25/02/20 – Three Issues: – tackling holiday hunger, the first 1001 days and the role of supermarkets in nudging children’s health

Speakers: Brian Jarrett, CEO of The People’s Supermarket; Edwina Revel, Programme Director, Early Start Group Ltd; Louisa Mason, Policy & Communications Executive, Royal Society for Public Health

25 February 2020

All-Party Parliamentary Group on a Fit and Healthy Childhood

‘Three Issues: – tackling holiday hunger, the first 1001 days and the role of supermarkets in nudging children’s health’

Chair: Steve McCabe MP

Speakers: 

Brian Jarrett, CEO of The People’s Supermarket; Edwina Revel, Programme Director, Early Start Group Ltd; Louisa Mason, Policy & Communications Executive, Royal Society for Public Health

Chair’s Opening Remarks

Good evening everybody and welcome to this, the 46th meeting of the All-Party Parliamentary Group on a Fit and Healthy Childhood and the first in this new Parliament.

Tonight we will be looking at three different issues.

Firstly, we will hear from Brian Jarrett, the CEO of The People’s Supermarket, on pilot schemes to combat holiday hunger and address inactivity. This initiative has come about by members such as yourselves banding together to get things done.

Then we shall hear from Edwina Revel, Programme Director of the Early Start Group, talking about ‘the first 1001 days’ issues. I understand there may have been a significant PHE launch over the weekend.

Finally, we shall hear from Louisa Mason, Policy & Communications Executive at the Royal Society for Public Health.

Louisa will talk about how supermarkets can make a positive contribution to tackling child overweight and obesity. The RSPH published a report on this last year and I hope you’ve all seen our own report published last week.

Could I ask all of our speakers to limit themselves to 6 or 7 minutes so there is sufficient time for a Q&A and a general discussion.

Thank you all for coming along tonight, and may I please hand over to you, Brian, to get us going.

Brian Jarrett, CEO of The People’s Supermarket

I started as a Chartered Accountant in the City of London but I help startups and tech companies. But it’s all about “giving back”, and when I was invited to get involved in the Holiday Hunger project it did at first seem quite daunting but actually, once we got into it, it was fine.

When I was first involved in this group we were looking at obesity in childhood, which as we know is a big worldwide problem. But we not only have a problem with obesity, we also have a problem with children going hungry. I got introduced to a number of MPs who had looked at this in some detail but for many different reasons hadn’t made progress, so I, along with a number of others in this room, was invited to start from scratch and start looking at it with the objective of influencing Government policy to the extent that some of it could be put into law. A Private Member’s Bill has gone forward, called the Holiday Hunger Bill, and that was the first objective we achieved. The second objective is one of awareness and trying to introduce a model and a report on a pilot that can be taken forward by different organisations but also that we can use as credible evidence when we are lobbying ministers and Government officials and others who have influence.

This is a problem that everyone needs to look at and understand. When we get to problem definition, what is happening out there – in the UK – in 2020 – was a shock to me. We have around 3 million children at risk of holiday hunger. There can be a number of reasons – family breakdown, language issues, lack of money – a lot of it is just deprivation. As we know, we always judge a society on the way they look after the needy and the children.

So at a time when children – in the UK, in 2020 – are going hungry and people are standing by and doing nothing about it, at least we can say as part of this group that we’re not going to stand by – we are going to do something.

So, what are we doing? We have set up a steering committee, with a chair, secretaries and people to look after the money. We started with zero pounds and zero pence and we’ve started fundraising. We have project managers in place working pro bono, and everyone at this stage is working for nothing – just like a number of people in this room.  We’re not getting paid: we’re just trying to effect change.

We’ve identified four areas around the country that we need to focus on, to make it tangible and to keep the scope manageable. Those areas are Blackpool, Bristol, Tower Hamlets and possibly Croydon. Where we are right now is that we have made some substantial progress in fundraising and contacting schools and we’ve identified a number of schools who will be part of the scheme. We’ve put a plan in place in terms of what the model will look like: this is 4 weeks, 4 days, and between 60-100 children getting involved.

