing; food and drink wholesaling; food and drink retailing; and non-residential catering) makes a major contribution to the UK’s economy:
• In 2018 the agri-food sector contributed £121 billion or 9.4 % to national GVA (Gross Value Added). The food sector
employs around 4.1 million people (see Figure 1).
• The UK food and drink manufacturing sector contributes more than £28 billion to the economy and is the biggest manufacturing sector in the UK. 96% of the UK’s 7,400 food and drink manufacturing businesses are small and medium-sized enterprises (SMEs).
• Agriculture and fishing employs almost half a million people in the UK, and in 2018, contributed £10.4 billion to GVA.
• In 2018 the value of imports was greater than the value of exports in each of the broad categories of food, feed and drink except ‘Beverages’ which had a trade surplus of £1.81 billion, largely due to exports of Scotch Whisky (see Figure 2).
• The supermarket industry is dominated by four large companies. The combined market share of food and non-alcoholic drinks of the largest four food and drink retailers (Tesco, Sainsbury’s, Asda and Morrisons) was 50% in 2017–18 (see Figure 3). The three largest discount supermarkets (Aldi, Iceland and Lidl) had a combined market share of 16%, up from 6% in 2010.
Source: Department for Environment, Food and Rural Affairs, ‘National Statistics: Food Statistics in your pocket: Food Chain’, (updated 30 March 2020):accessed 25 June 2020]
22.The industrial revolution changed our food system dramatically and together with free trade and cheap imports it has, over time, become disproportionately focused on the output of cheaper, less healthy foods. This has resulted in a situation where highly processed foods make up a significant proportion of the diet of typical families.
• In 2017, the largest manufacturing category (with a value of £6 billion, contributing 19% to the total food and drink manufacturing GVA), was ‘other food products’ which included prepared meals, confectionary, condiments and seasonings. Following this, bakery products made the second largest contribution (£3.9 billion), followed by meat and meat products (£3.7 billion).
• UK households have been shown to purchase the highest proportion of highly processed foods across 19 European countries. In the UK, more than half (50.7%) all total dietary energy from purchases came from highly processed foods, compared to only 10.2% in Portugal and 13.4% in Italy. Furthermore, this research found that across all 19 countries, for each 1% increase in national purchasing of highly processed foods, obesity prevalence increased by 0.25%.
• The proportion of advertising spend on less healthy foods is significantly higher than on more healthy products. The Food Foundation estimated that in 2017, over £300 million worth of advertising was spent on less healthy food products, compared to £16 million spent on fruit and vegetables in the UK. Overall, it estimated that 46% of food and drink advertising is spent on confectionary, sweet and savoury snacks, with only 2.5% on fruit and vegetables.
• The UK population’s fruit and vegetable consumption is low. The latest National Diet and Nutrition Survey found that only 31% of adults, 32% of 65- to 74-year-olds and 8% of teenagers meet the 5 a day recommendation for fruit and vegetables. The National Diet and Nutrition Survey also found that over the period 2008/09-2016/17, there was little change in fruit and vegetable consumption, with all age and sex groups showing a mean intake of below the 5 a day recommendation.
• While consumption of fruit and vegetables is low, consumption of less healthy food is high. Evidence from the Food Foundation, the London School of Hygiene and Tropical Medicine (LSHTM) and Sustainable and Healthy Food Systems (SHEFS) highlighted research that suggested that 37% of adults’ dietary energy comes from HFSS foods. It stated that children’s diets were found to be even worse with 47% of primary school children’s dietary energy from HFSS products.
• Those in the poorest deciles are even less likely to meet recommendations on healthy eating guidance. Evidence from the Food Foundation, LSHTM and SHEFS stated that: “The poorest households only purchase 3.2 portions of fruit and vegetables per day” and that only “17% of the poorest decile were consuming sufficient fruit and vegetables compared with 26% in the general population.”
Source: Department for Environment Food and Rural Affairs, National Statistics: Food Statistics in your pocket: Food Chain, (30 March 2020): [accessed 30 June 2020]. ‘Internet’ includes online orders from the largest supermarkets.
