Food Fight?

Aren’t we all on the same page in wanting Scotland’s population to enjoy a healthy nutritious diet? Not according to Stuart Gillespie’s excellent new book, Food Fight, which was published earlier this year. I had the good fortune to hear Stuart taking part in a Festival of Politics debate hosted by Emma Harper MSP held at Holyrood back in August. You can see the recording of Junk vs Jabs: our relationship with food here.

But, back to the book. Gillespie divides it into four sections. The first, titled Cascade, describes the situation we now find ourselves in - ‘overfed, undernourished’. He draws on his international experiences, to illustrate the co-existence of under-nutrition with overweight and obesity. The damage from malnutrition is huge, and poverty and food insecurity is strongly linked with obesity. A recent report from UNICEF reported that the global prevalence of obesity among school-age children and adolescents exceeded underweight for the first time. As the United Nation’s agency notes, this shift jeopardises the health and future potential of children and communities. 

The next section, Regime, describes food history through a ‘power lens’ moving from the post war period into the current corporate world in which Gillespie correctly argues our food system is embedded. This is the era of ‘massive transnational food corporations’ (Big Food). He describes how research and development have driven the rise of ultra-processed products which, while profitable to the food and drink industry, are of low nutritional quality, energy-dense, and not at all good for our health. Similar to Gillespie’s assessment, UNICEF’s report describes how food environments expose children and adolescents to a constant supply of cheap and aggressively marketed ultra-processed foods and sugary drinks, while failing to make nutritious options available and affordable. 

Unravelling is a long and detailed analysis of the structural causes of the unhealthy environments we are now faced with globally. It is packed with examples of the work of companies to prioritise profits before health. For example, aggressive marketing which revolves around misinformation on the nutritional value of formula milk in contrast with breastfeeding. Gillespie references Chris van Tulleken’s work on ultra-processed foods (UPFs) whilst describing how UPFs account for over 60% of food intake in the UK. Whilst food companies continue to urge us to consume their often unhealthy products, it is hardly surprising that individual self-regulation doesn’t work. ‘Urging individual responsibility in an environment flooded with harmful products is bound to fail’. And, of course, companies are now developing antidotes to the harms caused by unhealthy products – often their own – from the British diet industry to weight-loss drugs.

As Food Fight makes clear, ‘We are not free to choose what we eat. Food environments are created and curated by food and drink manufacturers and retailers, who decide what they will produce, market and sell, at what price, when and where’. Responses to widespread obesity need to be at a population-level and led by Government. Prevention needs to address our obesogenic environments. Gillespie describes ‘food deserts’ where it is a struggle to find healthy food co-existing with ‘food swamps’, places inundated with junk food and fast-food outlets. The commercial food sector has developed the concept of ‘anytime, anywhere snacking’. A third of all calories consumed by the average American adult now comes from snacks. Another old industry lie, that Gillespie shoots down, is that the marketing and advertising of food doesn’t work. Indeed, the opposite is true. He references report after report showing how marketing successfully glamorises and normalises the purchase and consumption of unhealthy products; particularly amongst children and young people. There is an important chapter detailing how the operations of the food industry – in manufacturing and packaging for example – are major generators of man-made greenhouse gas emissions. Whilst it takes up to 600 litres of water to produce a litre of soda.

Food Fight also focuses its fire on the handful of corporate players who now dominate the agrifood system today. The book is full of disturbing statistics – always well referenced. Two-thirds of the world’s agricultural land is controlled by 1 per cent of its farmers, whilst five companies have 70-90 per cent of the global trade in grain. Three-quarters of food retailing is in the hands of Nestlé, Coca-Cola, PepsiCo, General Mills and Unilever. And these corporations are huge; Nestlé’s annual sales are over US$100 billion which is about the same as the GNP of Kenya or Sri Lanka. The corporations also own multiple brands so Mondelēz International is the parent company of Cadbury, Oreo, Milka and Bournvita, for instance. Oxfam produced a great report and graphic back in 2014 which illustrates this very effectively. As Gillespie argues, ‘Commercial forces limit our freedom of choice a lot more than we think’.

The book’s chapter titled The Dark Arts is a very powerful read on the actions of corporations which impact negatively on population health. And of course, the starting point in any discussion on the commercial determinants of health begins with the efforts of the tobacco industry beginning in the 1950s to spread doubt and controversy to help fight off regulation and litigation for as long as possible. If you want to read more about their immoral and damaging activities, I recommend Allan M. Brandt’s book, The Cigarette Century. Gillespie makes a strong case for describing Big Food’s tactics as drawn from the ‘tobacco industry playbook’. Gillespie’s five Deadly Ds of the Dark Arts are: Dispute and doubt, Distort and deceive, Distract and deflect, Disguise and Dodge. That’s eight Ds to be pedantic. There is insufficient space here to describe these tactics in detail but the book discusses, for example, how corporate social responsibility (CSR) is used to fund a few good causes to distract attention from the core business of selling unhealthy products. He references how ‘fast-food restaurants bang on about their salads while continuing to serve heart-attack burgers’. You can read the BMJ’s recent report on McDonald’s using every trick in the book to push back against any blocks to their planning applications to see why this is a problem.

So, what do we do about all this? This provides the final section of Food Fight and is necessarily the most complicated (and important). After all, if there was an easy answer to improving the food and nutrition for the British population, we would have found it by now. One final canard to park first. This isn’t about freedom of choice and personal responsibility. Gillespie argues that ‘there is a social and political responsibility to regulate widespread environmental harm’. It is also not about the ‘nanny state’. That is simply a term used to deflect government action in trying to protect us from the damaging actions of the agrifood industry.

We need to transform our global food system to protect people’s right to nutritious food. And I hope, Gillespie will forgive me in trying to simplify and summarise this last and essential part of his book. Regulation at government level works. Whether that is taxing, marketing controls or food labelling. Don’t wait and expect industry to regulate itself. That simply never works. Focus on infant and young children. I recently did a BBC interview on projections on adult obesity prevalence in Scotland in 2040. That means focusing on our youngsters currently in school now. In addition, it is essential we provide a safety net to protect the members of our communities most at risk from food poverty.

If I can be slightly critical of one section of Gillespie’s admirable book, it is his summary of whole systems approaches. The British examples he gives are both from the south of England. The most disadvantaged local authority areas in England are generally in the North-East and North-West of England where, for example, levels of overweight and obesity are closely linked to socio-economic status. Here there are numerous examples - such as in Liverpool, Sunderland, and Warrington - where elected leaders, senior officers, and VCFSE organisations have joined together to take a collective stance to address policies to promote healthier weight environments. The key here is system leadership. As Gillespie says earlier in his book, whilst politicians are sometimes given the tools to exercise an ‘enabling environment for nutrition’, they may not make the political choice to put progressive policies in place. Food Fight argues that we are treated as consumers by the food industry when we need to act as citizens in our communities. In Gillespie’s words, ‘we need to be more vocal about food and public health and demand change from the political leaders we elect’. ‘Organise, mobilise’. Support civil society organisations in their campaigns for healthy, nutritious food.

And now, I would recommend getting hold of a copy of Food Fight to debate, argue and advocate for our right to access healthier food. There will be a serious price to pay if we don’t win the food fight.

- Dr Robin Ireland, Interim Head, Obesity Action Scotland