How much priority is given to nutrition and health in the EU Common Agricultural Policy?

Agriculture in the European Union (EU) is strongly influenced by the Common Agricultural Policy (CAP). There have been repeated calls for CAP to address nutrition-related health, particularly obesity and non-communicable disease (NCD) in the EU. However, aligning agricultural policy such as CAP with nutrition is complex, not least because the aims of agricultural policy are predominantly economic, presenting a challenge for developing coherence between agricultural trade and health policy. This research examined the political priority given to nutrition-related health concerns within CAP to date, and the solutions suggested by agricultural, trade and health policy-makers and public health nutrition advocates, via interviews of 20 high-level participants from respective sectors. The participants provided diverse perspectives, often varying by sector and institution, on the connections between agricultural policy and nutrition-related health, the extent to which nutrition concerns have "been addressed via CAP and whether CAP is an appropriate and effective policy approach to improve nutrition-related health in the EU in the future. The key findings suggest the need for communication and agreement of clear high-level nutrition guidelines, clarity on the EU mandate to address nutrition-related health concerns via policy, and stronger engagement of civil society in the issues if CAP is to address nutrition more than it is doing currently. The difference in worldviews between agricultural/trade representatives, and those from public health, also needs to be addressed. (C) 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.orgilicenses/by-nc-nd/4.0/)

Effect of increasing the price of sugar-sweetened beverages on alcoholic beverage purchases: an economic analysis of sales data

This is the final published version. Available from BMJ Publishing Group via the DOI in this record.Background Taxing soft-drinks may reduce their purchase, but assessing the impact on health demands wider consideration on alternative beverage choices. Effects on alcoholic drinks are of particular concern, as many contain similar or greater amounts of sugar than soft-drinks and have additional health harms. Changes in consumption of alcoholic drinks may reinforce or negate the intended effect of price changes for soft-drinks. Methods A partial demand model, adapted from the Almost Ideal Demand System, was applied to Kantar Worldpanel data from 31 919 households from January 2012 to December 2013, covering drink purchases for home consumption, providing ~6million purchases aggregated into 11 groups, including three levels of soft-drink, three of other non-alcoholic drinks and five of alcoholic drinks. Results An increase in the price of high-sugar drinks leads to an increase in the purchase of lager, an increase in the price of medium-sugar drinks reduces purchases of alcoholic drinks, while an increase in the price of diet/ low-sugar drinks increases purchases of beer, cider and wines. Overall, the effects of price rises are greatest in the low-income group. Conclusion Increasing the price of soft-drinks may change purchase patterns for alcohol. Increasing the price of medium-sugar drinks has the potential to have a multiplier-effect beneficial to health through reducing alcohol purchases, with the converse for increases in the price of diet-drinks. Although the reasons for such associations cannot be explained from this analysis, requiring further study, the design of fiscal interventions should now consider these wider potential outcomes.UK Department of Health Policy Research ProgrammeMedical Research Council (MRC

3rd Annual Conference of the Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), Developing methods in agriculture and health research, London, 13–14 June 2013

Non-PRIFPRI3; ISI; CRP4; B Promoting healthy food systemsPHND; A4NHCGIAR Research Program on Agriculture for Nutrition and Health (A4NH

Correction: Are sweet snacks more sensitive to price increases than sugar-sweetened beverages: analysis of British food purchase data.

Smith RD, Cornelsen L, Quirmbach D, et al. Are sweet snacks more sensitive to price increases than sugar-sweetened beverages: Analysis of British food purchase data. BMJ Open 2018;8:e019788. doi: 10.1136/bmjopen-2017-019788 The sentence referring to bottom left panel on Figure 1 should say: 'A price increase for chocolate and confectionary items is associated with small but significant decreases across all soft drinks (0.6-0.8% for 10% price increase) as well as biscuits (1.2%), cakes (1.6%) and savoury snacks (0.3%)' Instead of: 'A price increase for chocolate and confectionary items is associated with small but significant decreases across all soft drinks (0.6-0.8% for 10% price increase) as well as biscuits and cakes (1.2%), and savoury snacks (1.6%)'

Reducing consumption of unhealthy foods and beverages through banning price promotions: what is the evidence and will it work?