23.For most of the population in this country, buying food is based on choice, availability, price and personal preference. However, the dependency on less healthy, processed foods is having dire consequences for population health, and places a significant burden on the health system and the economy. The levels of obesity in the UK are perhaps the most obvious indication of the quality of the population’s diet. Obesity is a risk factor for a number of health conditions, including coronary heart disease, type 2 diabetes, some types of cancer, and strokes. The Government’s own assessment of the scale and impact of obesity makes for concerning reading:
• It is estimated that the NHS spent £6.1 billion on overweight and obesity-related ill health in 2014 - 2015. Annual spend on the treatment of obesity and diabetes is greater than the amount spent on the police, the fire service and the judicial system combined. Public Health England has warned that obesity has a serious impact on economic development, as it estimates that the overall cost of obesity to wider society £27 billion. Furthermore, PHE predicts that the UK-wide NHS costs attributable to obesity are projected to reach £9.7 billion by 2050, with wider costs to society estimated to reach £49.9 billion per year.
• Excess calorie consumption (in relation to energy expenditure) is the root cause of the obesity crisis. Overweight or obese children consume up to 500 extra calories per day, depending on their age and sex, while adults consume between 200 and 300 calories too many.
• In 2018, the majority of adults in England were overweight or obese (63%). Of these, 28% of adults were classified as obese. There has been a clear long-term increase in obesity levels from 15% in 1993 to 28% in 2018. Hospital admissions where obesity was a factor rose by 23% between 2017/18 and 2018/19.
• According to the Organisation for Economic Co-operation and Development (OECD), across its member countries, obesity rates continue to rise, with 56% of adults overweight or obese and almost one-third of children aged 5-9 are overweight (2019 publication). In 2017, OECD data showed that, among the countries reporting measured data (rather than self-reported data), the UK had the tenth highest rates of obesity among adults from the 23 countries listed.
24.A recently published (June 2020) report by Public Health England on the disparities in the risk and outcomes of COVID-19 suggested that “emerging evidence has established a need to better understand the association between obesity and COVID-19 particularly as 28% of adults in England in 2018 were obese (Body Mass Index (BMI) of 30kg/m2 or more) and 3% were morbidly obese.”The PHE report cited three studies on the relationship between obesity and COVID-19:
• A report from the Intensive Care National Audit and Research Centre that used data up to 21 May 2020 and showed that 7.7% of patients critically ill in intensive care units (ICU) with confirmed COVID-19 were morbidly obese compared with 2.9% of the general population (after adjusting for age and sex). This disparity was also seen when looking at white and non-white patients separately. The report also showed a relationship between BMI and death from COVID-19 in BMI over 30 kg/m2.
• A study using data from over 400,000 patients aged 40 to 69 from UK Biobank linked to COVID-19 test data from PHE found that higher BMI was associated with a positive COVID-19 diagnosis.
• A study by the OpenSAFELY collaborative used a dataset of 17 million adult primary care electronic health records linked to deaths data from the COVID-19 Patient Notification System up to 25 April 2020. This found a relationship between death from COVID-19 and BMI when controlling for demographics and other health conditions.
Public Health England noted that, although measuring the different outcomes of dying from COVID-19 once in ICU, contracting COVID-19 and dying from COVID-19, all three studies showed a relationship between COVID-19 and increasing BMI. PHE stated that these findings were also consistent with studies from other countries.
25.Given the focus of our inquiry, we were particularly concerned about the extent to which diet-related ill health affects those in lower income groups. There is considerable evidence to suggest that there is inequality when it comes to being able to eat a healthy diet:
• In 2017, prevalence of excess weight was 11 percentage points higher in the most deprived areas than the least deprived areas. In the most deprived tenth of areas, 67% of people were overweight or obese, compared to 56% in the least deprived.
• Children living in deprived areas are around twice as likely to be obese. Among children aged 4-5, 12.4% of those in the most deprived areas were obese compared to 6.4 % in the least deprived areas. By age 10-11, this had risen to 26.7% in the most deprived areas compared to 13.3% in the least.