The scheme is called SHAWS (School Holiday Activity Wellbeing Scheme) and the idea is to introduce it working with a partner, which is Play England, introduce the wellbeing side and get access to the parents and actually address areas by helping to sign on, fill in forms, and so on. A lot of the problems arise from not having enough money in the household and we want to deal with the cause of the problems rather than just the symptoms.

Edwina Revel, Programme Director, Early Start Group Ltd

I currently lead on delivering a nutrition programme in Newham, East London which aims to ensure all children have access to nutritious and affordable food to support their health, well-being and development. We know that giving children the best start in life is the most effective way to address health inequalities long term. With one in five children already overweight or obese before they start school, the early years is a crucial time to support young children and their families to establish healthy eating habits to take with them into their school years. In Newham our Early Start Nutrition team deliver a range of training sessions to early years staff and health visitors to ensure consistent, frequent and evidence based information is available to families.

One of the key messages that lays the foundations for our training sessions is to highlight the importance of the first 1000 days – that is the moment of conception and carries on through to a baby’s second birthday. The nutrition a baby receives in the first 1000 days of their life will determine their health, cognitive abilities and physical development for the rest of their lives.

Nutrition, in particular, plays a foundational role in a child’s development. Poor nutrition in the first 1,000 days can cause irreversible damage to a child’s growing brain, affecting their ability to do well in school and earn a good living—and making it harder for a child and her family to rise out of poverty. It can also set the stage for later obesity, diabetes, and other chronic diseases which can lead to a lifetime of health problems.

As a team of nutritionists we have to look at the key stages within those first 1000 days where we can have an impact. A lot of parents are very receptive to the idea of the importance of child health prior to conception and in the first 12 weeks of conception. We do, however, know that an estimated one in six of pregnancies are not planned so those present quite a challenge to getting the message across as health visitors, midwives etc. are missing out on opportunities to give out these healthy messages, and that’s something we want to eradicate.

What we’re also seeing where health professionals do have contact with future parents, they’re not also discussing advice around healthy weight gain and what a healthy diet might look like during pregnancy. So some of the key messages we want to get across include the importance of a balanced diet, foods to avoid, focussing in on some of the key nutrients like folic acid, vitamin D and calcium which will help the development of the baby’s skeleton, brain and nervous system.

We are supported by a lot of key public health policies: NICE has a lot of guidance around weight during pregnancy, and we have the Healthy Child Programme that is available for Health Visitors, but as a team of nutritionists we really want to ensure that all those contacts with families count, and as much as possible we want to get the message to families prior to pregnancy.

The other key stage that we focus on is nutrition for infants and so of course we encourage breastfeeding as the optimal nutrition for babies as they will get all the nutrients they need, all the antibodies to reduce infection, and we also know the importance of the bond that is built between mother and baby during breastfeeding. However, we need to bear in mind some of the mental, physical and emotional challenges too that parents face with breastfeeding.

Our team works with nursery staff and with childminders. As there are around 3 million childcare places in England, more and more children are eating meals outside the family home. There’s a huge opportunity therefore for these early years settings to influence the nutrition of children very early on.

We want to support mums to be able to continue to breastfeed when they go back to work and that is not always something that is supported. We want to make sure that childcare settings have facilities for mums to be able to breastfeed before and after work and to be able to express milk. We know that every additional breast feed reduces the risk of obesity later on: every additional month of breastfeeding that a child has results in a 4% reduction in risk of later obesity.

We will of course have a number of mums who choose to formula feed and again, we want to support those mums to think about the bond that they can also have with their baby, to think about responsive feeding and also to think about how to safely prepare formula milk.

We do a lot of training around the introduction of solid foods and we are supporting our early years settings to think about the UNICEF baby-friendly initiative as well and how they can roll that out in their settings.

