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Get much tougher on salt and sugar in foods, CMO urges government

Extend use of levies to force companies to reformulate, she says in annual report

Caroline White

Friday, 21 December 2018

The government needs to get much tougher on the salt and sugar content of manufactured foods, and consider applying further levies to force companies to reformulate, says the chief medical officer (CMO) for England in her annual report* published today.

The report, which sets out her ambitions for improving the health of the nation and narrowing health inequalities by 2040, focuses on prevention, in recognition of the fact that half of all ill health in England is down to: poor diet, smoking, excess drinking, and lack of exercise.

“Effectively tackling tobacco and other leading risk factors such as poor diet, obesity, physical inactivity, air pollution and excess alcohol consumption, would transform the health landscape and current inequities in drivers of ill-health such as obesity,” she writes.

In 2017-18 there was a 17-fold difference between Clinical Commissioning Groups in smoking at childbirth, and one of her key recommendations is that NHS England and local authorities commit to halving existing inequalities in smoking in pregnancy by geography by 2024.

Obesity is also an inequalities issue, she insists, urging the government to make sure that future developments of the Childhood Obesity Plan include a specific target to halve current inequalities in childhood obesity by 2030 or sooner, with support for councils to meet this target.

“Structural” changes that require little or no action from individuals are consistently more effective and see the largest population health gains in the most vulnerable communities when compared to individual-based approaches, she says, citing the success of the sugar tax.

This prompted falls in the sugar content of half of soft drinks, even before it was rolled out, she highlights.

“These measures are effective and they are also equitable. We must not allow a situation where we look back on this era and regret allowing less effective policies to be implemented because they were either easier or avoided facing difficult trade-offs,” she warns.

And she recommends that the government extends the Soft Drinks Industry Levy to sweetened milk-based drinks with added sugar and takes action to eliminate added sugar in commercial infant and baby foods.

She also wants the government to review the use of fiscal disincentives in relation to foods that are high in sugar and salt as well as incentives to increase fruit and vegetable consumption.

While the salt content of foods fell by 11 per cent between 2003 and 2011, this has now stalled and Public Heath England now needs to set more ambitious targets for salt reduction in food, she recommends.

“This should apply equally to the out-of-home sector, which has lagged behind. If these targets are not met then they should be mandated and a range of other interventions considered, including mandating front of pack labelling,” she insists.

Local authorities need to be given legal powers and tool kits to enable them to improve the health environment for their local populations, particularly in areas surrounding schools. This includes looking at boosting the availability of healthier food options on the high street, she says

Recommendation 8 recommends that the Ministry of Housing, communities and local government explore, with the Local Government Association, how it can better support local government action to encourage healthier food options on the high street.

Tim Elwell-Sutton, assistant director of strategic partnerships at the Health Foundation, who contributed to the report, said that the ambition to achieve a healthier nation and reduce health inequalities by 2040 was aspirational, but not unachievable.

“However, it will need action across all sectors of society and investment to tackle the underlying causes of health inequalities – such as poverty, education and housing. We are pleased to see recommendations which focus on tackling health inequalities and taking significant action on childhood obesity,” he said.

“Local government has a vital role to play in creating healthy local environments. However, the ability of many local authorities to make long-term investments in improving health is constrained by a combination of deep budget cuts and growing demand for services,” he pointed out.

“Local leaders must be adequately resourced, empowered and incentivised to prioritise long-term health over short-term service provision,” he insisted.


*Health 2040 Better health within reach. Annual Report of the Chief Medical Officer, December 2018.

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