26.Figures from the Office for National Statistics have shown that life expectancy for males in the most deprived areas can be up to 9.5 years less than those in the least deprived areas, with the difference at 7.7 years for females. (See Figure 4).
27.In February 2020, Health Equity in England: The Marmot Review 10 years on was published, the follow up report to Professor Sir Michael Marmot’s landmark report on health inequalities. The report examined the progress that has been made in addressing health inequalities in England over the last decade. It stated that:
• Life expectancy follows the social gradient—the more deprived the area the shorter the life expectancy. This gradient has become steeper; inequalities in life expectancy have increased. Among women in the most deprived 10 percent of areas, life expectancy fell between 2010–12 and 2016–18.
• The gradient in healthy life expectancy is steeper than that of life expectancy. It means that people in more deprived areas spend more of their shorter lives in ill health than those in less deprived areas.
Source: Office for National Statistics, ‘Health state life expectancies by national deprivation deciles, England: 2016 to 2018’, 27 March 2020: .Life expectancy refers to period life expectancy, the average number of years a person would live, if they experienced that particular area’s age-specific mortality rates for that time period throughout their life. Based on survey data. Survey respondents who answered their general health as “very good” and “good” were classified as having good health. Those who answered “fair”, “bad” and “very bad” were classified as having poorer health.
28.The report also referred to the issue of food insecurity and observed that:
“One of the clearest and most immediate impacts of being in poverty is an inability to buy nutritious food. The 2010 Marmot Review discussed the relationship between food and health but the common use of food banks and the term arose after the report was published. There is also widespread concern at food insecurity and poor nutritional intake and impacts on health and wellbeing; likely contributing to inequalities in cancer, diabetes and coronary heart disease.”
29.Diet-related ill health is more likely to affect those in lower income groups and it is reasonable to conclude that those who are struggling to eat are certainly struggling to eat well. Evidence from the Food Foundation, LSHTM and SHEFS told us that:
“Food insecurity not only damages physical health but also causes social harm bringing profound anxiety and stress to families and can affect children’s school attendance, achievement and attainment. It is associated with poor social well-being, poor quality of life and unhealthy lifestyles with food insecure children being more likely to report poorer health status and more likely to be hospitalised than food secure children.”
30.Professor Marmot also pointed to the relationship between food insecurity and poor diet, stating that:
“There is evidence to reject the twin notions that people are poor because they make poor choices, and that the poor health of the poor results from poor choices. Rather, it is poverty that leads to less healthy choices and the poor health of those lower down the social hierarchy results from the restricted range of options available to those on low incomes, as well as the direct health impacts associated with the stresses and poor conditions which result from poverty.”
31.The report by Public Health England on the disparities in the risk and outcomes of COVID-19 confirmed that the impact of COVID-19 has replicated existing health inequalities, and in some cases, has increased them. It found that:
• Risk of dying among those diagnosed with COVID-19 was also higher in males than females; higher in those living in the more deprived areas than those living in the least deprived; and higher in those in Black, Asian and Minority Ethnic (BAME) groups than in White ethnic groups.
• People who live in deprived areas have higher diagnosis rates and death rates than those living in less deprived areas. The mortality rates from COVID-19 in the most deprived areas were more than double the least deprived areas, for both males and females.
32.We also received evidence on the environmental impact of food production, including that:
• Agriculture is responsible for 87% of UK ammonia emissions (mainly from livestock farming and fertiliser use. Agriculture is also responsible for 10% of the UK’s greenhouse gas emissions.
• Evidence from the Food Foundation, the London School of Hygiene and Tropical Medicine (LSHTM) and SHEFS highlighted LSHTM research which had found that the least healthy diets on average produce around 25% more greenhouse gas emissions than the healthiest, largely because they contain more meat and less fruit and vegetables.
• There are high levels of food waste in the UK: “an estimated 10.2 million tonnes of food and drink are wasted annually after the farm gate, worth around £20 billion.”