Another important area for us in relation to the first 1000 days is the introduction of solid foods. About 75% of parents will have introduced solids earlier than the recommended six months, so again it’s very much about providing the education to families and early years settings on how they can safely introduce solid food and to think about the development of a healthy well-balanced diet that the children will take with them into the toddler years.

We know that a lot of the eating behaviours that children develop in early years are taken with them into adulthood, so it’s very much about the key stages that we would influence, which are in pregnancy, through breastfeeding or safe introduction of formula milk, through the weaning stages as well. Brian talked about the impact of children going hungry in the holidays and that’s something we are also looking at in the early years. We have a number of children accessing the free 15 hours which means while they’re in childcare they will have access to healthy and nutritious food, but in the times that they are not in childcare they may be challenged to get a balanced diet.

We have the healthy start scheme, which is available for families who are eligible (in receipt of child tax credits, income support, jobseeker’s allowance, etc.) Uptake is quite low at 53% in the UK, which means there is a huge proportion of families losing out on access to vouchers for fruit and vegetables, milk and vitamin D supplements, so that’s another area of work that we really need to push forward to make sure that we are maximising the ability of families to access affordable and healthy food.

So those are some of the key areas that we are addressing through our nutrition training and support of optimum nutrition in the first 1000 days.

Louisa Mason, Policy & Communications Executive, Royal Society for Public Health

The Royal Society for Public Health is a health and education charity and we campaign on various health issues including obesity. Related to obesity in the past couple of years we’ve shifted towards the “obesogenic environment”: basically an environment that makes it quite difficult to maintain a healthy weight. One area we wanted to hone in on was the role of supermarkets and how they could be more helpful by promoting spaces and nudging consumers into making slightly healthier choices, with the consumers even realising they were doing so.

This APPG’s most recent report, Healthy Families: The Present and Future Role of the Supermarket, echoed much of our research and calls to action. Pleased to see that this issue has traction/political support, and the coverage it garnered.  

We teamed up with Slimming World and The People’s Supermarket and over the course of last year we developed a plan and then took over The People’s Supermarket and opened a pop-up over a couple of days. We called the pop-up “Nudge at The People’s Supermarket”.

It was quite a process to get to the point of being able to do that. We started off by consulting a panel of experts (public health professionals, retailers, nutrition and behaviour change specialists) and we asked them “in an ideal world” how they would design a supermarket that would be for the good of children and families so that when they went shopping it would be easy to get the best food. What would a supermarket that would nudge customers towards better health look like?

Some progress has been made e.g. Tesco banned sweets at the checkout, Morrisons give out free fruit to children. While we applaud that we felt that retail can do more, and the idea of this panel was to try to supersize that idea, do a bit more and put it all into one shop.

So we had a long list of recommendations around food allocation and position, shopper experience for both adults and children (quite different), labelling and education on nutrition.

We also wanted to consult with the public because for everything we do we try to get the public onside as we are doing this for them. 36% said they impulse purchase unhealthy products because they’re on special offer. 75% of parents with children under 10 think that supermarkets should do more to promote healthy food and drink to children. 69% said that unhealthy products are often at their child’s eye level, which leads to a lot of “pester power”.

We worked with Brian at The People’s Supermarket by taking it back to square one, looking first of all at the type of products that were stocked. Changes we made included new signs to promote healthier food categories, re-distribution of healthier food to most prominent positions (gondolas and top shelf), junk food away from checkout, food samples, nudges e.g. healthier swaps, recipe cards, proportion of stock in line with Eatwell Guide (e.g. increased water and reduced soft drinks), and Eatwell Guide promoted throughout store.

In the Eatwell Guild a third of our diet should be fruit and vegetables, so we wanted a third of the supermarket’s space to be fruit and vegetables. Equally, whole grains and starches (which should take up another third of the plate) were also given more space.

We took the idea from sugary cereals where cartoon characters are used for promotion and we used our own cartoon characters to draw children’s attention to fruit and vegetables. We replaced sugary drinks with water, took sweets away from the checkout, and produced tasting samples from the kitchen we were lucky to have access to. Free samples were available throughout the pop-up which was especially good for getting children to try new things. People on a limited budget are often constrained from buying unfamiliar food that the family potentially might not eat, so the tasters were a good way for customers to try something before they bought it.

