Welsh academic calls for ‘good food revolution’ to help rescue the NHS

Martin Shipton

A “good food revolution” must take place to make Wales a healthier country and ease spending pressures on the NHS, according to a leading academic.

Professor Kevin Morgan of Cardiff University has published a new book called Serving the Public: The Good Food Revolution in Schools, Hospitals and Prisons.

In it, he examines the causes of obesity and other diet-related health conditions that kill many more people than cancer, gives examples of positive initiatives that have led to improvements and sets out how such improvements can be sustained.

He looks particularly at changes that have taken place in the provision of school meals, food in hospitals and food in prisons.

Values

At the outset of his analysis, Morgan states: “The school meal is an infallible index of the values of a society. If that sounds too overblown, it’s probably because we rarely think that a prosaic institution such as the school meals service can play such a grand role.

“Yet in its British guise, the school meal has proved to be a remarkably accurate reflection of the tectonic shifts in the political system: from being a pillar of the welfare state following its introduction in 1906, to being debased and marginalised by Thatcherism, and now, in its most recent incarnation, being a measure of a country’s commitment to sustainable development.

“But whatever the national context, the reform of school food raises some of the most compelling questions that a society can ask itself in the 21st century. Does the state have a duty to try to change the behaviour of its citizens for the better? Can a society truly claim to be sustainable if it fails to invest in nutritious school food for young and vulnerable people? What are the defining features of a sustainable school food service? And, as regards the provenance of the food, should societies seek to promote more ‘localisation’ of their food and farming sectors in the name of sustainability or more ‘globalisation’ in the name of fair trade? These are some of the questions that have been triggered by the school food reform movement.”

Budget cuts

For Morgan, there is no question that getting young people into the habit of eating nutritious food is absolutely the right thing to do. He deplores the fact that budget cuts in the Thatcher period and subsequently during the more recent austerity years led to a reduction in the quality of school meals to a point where pupils were being fed junk food because it was cheaper. The implementation of such change for the worse has seen an explosion in childhood obesity that will be costly for the NHS in the long run.

He argues strongly against the right-wing view that public sector intervention to improve the quality of school meals is a manifestation of the “nanny state” at work, stating that the implications of a poor diet are potentially devastating for individuals as well as extremely costly for the NHS in the long run.

Morgan regrets that success in improving the quality of school meals has been patchy, but praises local initiatives and makes the point that change for the better is not entirely related to the cost of food but to the creative enthusiasm of individuals managing the school meals service.

The introduction of healthier meals in hospitals has also been problematic, leading to the paradox that while sick patients have an urgent need to eat nutritious food, they find themselves too often eating meals that are sub-standard. He cites the shocking statistic that nearly a third of patients admitted to hospital are at risk of malnutrition, while the number of admissions for malnutrition is itself rising rapidly. A survey by Age Concern suggested that six out of 10 older people are at risk of becoming malnourished in hospital, a fact that has a ripple effect on the hospital economy: malnourished patients stay in hospital for longer, are three times as likely to develop complications during surgery and have a higher mortality rate than well-fed patients.

But there are examples of successful change in the hospital meals sector, including in those run by the North Bristol NHS Trust, where senior managers were praised by the then Prince of Wales for implementing a local quality food sourcing programme that entailed buying from local suppliers. However, the project was unable to continue its progress as buying more organic meat was seen as unaffordable, and when the senior management team responsible for the improvements retired their replacements were not as enthusiastic about sustainable food provision.

Prisons

Prisons have also presented difficulties in terms of getting improved meals because some senior staff – and tabloid newspapers – take the view that it is wrong that criminals should be “rewarded” with quality food. But a now famous study carried out more than 20 years ago in Aylesbury Young Offenders Institution demonstrated that prisoners whose diet contained nutritional supplements committed an average of 26.3% fewer offences when released, with the most violent offences decreasing by 37%.

Finally, Morgan explores the upsurge in locally based good food movements that are seeking to overcome the reluctance of central governments to go as far as they should in developing quality food policies.

He writes: “For more than a century the only food voices that seemed to command attention from the mainstream media and the political class were from the agrifood industry – farmers, processors and manufacturers – and the government department responsible for food and farming. A radically new voice emerged with the advent of local food movements, perhaps the most distinctive feature of the UK food policy landscape in the past 25 years.

“A combination of global and local factors triggered the growth of these place-based food movements … Locally in the UK, the noxious effects of the industrial food system were becoming ever more apparent in the form of diet-related diseases and ecological damage. Although these local food movements emerged slowly and unevenly across the country, around 90 of them are now affiliated to the Sustainable Food Places network, the main forum for local food movements in the UK today.”

Morgan concludes: “Public health scholars rightly argue that the food industry is at a crossroads: one path involves fighting change (by targeting children, forestalling regulation and selling as much product as possible no matter the consequences), while the other path involves a radically different strategy, such as working with the public health community, selling less harmful products and promoting healthier options.

“The question for the food industry is stark: ‘Adopting the first option while laying claim to the second was the path taken by the tobacco industry. Is the food industry different, or is history repeating itself, this time with another substance?”

* Serving the Public by Kevin Morgan is published by Manchester University Press at £14.99.