33.A number of witnesses suggested that the current food system is biased towards producing less healthy foods. UK Research and Innovation provided the following summary of the impact of this demand:
“Food production processes directly and indirectly impact consumers’ dietary choices, with the effects related to food production extending across income groups, with some impacted more than others. The global food system produces more grains, sugars and fats than we need for health, but not enough fruits and vegetables. These grains, sugars and fats are highly subsidised, and when refined and combined in manufacturing, lead to cheap and unhealthy products that permeate our food environments, resulting in over-consumption, poor nutrition and health.”
34.In August 2016, the Government published Childhood Obesity: A Plan for Action, the first of three chapters which include measures to help tackle meet the Government’s ambition both to halve childhood obesity and to reduce significantly the gap in obesity between children from the most and least deprived areas by 2030.
35.Although this ambition has been welcomed, concerns have been raised that significant challenges still exist, including: that childhood obesity rates are showing little signs of reducing, and are actually increasing in some age groups; that obesity continues to place a considerable burden on the NHS; and that some of the measures outlined in the Plan are not sufficiently robust or sustainable to facilitate the change in levels of childhood obesity needed to meet the Government’s 2030 target.
36.The efficacy of the individual policies set out in the chapters of the Childhood Obesity Plan are considered in further detail in Chapter 4, the Food Environment. There was, however, a clear consensus across the evidence that efforts to tackle obesity have stalled. This was a view very clearly expressed by Professor Susan Jebb, Professor of diet and population health at the University of Oxford, who said:
“Action is still far too slow. Most of the childhood obesity plans have said, “We will consult on”, “We will discuss”, “We will consider”, or, “We will think about”. Many of those consultations have been out and closed months and months ago. There is simply no apparent sense of urgency.”
37.In 2019, Professor Dame Sally Davies, the then Chief Medical Officer, published an independent report on childhood obesity, which stated that: “The Government ambition is to halve childhood obesity by 2030—in England, we are nowhere near achieving this.” The report went on to conclude that:
“The Government has laid important foundations for change with two ‘chapters’ of a national childhood obesity plan, a prevention green paper, Advancing our health: prevention in the 2020s, and the NHS Long Term Plan. If implemented in full, these plans will significantly reduce levels of childhood obesity and improve our children’s health. This would be a major achievement, but the plans, alone, will not meet the 2030 ambition. To meet the ambition and children’s needs, we must go further and faster.”
38.Jenny Oldroyd, Deputy Director Obesity, Food and Nutrition at the Department of Health and Social Care (DHSC), highlighted that UNICEF and World Obesity Federation reports had set out how the UK is paving the way to ensure children grow up in a healthy food environment. When questioned further by the Committee, however, as to whether there was any evidence to suggest that childhood obesity is declining, Jenny Oldroyd confirmed that: “No, that evidence is not there at the moment … It is slowly moving up.”
39.The Agriculture Bill 2019–20 (preceded by the Agriculture Bill 2017–19 which fell at Dissolution in October 2019), will provide the legislative framework for agriculture support schemes to replace the EU’s Common Agricultural Policy (CAP). Current payments to farmers for environmental protection are incorporated within the Countryside Stewardship funding or the Basic Payment Scheme, and will be replaced by the Environmental Land Management scheme (ELMS) contained in the Agriculture Bill.
40.The ELMS proposes to reward a number of environmental ‘public goods’ with public money. The Government will support and reward farmers for providing improved environmental outcomes such as improved soil health and carbon emissions. The Department told us that the scheme may lead some farmers to move away from “traditional agricultural activity”. The discussions of the scheme, including what, exactly, farmers will be rewarded for and the frameworks by which progress will be measured, are at a very early stage, and few details are available.
41.The Government told us that it recognises that there are a number of interconnected challenges across the food system, including food security, health and climate change. It told us that its response to these challenges has been to commission the National Food Strategy review.
42.On 27 June 2019, the Department for Environment, Food and Rural Affairs (DEFRA) announced an independent review of the UK food system. The review, supported by DEFRA officials and an advisory group, is being led by Henry Dimbleby, co-founder of the restaurant chain Leon, and lead non-executive board member of DEFRA. Its findings will be used to develop a National Food Strategy for England.