We also trained staff members. We weren’t expecting staff to become trained nutritionists but they had enough training to signpost customers to healthy swaps and so on.

One of the most significant things we did, and why it was called “Nudge at The People’s Supermarket”, was that we covered the store in “nudges”: snippets of advice, suggestions, prompts, etc. so that customers were reminded of healthy swaps and choices as they were going round doing their shopping.

It went pretty well. We had a lot of customer feedback: 70% positive and parents especially were encouraged to see the reduction in sugary drinks and children were intrigued by the cartoon characters.

So, we saw it as a success and we hope that we demonstrated an example of what supermarkets could be doing.

Questions and Comments:

Paul Wright WRS Health Edco: (to Louisa) What is your opinion of foods showing the activity level of food (e.g. the amount of activity required to burn off the food). This seems to have been well received by young people and I wonder if it would make a difference?

Louisa Mason: Potentially it could do and it was in the news back in November when a study came out saying that these labels could be helpful. When it comes to obesity we are never going to find a silver bullet but lots of little things can make an overall difference. However, we do have to also consider the other side, which is that this kind of labelling isn’t necessarily beneficial for all members of society and the flip side is that it can have a very negative impact on people with eating disorders.

Steve McCabe: Is it about educating the parents?

Edwina Revell: Yes it is definitely about educating families about the nutritional content of food. Calorie counting isn’t always beneficial, especially in the early years, and we do want a shift more towards an overall balanced diet in general.

Brian Jarrett: Changing behaviour is also very difficult. Take cigarette smoking for example – some of the pictures on the packets are horrendous but it makes no difference to a lot of smokers. Some people deliberately do not look at the packets – they know what it’s doing to them but they are looking away. It’s obviously a deeper problem and it’s not just food – it’s all things that are bad for us. We have to look at the science of change and that’s why we prefer the ‘nudge’ approach and not the ‘nag’ approach.

Eunice Lumsden, University of Northampton: I have two questions. The first is “where is our outrage?” As a nation we should be outraged at the state of provision. The other question is about our language. We do not have a family policy in this country and we are not going to have one for another five years as we’re on our fifth minister for Education and Child Care. Yes, we might have children in nurseries but the policy at the moment is asking nurseries to ask the parents to pay for the food. We have a jigsaw, with various practices across the country. So isn’t our job less about educating parents but more about giving parents a voice and allowing them to shout loudly? We’ve removed all the children’s centres, removed all the support – so you cannot expect a mother who is having the 15 hours free entitlement because they’re living in poverty and disadvantaged, to do what you’re asking. They haven’t go the time or the energy. Yes, it’s very good for middle-class parents but actually our society isn’t like that any more. So how do you empower parents to shout louder? The piecemeal things that are being done have to be applauded, of course, but there are some deeper ingrained issues that have grown over the last ten years.

Steve McCabe: Are you saying that unless there is a better politically-framed family policy the other aspects of this will struggle?

Eunice Lumsden: Yes. The families that you need to reach out to are the families who haven’t really got the capacity to, because they’re working for zero credits, which drives poverty.

Steve McCabe (to panel): So, what do you think? Three million children going hungry . . .

Brian Jarrett: Takingagroup of, say, 100 children in one of our schemes, you could find 20 different reasons for why they are hungry. The reason why we focus on activity is to do with the stigma that is attached to feeding children. It is hard for a parent to bring a child to a school for food – it’s like admitting that they have failed. The shocking part, which is so unfair, is that society looks at this situation and blames the parents. Society doesn’t want to talk about it, so this is why we have the wellbeing focus in SHAWS as we have to find a way of talking to the parents and getting them to open up. When we first started talking about holiday hunger, not many people had heard of it because it’s just not talked about.