Increasing prevalence of overweight and obese people in England has led policymakers to consider regulating the use of price promotions on foods high in fat, sugar and salt content. In January 2019 the Government opened a consultation programme for a policy proposal which significantly restricts the use of price promotions that can induce consumers to buy higher volumes of unhealthy foods and beverages. These proposed policies are the first of their kind in public health and are believed to reduce excess purchasing, and therefore over-consumption of unhealthy products. While the impact of price promotions on sales has been of interest to marketing academics for a long time with modelling studies showing its use increases food and drink sales by 12-43%, it is only now being picked up in the public health sphere. However, the existing evidence does not consider the effects of removing or restricting the use of price promotions across the food sector. In this commentary, we discuss existing evidence, how it deals with the complexity of shoppers’ behaviour in reacting to price promotions on foods and, importantly, what can be learned from it in this policy context. The current evidence base supports the notion that price promotions increase purchasing of unhealthy food, and while the proposed restriction policy is yet to be evaluated for consumption and health effects, there is arguably sufficient evidence to proceed. Close monitoring and proper evaluation should follow to provide empirical evidence of its intended and unintended effects

Recent trends in energy and nutrient content of take-home food and beverage purchases in Great Britain: an analysis of 225 million food and beverage purchases over 6 years

This is the final version. Available on open access from BMJ Publishing Group via the DOI in this recordIntroduction In recent years, there has been an increased focus on developing a coherent obesity policy in the UK, which has led to various national policy initiatives aimed at improving population diet. We sought to determine whether there have been concurrent changes in trends in the nutrient content of take-home food and beverage purchases within this policy environment. Methods We used 2012–2017 data from the UK Kantar Fast-Moving Consumer Goods (FMCG) panel, a nationally representative panel study of food and beverages bought by British households and brought into the home (n≈32 000 per year). Households used hand-held barcode scanners to report over 225 million product-level purchases of food and beverages, for which nutritional information was obtained. We estimated daily per capita purchases of energy and nutrients from 32 healthier and less healthy food groups defined using the nutrient profiling model used by the UK Department of Health. Results From 2012 to 2017, daily purchases of energy from food and beverages taken home decreased by 35.4 kcal (95% CI 25.5 to 45.2) per capita. This is explained by moderate decreases in the purchase of products with high contents in carbohydrate (−13.1 g (−14.4 to –11.8)) and sugar (−4.4 g (−5.1 to –3.7)), despite small increases in protein (1.7 g (1.4 to 2.1)) and saturated fat (0.4 g (0.2 to 0.6)). Food and beverage purchases exceeded daily reference intake values in fat (on average +6%), saturated fat (+43%), sugar (+16%) and protein (+28%) across all years. Although substitutions between individual food groups were large in energy and nutrients purchased, the heterogeneity of these patterns resulted in modest overall changes. Conclusion There have been small declines in the purchase of less healthy food products, which translated to a small reduction of total energy and sugar purchases taken home. However, the rate of change needs to be accelerated in order to substantially reduce the health risks of poor diets, suggesting that more radical policies may be needed to attain larger population effects.Medical Research Council (MRC

Framing and signalling effects of taxes on sugary drinks: A discrete choice experiment among households in Great Britain

This is the final version. Available on open access from Wiley via the DOI in this record. Taxes on sugar-sweetened beverages (SSBs) are in place in many countries to combat obesity with emerging evidence that these are effective in reducing purchases of SSBs. In this study, we tested whether signalling and framing the price increase from an SSB tax explicitly as a health-related, earmarked measure reduces the demand for SSBs more than an equivalent price increase. We measured the demand for non-alcoholic beverages with a discrete choice experiment (DCE) administered online to a randomly selected group of n = 603 households with children in Great Britain (GB) who regularly purchase SSBs. We find a suggestive evidence that a price increase leads to a larger reduction in the probability of choosing SSBs when it is signalled as a tax and framed as a health-related and earmarked policy. Respondents who did not support a tax on SSBs, who were also more likely to choose SSBs in the first place, were on average more responsive to a price increase framed as an earmarked tax than those who supported the tax. The predictive validity of the DCE, to capture preferences for beverages, was confirmed using actual purchase data. The findings imply that a well-signalled and earmarked tax on SSBs could improve its effectiveness at reducing the demand.Economic and Social Research Council (ESRC

Framing and signalling effects of taxes on sugary drinks: a discrete choice experiment among households in Great Britain