43.The review aims to address environmental and health problems caused by our food system, to ensure the security of our food supply, and to maximise potential of the coming revolution in agricultural technology. The aims of the National Food Strategy were universally welcomed throughout the evidence.
44.Throughout the evidence, a clear concern emerged; that, through the damage to health and the environment it causes, the food system is generating considerable ‘external’ costs (sometimes referred to as ‘externalities’) that it is not accounting for. Professor Tim Lang, Professor of Food Policy, City University of London stated that: “We have very cheap food, relatively, but the costs are dumped elsewhere, on health and on the environment.”
45.According to one estimate made by the Sustainable Food Trust:
“for each £1 spent on food in the shops in the UK, consumers incur extra hidden costs of £1. In addition to the £120 billion spent annually on food by consumers in the UK as a whole, the UK food system generates further costs of £120 billion in external costs.”
46.In reaching the figure of the “hidden £1”, the Sustainable Food Trust stated that it had accounted for the cost of factors, including: natural capital degradation; biodiversity loss; diet-related ill health; farm support payments; and regulation though we recognise that this is just one view on the potential external costs of the food system.
47.A number of witnesses suggested that extra costs incurred by the food system to health and the environment are currently not paid by the food manufacturers and retailers that cause the damage, nor are they included within the retail price of food. The Sustainable Food Trust claims those costs are passed on to the public through “taxation, lost income due to ill health and the price of mitigating and adapting to climate change and environmental degradation.”
48.The food system is vast and complex. Any measures aimed at ‘wider system change’ will need to take into account the diversity of the industries. Decisions about the food system will also have implications for health and for the economy. As Henry Dimbleby, the leader of the National Food Strategy Review, said about the food system: “it is almost impossible to act on it in any way without creating winners and losers.”
49.Over the course of the inquiry, we have encountered several ‘quick fix’ policy areas. These are either: policies which are being poorly implemented and not therefore having the intended effect, or policies which are causing harm and should be removed.
50.Many witnesses spoke of the need for overwhelming ‘system change’, although this term was not satisfactorily explained. We have decided to refine these requests and recommend an overhaul of Government policy to address three specific problem areas identified in the evidence as crucial to the functioning of the current ‘system’:
(a)Changing ‘the food environment’, for example by regulation, education, or incentive;
(b)Changing agricultural practices by altering criteria for farming subsidies and providing support and clarity to the sector; and
(c)Improving the governance of ‘food policy’ and integrating this into social and economic policy.
30 Department for Environment, Food and Rural Affairs, National Statistics: Food Statistics in your pocket: Food Chain (updated 30 March 2020): [accessed 30 June 2020]
31 DEFRA states that ‘food’ includes non-alcoholic drinks: Department for Environment, Food and Rural Affairs, National Statistics: Food Statistics in your pocket: Summary (updated 30 March 2020): [accessed 30 June 2020]
32 DEFRA states that the agri-food sector employs 4.1 million people if agriculture and fishing are included along with self-employed farmers: Department for Environment, Food and Rural Affairs, National Statistics: Food Statistics in your pocket: Summary (updated 30 March 2020): [accessed 30 June 2020]
33 The Food and Drink and Federation, Our Industry at a glance (June 2020): [accessed 30 June 2020]
35 Department for Environment, Food and Rural Affairs, National Statistics: Food Statistics in your pocket: Food Chain (updated 30 March 2020): [accessed 30 June 2020]
36 2018 figures are provisional. Department for Environment Food and Rural Affairs, National Statistics: Food Statistics in your pocket: Global and UK supply (Updated 30 March 2020): [accessed 25 June 2020]
37 Department for Environment, Food and Rural Affairs, National Statistics: Food Statistics in your pocket: Food Chain (updated 30 March 2020): [accessed 30 June 2020]