So how do we get people to talk, to get people to shout louder? There are hundreds of schemes trying to do something and we want to be able to have a “heat map” and get them all connected – and maybe by this time next year have a way of getting everyone together and getting parents to say, “We are not going to be ignored any more”.

Steve McCabe: It’s difficult to marry assistance with outrage. If you’re having to turn up at a food bank, you’re probably not at your most receptive to hearing someone tell you, “this is ridiculous and you need to listen . . .  “ My sense is that you’re right that parents will prefer to come to a scheme for the activity rather than to admit that they can’t feed their child. It’s a way round it but it’s quite difficult to communicate those messages when people are already at a fairly low ebb.

Pippa Bagnall, Resilience & Co: I’m a former school nurse and children’s health campaigner and I’m happy to be outraged with you any day! I think it’s so sad that the publication of today’s Marmot Report shows us that in ten years we have gone backwards. Brian, I hope you don’t have to be pro bono for too long. It’s a fantastic job and you – and people like you – shouldn’t have to do this pro bono. We need to recognise such great work.

Brian Jarrett: I sat with two project managers yesterday and explained that I would try to pay them, maybe in a month’s time. They said that they had already accepted that they wouldn’t be paid, and not to worry, they weren’t going to leave and they would join with us to get this through and deliver the project.

This is not a hard sell but we are fundraising, so I say to people in this room that if any of you can connect me to any funding sources or organisational grants, please get in touch. There are many big companies with holiday hunger on their doorsteps and we need to approach them for funding. I’m looking for warm introductions though, so anyone who can help with that should get in touch.

Pippa Bagnall, Resilience & Co: A question for Edwina: You mentioned breastfeeding in the workplace. I know of a mother who had such a hard time doing this at work, which is appalling – especially as they had a smokers’ shelter outside!

Edwina Revel: I know that there’s a lot of work going into making London more baby-friendly. This is not just in work but also in supermarkets, early years settings, public buildings etc. We want to make all families feel that they are supported in breastfeeding for as long as they want to, even beyond the first year.

Steve McCabe: I thought that was an amazing statistic you quoted earlier – that there is a 4% reduction in the risk of obesity for every additional month of breastfeeding.

Vaness Lucas, Local Government Association: Regarding Healthy Start Vouchers, the uptake is very low and we’ve been thinking about ways of promoting them. There’s a lot of work done locally but not nationally. How about targeting parents who go to claim Universal Credit, for example? What other ideas could help increase awareness so that more people claim these vouchers?

Edwina Revell: A lot of claimants of the free 15 hours childcare will also be eligible for the Healthy Start Vouchers. I think a lot of emphasis was put on health visitors to talk about this scheme, and some of the barriers are related to the sign-up as it has to be signed off by a health visitor, GP or midwife. Also, a lot of the information isn’t always in the parents’ first language and they struggle with the application process. Some of the other challenges are in terms of the vendors where the vouchers are exchanged. At one point they were looking to have a card-based system, so absolutely there’s a lot more work that needs to take place in terms of spreading the word and not just relying on health visitors and midwives. It should be something that all of us professionals should be talking about.

Steve McCabe: Couldsupermarkets do more to promote the scheme?

Louisa Mason: I’m sure if there was more funding we could get it into more supermarkets, especially the smaller community-based ones like The People’s Supermarket. It fits well with the more local supermarkets to help support new parents.

Brian Jarrett: Manypeople now use their phones for payment so really there should be a phone-based system for people to spend these vouchers. That would have the added advantage of being discreet.

John Wheatley, Children’s Cancer and Leukaemia Group: Howmany of your target families for this have smart phones – do you know?

Brian Jarrett: We don’t know, unfortunately, but a lot of the problem is with young mothers and they do spend a lot of time on social media. That’s part of the problem because they haven’t got that physical support network around them. One young mother we know has to hide cash from her partner because as soon as there is money in the house he will come in and take it – so technology would help but we are only just scratching the surface of the problem.

Steve McCabe: There’s an argument following the principle of Universal Credit that these extra things could be on there as well.