Taxes on sugar-sweetened beverages (SSBs) are in place in many countries to combat obesity with emerging evidence that these are effective in reducing purchases of SSBs. In this study, we tested whether signalling and framing the price increase from an SSB tax explicitly as a health-related, earmarked measure reduces the demand for SSBs more than an equivalent price increase. We measured the demand for non-alcoholic beverages with a discrete choice experiment (DCE) administered online to a randomly selected group of n = 603 households with children in Great Britain (GB) who regularly purchase SSBs. We find a suggestive evidence that a price increase leads to a larger reduction in the probability of choosing SSBs when it is signalled as a tax and framed as a health-related and earmarked policy. Respondents who did not support a tax on SSBs, who were also more likely to choose SSBs in the first place, were on average more responsive to a price increase framed as an earmarked tax than those who supported the tax. The predictive validity of the DCE, to capture preferences for beverages, was confirmed using actual purchase data. The findings imply that a well-signalled and earmarked tax on SSBs could improve its effectiveness at reducing the demand

Patterns of beverage purchases amongst British households: A latent class analysis

This is the final version. Available on open access from the Public Library of Science via the DOI in this recordData Availability: The terms of our data access agreement mean that we cannot share data. However, data are available directly from Kantar Worldpanel (see www.kantarworldpanel.com/en for contact details). Our contact was Alex Rowberry: [email protected]: Beverages, especially sugar-sweetened beverages (SSBs), have been increasingly subject to policies aimed at reducing their consumption as part of measures to tackle obesity. However, precision targeting of policies is difficult as information on what types of consumers they might affect, and to what degree, is missing. We fill this gap by creating a typology of beverage consumers in Great Britain (GB) based on observed beverage purchasing behaviour to determine what distinct types of beverage consumers exist, and what their socio-demographic (household) characteristics, dietary behaviours, and weight status are. Methods and findings: We used cross-sectional latent class analysis to characterise patterns of beverage purchases. We used data from the 2016 GB Kantar Fast-Moving Consumer Goods (FMCG) panel, a large representative household purchase panel of food and beverages brought home, and restricted our analyses to consumers who purchase beverages regularly (i.e., >52 l per household member annually) (n = 8,675). Six categories of beverages were used to classify households into latent classes: SSBs; diet beverages; fruit juices and milk-based beverages; beer and cider; wine; and bottled water. Multinomial logistic regression and linear regression were used to relate class membership to household characteristics, self-reported weight status, and other dietary behaviours, derived from GB Kantar FMCG. Seven latent classes were identified, characterised primarily by higher purchases of 1 or 2 categories of beverages: 'SSB' (18% of the sample; median SSB volume = 49.4 l/household member/year; median diet beverage volume = 38.0 l), 'Diet' (16%; median diet beverage volume = 94.4 l), 'Fruit & Milk' (6%; median fruit juice/milk-based beverage volume = 30.0 l), 'Beer & Cider' (7%; median beer and cider volume = 36.3 l; median diet beverage volume = 55.6 l), 'Wine' (18%; median wine volume = 25.5 l; median diet beverage volume = 34.3 l), 'Water' (4%; median water volume = 46.9 l), and 'Diverse' (30%; diversity of purchases, including median SSB volume = 22.4 l). Income was positively associated with being classified in the Diverse class, whereas low social grade was more likely for households in the classes SSB, Diet, and Beer & Cider. Obesity (BMI > 30 kg/m2) was more prevalent in the class Diet (41.2%, 95% CI 37.7%-44.7%) despite households obtaining little energy from beverages in that class (17.9 kcal/household member/day, 95% CI 16.2-19.7). Overweight/ obesity (BMI > 25 kg/m2) was above average in the class SSB (66.8%, 95% CI 63.7%-69.9%). When looking at all groceries, households from the class SSB had higher total energy purchases (1,943.6 kcal/household member/day, 95% CI 1,901.7-1,985.6), a smaller proportion of energy from fruits and vegetables (6.0%, 95% CI 5.8%-6.3%), and a greater proportion of energy from less healthy food and beverages (54.6%, 95% CI 54.0%-55.1%) than other classes. A greater proportion of energy from sweet snacks was observed for households in the classes SSB (18.5%, 95% CI 18.1%-19.0%) and Diet (18.8%, 95% CI 18.3%-19.3%). The main limitation of our analyses, in common with other studies, is that our data do not include information on food and beverage purchases that are consumed outside the home. Conclusions: Amongst households that regularly purchase beverages, those that mainly purchased high volumes of SSBs or diet beverages were at greater risk of obesity and tended to purchase less healthy foods, including a high proportion of energy from sweet snacks. These households might additionally benefit from policies targeting unhealthy foods, such as sweet snacks, as a way of reducing excess energy intake.Medical Research Council (MRC