38 The Food Foundation, Food System Challenges: [accessed 19 June 2020]
39 Department for Environment, Food and Rural Affairs, National Statistics: Food Statistics in your pocket: Food Chain, (updated 30 March): [accessed 19 June 2020]
40 Written evidence from the University of Southampton and the MRC Life Course Epidemiology Unit Southampton General Hospital () cited: CarlosMonteiro , et al (2018) Household availability of ultra-processed foods and obesity in nineteen European countries. Public Health Nutrition. 21(1):18-26, DOI:
41 The Food Foundation, The Broken Plate, (26 February 2019) p 14: [accessed 30 June 2020]
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43 Public Health England and Food Standards Agency: National Diet and Nutrition Survey, Years 1 to 9 of the rolling programme (2008/2009–2016/2017): time trend and income analyses (January 2019) p 25: [accessed 30 June 2020]
44 Written evidence from the Food Foundation, London School of Hygiene and Tropical Medicine and Sustainable and Healthy Food Systems (SHEFS) ()
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46 Written evidence from the Food Foundation, London School of Hygiene and Tropical Medicine and Sustainable and Healthy Food Systems (SHEFS) ()
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52 List of OECD countries:
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55 Public Health England, Disparities in the risk and outcomes of COVID-19 (June 2020) p 60: [accessed 30 June 2020]
56 PHE states that this analysis controlled for other demographics and health conditions but is restricted to those patients admitted to ICU from 289 participating trusts. Public Health England, Disparities in the risk and outcomes of COVID-19 (June 2020) p 60: [accessed 30 June 2020
57 PHE states that compared with non-overweight people (BMI < 25 kg/m2), the odds ratios were 1.26 (confidence interval of 1.01-1.56) for those who were overweight, 1.37 (1.06-1.76) for those in obese class I and 2.04 (1.50-2.77) for those in obese classes II and III combined. Public Health England, Disparities in the risk and outcomes of COVID-19 (June 2020) p 60: [accessed 30 June 2020]
58 PHE states that the hazard ratio compared to those who were not obese increased as BMI increased and was 1.27 (1.18-1.36) for those in obese class I, 1.56 (1.41-1.73) for those in obese class II and 2.27 (1.99 to 2.58) for those in obese class III (morbidly obese).
59 Public Health England, Disparities in the risk and outcomes of COVID-19 (June 2020) p 60: [accessed 30 June 2020]
60 House of Commons Library, Obesity Statistics, Briefing Paper , 6 August 2019
61 Office for National Statistics, Health state life expectancies by national deprivation deciles, England: 2016 to 2018’, (27 March 2020): [accessed 30 June 2020]
62 Institute of Health Equity, Health Equity in England: The Marmot Review 10 year on (February 2020) p 84: [accessed 30 June 2020]
63 Institute of Health Equity, Health Equity in England: The Marmot Review 10 year on (February 2020) p 84: [accessed 30 June 2020]
64 Written evidence from the Food Foundation, London School of Hygiene and Tropical Medicine and Sustainable and Healthy Food Systems (SHEFS) ()
65 Institute of Health Equity, Health Equity in England: The Marmot Review 10 year on (February 2020) p 35: [accessed 30 June 2020]
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69 Written evidence from HM Government ()
70 Written evidence from UK Research and Innovation ()
71 Department of Health and Social Care, Childhood Obesity: a plan for action, Chapter 2 (June 2018) p 5: [accessed 30 June 2020]
72 (Professor Susan Jebb)
73 Professor Dame Sally Davies, Time to Solve Childhood Obesity. An Independent Report by the Chief Medical Officer (2019), p 2: [accessed 30 June 2020]
75 (Jenny Oldroyd)
77 (Alison Ismail)
78 Written evidence from HM Government ()
79 (Professor Tim Lang)
80 Written evidence from the Sustainable Food Trust ()
81 The full breakdown of these extra costs was listed as: natural capital degradation; biodiversity loss; production-related ill health; diet related disease; imported food; farm support payments; and regulation and research. The Sustainable Food Trust, The Hidden Cost of UK Food (21 November 2017) p 8: [accessed 30 June 2020]
82 The Sustainable Food Trust, The Hidden Cost of UK Food (21 November 2017): [accessed 30 June 2020]
83 (Henry Dimbleby)