The Scottish Health Survey – Any good news on diet is in very short supply

The Scottish Health Survey – SheS - comes around once a year, and the latest edition was published in October, reporting on survey data collected last year  The Scottish Health Survey 2024 - volume 1: main report - gov.scot . The survey tracks progress on health, and influences on health, over time. 

Running since the start of this century, it is instructive to look both at progress over the recent past, for instance recovery since COVID pandemic, and the longer-term view over 25 years.  

The National Centre for Social Research, who have run the survey, says ‘around 7,000’ people take part. Children are included if they are part of household where the adults have agreed to take part. So apparently sizable changes of, say 3%, may not amount to a large number of survey respondents changing their answers from year to year, especially if the survey is subdivided by age, sex or socio-economic circumstances. It is prudent to look at established trends – over 5 years through COVID-19, for 25 years since surveys began – to spot consistent changes for the whole population. 

Most of the food-related data in the survey starts at age 16 – children’s diets will be a focus of the forthcoming report - the Active Healthy Kids Scotland report card.  

For the first time, there have been questions about evidence for ‘eating behaviours, and feelings related to food that could be indicative of a possible eating disorder’ that follow through on service development in this area. They are remarkably common amongst young people, declining steadily with older age groups. We do not discuss the findings further here. 

The general picture the survey describes is about progress in Scotland’s health as reported in this survey, over time – such as the falls in smoking prevalence, and hazardous levels of alcohol consumption. The picture may be static at best over the past 5 years since the COVID pandemic took hold, but the longer-term trend is undramatically positive. Scotland is rightly known internationally for steps it took between 2006 (fresh air in public places) and 2019 (Minimum Unit Price for alcohol), with several associated regulations and public protection measures on sales and availability of these health harming products. Bold policies in the past 20 years to tackle tobacco and alcohol harm – what about our diet?  

Any good news on diet is in very short supply. Food insecurity is less prevalent this year, although over a third of single parent households still worry about putting enough food on the table. But what is on offer if we can afford it? – what is available, attractive and affordable drives food choice; there is a distinct lack of progress. One prominent setback is reported consumption of fruit and vegetables; adult consumption of 5-a-day has fallen back sharply. This report records in 2024 the worst level that the survey has recorded, at 11%. We reported 22% for the 2021 survey; until now, the level was hovering above 20% since surveys began. 

Reaching targets for lowering the proportion of food that is calorie-dense, fatty, sugary, low in fibre – for instance, Scots eat half of what’s a healthy level; 3% eat enough fibre - is a far-off ambition, according to this year’s findings. We’re making progress on reducing red and processed meat. Generally speaking, youngsters eat a higher quality diet than older age groups, but it’s not a rosy picture of health in itself; the socio-economic gradient shows a progressively poorer outlook for people on tight budgets, in turn most vulnerable to inflation, with fewer resources and even poorer healthy food availability in their neighbourhoods. 

We last took a look at the Scottish Health Survey’s findings in our blog series at the start of 2023 Obesity Action Scotland  Scotland’s health: The data demanding action. In earlier surveys, there have been specific questions about obesity rather than solely diet, which is the focus this year. It is normally reasonable to take a measured approach to one-off dramatic changes in behaviour, not least in food and eating behaviour. But the sharp drop in eating fresh fruit and vegetables is remarkable; with the backdrop of stalling progress towards recommended dietary levels in most other respects, we can conclude that Scotland is nowhere near where it should be on diet. Grim.  

As the title of our last blog on the subject makes clear, the data demand action. We don’t have to look far to know what action is – consult many other trusted health sources on diet and the determinants of good health, including elsewhere on this website.  

Food security trends and perhaps background levels of poverty are a good sign – but what happens when people have the bare essentials and can buy food to eat? Their choice isn’t a healthy one. For that, we have to look at the food environment around us – that’s where we have to demand action – progressive, level-playing field action addressing the causes of poor diets, creating a world where a healthy choice is the easy choice. It’s anything but that at the moment. These demands for action, and the urgency of them, are not going away. 

The SHeS – and the wealth of data we have in this country to describe the health problems we have and the progress we might make - doesn’t point us in the direction of what to do, but it does set us a challenge. What we also know from the time it takes to make lasting change – in the cases of alcohol and tobacco - there is still great potential for health benefit yet to run. What we can safely say about diet and healthy weight is that we have barely started; there aren’t the landmark measures on the statute book, or national ambitions to transform our food and drink-related environment.  

Looking back, the picture is bleak over 5 years, 25 years; looking forward, predictions published this month on levels of obesity for Scotland are of a worsening position over the next 15 years https://www.sciencedirect.com/science/article/pii/S0033350625004275. Unless we put effort, momentum and ambition into population health, we are going to fulfil these predictions. Epidemics such as obesity don’t cure themselves. 

Dr Andrew Fraser, Chair of Obesity Action Scotland Steering Group