The Whole Grain Truth

Posted on 1 May, 2015 by Fiona

Professor Chris Seal is a Professor of Food and Human Nutrition, and Kay Mann is a postgraduate student, within the Human Nutrition Research Centre at Newcastle University. They are calling for the next government to introduce clear guidelines on the amount of whole grain we should be consuming.

The evidence: Whole grains are good for us

Current literature suggests that those eating three or more servings of whole grain, compared with those that eat none or only small amounts, have a 20-30% reduction in their risk of developing cardio-vascular disease and type 2 diabetes. Higher whole grain intake has also been linked to lower body weight, BMI and cholesterol levels. Other research suggests that eating whole grains can make you feel fuller for longer and that you do not need to eat as much of a wholegrain food compared with a refined version to feel full.

The problem: The picture in the UK

Our new research on over 3000 UK adults and children who took part in the National Diet and Nutrition Survey (NDNS) between 2008 and 2012 shows that over 80% of us are not eating enough whole grains. Amazingly, almost one in five people don’t eat any whole grains at all!

One reason for this may be that in the UK there aren’t any specific recommendations on the amount of whole grain we should eat each day, other than the NHS Eatwell Plate advice to “choose wholegrain varieties whenever you can”. Countries such as the US, Canada, Australia and Denmark give much more specific daily recommendations. These range from a minimum of 3 servings (or 48g) per day in the US to between 60g and 90g per day for women and men in Denmark.

Three servings (around 48g) is equivalent to:

3 slices of wholemeal bread
A bowl of porridge or wholegrain breakfast cereal and a slice of wholemeal toast
A portion of whole grain rice/pasta/quinoa or other whole grains

UK public advice about whole grains was first introduced back in 2007, when it was recommended to look out for ‘whole’ on food labels and to ‘choose brown varieties where possible’. We analysed whole grain intake from the NDNS back then and it seems little has changed in consumer habits since.

The amount of whole grain we eat in the UK is still very low – an average of around 20g a day for adults– compared with Denmark where the average daily intake is around 55g. In the UK, we tend to eat a lot of white bread, rice, pasta and cereals and lots of processed foods, all of which have no – or very little – whole grain in them and also tend to be higher in fat and sugar.

In Denmark, since the introduction of a whole grain campaign backed by the government and food producers, whole grain intake has risen by 72 per cent. We’d like to see a similar commitment here in the UK with a government-backed daily intake recommendation which can be used to develop successful public health campaigns.

So what are whole grains and what do they do?

Whole grains are defined as the ‘intact, ground, cracked or flaked kernel after the removal of the inedible parts such as the hull and husk’. This means that the three component parts of a grain – the outer bran, the germ and endosperm – remain in the final food product. Combined, these contain important nutrients such as fibre, vitamins and minerals and phytochemicals. When grains are refined to make white flour, many of these valuable nutrients are lost, and only a few are return with mandatory fortification.

Whole grains include; whole wheat (wholemeal), whole/rolled oats, brown rice, wholegrain rye, whole barley, whole corn/maize, whole millet and quinoa. The key is to look for the word ‘whole’ on an ingredients list and also for the ingredient to be high up on the list. These ingredients can be found in foods such as wholemeal bread, wholegrain breakfast cereals, porridge, wholegrain pasta and rice.

There are a small number of people that suffer from a gluten intolerance, which means that they have to avoid eating grains that contain high levels of gluten such as wheat, barley and rye. It is still possible for them to get their whole grains. Whole grain oats do not contain gluten but can sometimes be contaminated with wheat during harvesting and processing, others such as amaranth, buckwheat, brown rice and quinoa are also gluten free.

How whole grains have their effects is not clear. Certainly a key factor is better digestive health, but we also see lowered blood cholesterol, reduction in inflammation, lower body weight and lower weight gain in people who eat more whole grains.

The solution

We advocate:

the introduction of specific guidelines to promote whole grain intake in the UK
an emphasis on how easy it is to introduce more whole grains into diet – no major lifestyle change is needed
small tweaks to diet such as replacing white rice and pasta for brown, eating porridge or a wholegrain cereal for breakfast instead of a refined grain breakfast cereal, or swapping white bread for whole meal bread

Tackling Obesity – Through Planning and the Built Environment

Posted on 14 April, 2015 by Fiona

With obesity rates at crisis point across the UK, Dr Tim Townshend, Director of Planning and Urban Design within the School of Architecture, Planning and Landscape, discusses the part that our built environment has to play. Part of the Newcastle University Institute for Social Renewal‘s Ideas for an Incoming Government series, Dr Townshend argues that central government and local authorities need to take action now to promote healthy living in our communities.

What is the problem?

Rates of obesity have reached crisis point, with accompanying health problems (type 2 diabetes, coronary heart disease etc.). In 2007 the Foresight Report ‘Tackling Obesities: Future Choices’ suggested there was enough expert evidence to implicate built environment in the obesity crisis. The places where we live, work, go to school and spend our leisure time can either provide, or constrain, opportunities for physical activity and access to both healthy and unhealthy food. However, the planning system in England is ill equipped to act on this evidence.

