Dietary inequalities worsened in last two years as healthier foods grew more expensive

Dietary inequalities worsened in the UK over last two years as healthier foods grew more expensive at twice the rate of less healthy options 

The Food Foundation has today published its annual Broken Plate report, funded by The Nuffield Foundation, which looks into how the food system impacts citizens and the actions needed from policymakers to ensure healthy and sustainable food is available and affordable for everyone. The report found that:

• Healthier foods are more than twice as expensive per calorie as less healthy foods, with healthier food increasing in price at twice the rate in the past two years. 
• The most deprived fifth of the population would need to spend 45% of their disposable income on food to afford the government-recommended healthy diet, rising to 70% for households with children. The overall figure has decreased from the peak of the cost-of-living crisis (50% in 2021-22) but remains higher than the previous year's figure (43% in 2020-21) 
• Over a third (37%) of supermarket promotions on food and non-alcoholic drinks are for unhealthy items  
• A quarter (26%) of places to buy food in England are fast-food outlets, rising to nearly 1 in 3 in the most deprived fifth of areas 
• Over a third (36%) of food and soft drink advertising spend is on confectionary, snacks, deserts and soft drinks, compared to just 2% for fruit and veg, and has increased (up from 33% in 2022) 

The report brings together data from a range of sources and reveals a food system that has health inequalities built into it.

In the UK healthier food is now more expensive and less available to those on lower incomes, with the situation having got worse rather than better in the last couple of years across several key metrics.

The report also found that the food environment is having a negative impact on health outcomes, with children from deprived backgrounds suffering the most.

While children across all income groups are consuming significantly less healthy foods, and significantly more unhealthy foods than recommended for good health, children from the most deprived income quintile consume 20% less fruit and vegetables than the least deprived income quintile (2.1 portions/day compared to 2.6 portions/day respectively).

Children in the most deprived fifth of the population were further found to be nearly twice as likely to be living with obesity as those in the least deprived fifth by their first year of school.

Deprived groups are much more likely to be affected by type 2 diabetes, and, as a result, people with diabetes in the most deprived quintile were almost three times more likely to experience a lower-limb amputation than the least deprived quintile in 2022.

Similarly, children in their last year of primary school in the most deprived areas are more than twice as likely to have experienced tooth decay in their adult teeth (23%) compared to those in the least deprived areas (10%).

In recent months we’ve seen confirmation of the ban on junk food adverts online and on TV before 9pm, the Government’s Chief Medical Adviser, Chris Whitty, calling for the government to introduce a sugar tax on unhealthy foods, and the announcement by government of a new National Food Strategy.

These are signs that there is an increasing awareness of the important role that the food system and diet have to play in relieving pressure on the NHS, ensuring people are healthy enough to work, strengthening the economy and achieving climate goals.

The Broken Plate report's findings, however, are a stark reminder that there is a lot more still to be done if we are to see improvements across a complex food system that has become an active driver of health inequalities.

The report publication is timely as Wes Streeting is expected to respond to a previous report from the House of Lords Committee on Food, Diet and Obesity which forcefully called for the government to fix our broken food system and turn the tide on the public health emergency by the end of the month.

Steve Reed, the Secretary of State for Environment, Food and Rural Affairs, is also expected to announce more detail on the National Food Strategy and next steps in its development, in due course.

Anna Taylor, Executive Director of The Food Foundation, said: "The Broken Plate report sadly shows that our food system is failing to provide large swathes of the population with the basic nutrition needed for them to stay healthy and thrive.

"There is a tragic imbalance in the UK between the food that is marketed, available and affordable, and foods that are healthy and sustainable.

"Often it is the most vulnerable children in our society who suffer the worst consequences of this. Not only can lack of nutrition lead to serious health conditions, it can also lead to children being unable to concentrate in school and have lasting negative impact on mental health, entrenching inequalities from a young age.

"The Government has recently announced that it has started working on a National Food Strategy. We hope that this will be seized as an opportunity to tackle these inequalities through cross departmental working, with acknowledgement that key changes to the food system can help to achieve Labour’s missions, from economic growth, to breaking down barriers to opportunity to relieving pressure on the NHS."

Henry Dimbleby, the former government food tsar and author of the last National Food Strategy, said: "This report couldn’t come at a more critical moment.

"As the government rolls out its new food strategy, addressing the incentives that drive the sale and aggressive marketing of unhealthy foods must be a top priority. The human and economic toll is too great to ignore any longer."

Professor Susan Jebb, Food Standards Agency Chair, said: "I'm very pleased to welcome the publication of the Food Foundation's new Broken Plate report. Its focus on the food environment and support for healthier and more sustainable diets chimes with the FSA's priorities.

"We need to find ways to deliver safe, healthy, sustainable food as the default across the food system. If we can reshape the food environment, I feel confident we can improve people’s experience so that everyone – whatever their circumstances – can get the physical and mental nourishment that comes from good food."