Paul Aagaard, Recipe for Change: I think you said that 75% of parents feel that supermarkets could do better. Could we use that as a lever to make the healthy nudge promotions much better and much bigger? For example, the free fruit for children in Tesco’s is great, but it’s not great because the free-standing display is tiny versus the mountain of chocolate and sugary drinks. And the health swaps one that they did, fronted by Jamie Oliver, where people could swap for a cheaper healthier product, was for a limited period only. At the end of the period the healthy options increased in price and became dearer than the unhealthy options.

Louisa Mason: I think having those voluntary initiatives is a good start but it would be good to have a level playing field for supermarkets. It’s definitely something we could all lobby for.

Paul Aagaard, Recipe for Change: Also the school fruit scheme, which I helped launch 15 years ago, is great – except that it’s not great when the children are given the fruit at playtime and then run around with it creating a choking risk and creating a lot of waste. The biggest problem can be around the delivery of these policies.

Louisa Mason: Completely unrelated, but I visited a school in Lambeth with a great initiative around lunchtime where everyone sits down together at tables with mixed year groups. They call it family lunchtime to spend half an hour sharing food together.

Paul Aagaard, Recipe for Change: Yes, that’s exactly what I do – I convert school canteens into restaurant, making them user-friendly and use that time sensibly and smartly rather than it being just an inconvenience.

Edwina Revel: In terms of early years we support a positive eating environment and it can be a challenge for a lot of children making the transition from pre-school into primary school where there’s more or less a free-for-all. There needs to be a more joined-up approach between nurseries and schools so that the opportunities to learn and look at the social opportunity around mealtimes (often lost as children get older) are not lost. We do have a fifth of children leaving nursery already overweight or obese and that almost doubles as they leave primary school, so there must be something positive that is happening in the early years settings where children are supported to sit down, have a mealtime and a routine.

Brian Jarrett: On the subject of supermarkets, it’s important to know that 70% of products fall into the addictive, unhealthy, negative sector – but these products are legal and profitable. It’s nice to think that a supermarket might not sell these products but in reality that would never happen because the firm would go out of business. To move the 70% to something closer to 30% represents a huge shift in revenue – it’s very significant. It’s also a global problem and we have global supermarkets operating in the UK, so even the UK Government has a limit to what they can do.

Pippa Bagnall, Resilience & Co: On the subject of packaging, why is it that only some foods are marketed to children with, e.g. colours and cartoon characters? Why can’t fruit and vegetables be marketed in this way?

Paul Wright, Health Edco: I come from a background of graphic design for products and the problem we always have is knowing that we have to get to fathers and grandparents because we know they have a substantial amount of time with children, but this can be difficult.

Louisa Mason: TheVeg Power fund is a really good example of how we can do more to promote healthy eating, and we should be doing more of this kind of thing. It’s great that Lidl have pledged to take cartoon characters off their own-brand cereals but unfortunately if we want them to all do it, it comes back to legislation.

For example in Chile there are now warning labels on HFSS foods. These are big black symbols on the front of products indicating (e.g.) “high fat” or “high salt”. So that’s quite a radical approach they’re taking over there and definitely something to keep an eye on.

Brian Jarrett: Just to wrap up on that point, coming back to why people do things. Do they do it because they have to – because you can put double-yellow lines on the road and people will still park on them. People break rules! You have to incentivise them so that people do things that they want to and enjoy, and feel the benefit of changing. You can get someone to change if the change is driven psychologically by them because they find it cool or fashionable or beneficial – and not because it’s a rule. We have to come at it from a different angle. Government cannot solve it because all Government can do is impose rules and people will still break them. But the big change may come soon – ecological, sustainability, green. It actually will, because somehow that has become fashionable, for example a surprising amount of people are now proud to be vegans.

Steve McCabe: It’s much easier to impose rules when people want them. I remember when the smoking ban was introduced, there was great turmoil in this place, but look at how readily that was accepted by the mass of the public. They were obviously ready for it.

After some further discussion, questions and comments, the meeting closed at 6.10 pm.

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