FOOTNOTES

1.    The MRC Epidemiology Unit at the University of Cambridge built on food price research first conducted in 2014 and matched price data for food and drink items that have been continuously tracked by the Office for National Statistics’ Consumer Price Index (CPI) between 2014 and 2024 to food and nutrient data from the National Diet and Nutrition Survey. Price per 1,000 kilocalories in each quarter of each year was calculated for each item as well as the mean price across all quarters in each year calculated. Using price per kilocalories is a helpful way to understand the relative prices of foods which make up diets and meals, rather than comparing individual products within specific food categories. Each item was categorised as either ‘more healthy’ or ‘less healthy’ using the nutrient profiling model developed by the Food Standards Agency (FSA). The methodology for this metric was updated to include food items from each CPI basket from 2014 to 2024, without excluding items that were not consistently present throughout the entire period. Calorie content was also updated. Outlier items (those priced significantly above the mean) were excluded. Previous years data have been re-analysed to reflect the changes in the set of products that have been consistently measured over the time period. 
2.    The estimated cost of the Eatwell Guide was estimated using a methodology based on modelling undertaken by researchers at the University of Oxford from online supermarket price data collected in May 2022. This cost (£7.48) was then adjusted for inflation since May 2022 (giving an updated cost of the Eatwell Guide for April 2024 of £9.07) and based on household composition. Data on household income from the Family Resources Survey for 2022/23 were used to calculate the proportion of disposable income (after housing costs were removed) that would be used up by the recommended diet. Data were analysed by income quintiles. The methodology used this year for this metric was updated in 2022, so the findings are not directly comparable to pre-2022 reports. 
3.    Questionmark identified a total of 17,686 multibuy and price reduction promotions. The Government’s Nutrition Profiling Model (NPM) was used to assess the healthiness of offers. According to these criteria, foods scoring 4 or more points, and drinks scoring 1 or more points are classified as high in fat, salt and/or sugar (HFSS). Products lacking nutrient information online were categorised as “unknown”. The ingredients list was used to identify products containing sweeteners and emulsifiers. 
4.    Data on the proportion of fast-food outlets out of the total number of food outlets for each local authority were obtained by the MRC Epidemiology Unit at the University of Cambridge from Ordnance Survey’s Points of Interest (POI) dataset for June 2024. The average proportion of fast-food outlets out of all food outlets within all local authorities in England was calculated. The data have been compared to data from previous Broken Plate reports to assess changes over time. All local authorities were numbered according to their IMD ranking and divided into quintiles in equal proportions. The average density of fast-food outlets for each quintile of deprivation was then calculated. 
5.    Data from Nielsen on advertising spend in the UK for food and soft drinks between August 2023 and July 2024 were analysed, covering cinema, direct mail, door drops, outdoor, press, radio and TV. The percentage of advertising spend on different categories of food and drink, and on brand advertising was then calculated. Data was compared to previous years’ Broken Plate reports. This year Nielsen also ran a report on food and drink advertising spend on digital and social media channels during this period. Given the fast-moving and highly targeted nature of advertising spend on digital and social media, Nielsen data on these channels is indicative rather than capturing actual spend. 
6.    This metric used data from the National Diet and Nutrition Survey Year 9-11 for children less than 19 years old. Quintiles represent equivalised income 
7.    The data presented were from the Governments’ national child measurement programmes in Reception in England and Wales, and in Primary 1 in Scotland (aged 4-6 years). The most deprived quintile has been compared with the least deprived quintile. Northern Ireland uses a different definition of obesity and therefore, we are unable to compare it to the other nations. 
8.    Data analysed were from the National Diabetes Audit (NDA), Hospital Episode Statistics (HES), Patient Episode Database for Wales (PEDW), and the Office for National Statistics (ONS). Lower limb amputation data is presented for England and Wales for the calendar years 2009 to 2022. Deprivation quintiles are based on the Index of Multiple Deprivation. 
9.    The data presented are from the Sixth National Dental Epidemiology Programme survey of children in Year 6 England, 2023, and the Hospital Episode Statistics for 2022-2023 conducted by the Office for Health Improvement and Disparities. Deprivation groups are based on the index of multiple deprivation 2019 (IMD 2019) scores based on the home postcodes of the participants. Deprivation scores were used to allow weighting of the data to more closely match the actual distribution of deprivation quintiles in the source population. 

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ABOUT THE FOOD FOUNDATION
The Food Foundation is a charity working to influence food policy and business practice, shaping a sustainable food system which makes healthy diets affordable and accessible for all. We work in partnership with researchers, campaigners, community bodies, industry, investors, government and citizens to galvanise the UK’s diverse agents of change, using surprising and inventive ideas to drive fundamental shifts in our food system. These efforts are based on the continual re-evaluation of opportunities for action, building and synthesising strong evidence, convening powerful coalitions, harnessing citizens’ voices and delivering impactful communications.        
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WITH THANKS TO OUR FUNDER
The Nuffield Foundation is an independent charitable trust with a mission to advance social well-being. It funds research that informs social policy, primarily in Education, Welfare, and Justice. The Nuffield Foundation is the founder and co-funder of the Nuffield Council on Bioethics, the Ada Lovelace Institute and the Nuffield Family Justice Observatory. The Foundation has funded this project, but the views expressed are those of the authors and not necessarily the Foundation. Visit www.nuffieldfoundation.org