This needs action now. Even if the influence of the built environment is small at the individual level, given its impact is over whole communities and that it generally survives several generations unchanged, it is highly significant in aggregate. The change in policy initially needs to address the National Planning Policy Framework (NPPF). The NPPF calls for the planning system to promote ‘healthy communities’, but it is vague in its focus and how this might be achieved.

Obesity is not the only health crisis to face the country – however, it is one in which intervention in the built environment could make a significant difference and interventions to tackle obesity have the potential to deliver broader health and well-being benefits. For example, there is evidence that providing adequate good quality open spaces will encourage physical activity – we also know that physical activity and greenery/green space are also linked to improved mental health and well-being. Moreover obesity is also a problem that has a distinct socioeconomic profile – poorer communities are more adversely affected by obesity and related health/well-being issues than their better off neighbours – and therefore addressing this issue can help tackle health inequalities through the planning system.

The Solution

Action by Central Government/ Department of Communities and Local Government (DCLG)

The NPPF:

The NPPF (or its replacement) needs to be strengthened – it should state that planning policies must deliver (not merely promote) environments that support healthy lifestyle choices.
The NPPF should be clear that policies that deliver healthier environments should be enshrined in core polices of the Local Development Framework (LDF) – i.e. not just Supplementary Planning Documents (SPD) so they carry enough weight to be acted upon.
The viability clause – paragraph 173 – must be rewritten. The elements which support healthy lifestyles, good quality public realm, greenspace, bespoke cycle provision are expensive – however ‘viability’ should not be used as an acceptable reason to remove elements of design in the planning process which are proven to be linked to healthy behaviours and outcomes.

More broadly non-planning actions DCLG should consider include:

Including directives that aim to improve health and wellbeing in other built environment guidelines – such as UK Building Regulations
Introducing a ‘healthy lifestyle’ kitemark or rating system (like that used for energy efficiency) for new buildings, particularly housing.

Action by Local Authorities

Local authorities should have planning policies that:

Deliver healthier lifestyles and greater well-being through the built environment incorporated in their Local Development Framework – to ensure enough weight is attached to these policies. Supplementary Planning Documents may be used to support and/or enhance core policies.
Enable ‘active travel’ (walking/cycling) to be ‘designed in’ as part of everyday life for communities wherever possible
Ensure adequate greenspace – in its full variety of forms (pocket parks; parks; sports pitches; garden allotments; wildlife areas etc) – is provided, particularly when new housing is developed
Restrict the proliferation of fast food outlets – in particular prohibit new outlets in the proximity of schools and children’s centres

More broadly:

Ensure the new public health responsibilities in local authorities (Public Health Boards etc.) are fully linked into to planning practice – for example through robust review processes.

The evidence

There is a vast body of evidence, it’s not all in a form that can be used by planning – however the Government Office for Science Foresight Report provides a useful summary:

FORESIGHT 2007. Tackling Obesities: Future Choices – Project report. London: Government Office for Science.

Also see:

LAKE, A. & TOWNSHEND, T. 2006. Obesogenic environments: exploring the built and food environments. The Journal of the Royal Society for the Promotion of Health, 126, 262-267.

TOWNSHEND, T. G. & LAKE, A. A. 2009. Exploring obesogenic urban form, Theory, policy and practice, Health and Place, 15, 909-916.

Townshend T.G. (2014) Walkable Neighbourhoods: principles, measures and health impacts, in Burton E., & Cooper, R Well-being and the Environment, Oxford, Wiley-Blackwell

TOWNSHEND, T.G., GALLO, R. & LAKE, A.A. (May 2015) Obesogenic Built Environment: Concepts and Complexities in BARTON, H., GRANT, M., THOMPSON, S., & BURGESS, S. (Eds) The Routledge Handbook of Planning for Health and Well-being, Abingdon, Routledge.

Restricting the Marketing of Alcohol Directed Towards Young People

Posted on 11 March, 2015 by Fiona

What impact does alcohol marketing have on young people? Our newest Idea for an Incoming Government is from Professor Eileen Kaner and Dr Stephanie Scott (Institute of Health and Society), who call for restrictions to be put in place, protecting our national health, and improving young lives.

What is the problem?

Alcohol use is the leading risk to health and well-being in young people, accounting for seven percent of disability adjusted life years in 10-24 year olds globally, with UK adolescents amongst the heaviest drinkers in Europe. Frequent, often high-intensity drinking in early to mid-adolescence has been linked to a myriad of adverse effects. Short-term implications, which pose the greater immediate risk, include accidents; early and unprotected sex; exacerbation of mental health problems; and poor school attendance and reduced educational attainment. Acute problems may have life-time consequences, such as early disfigurement or unintended pregnancies. Moreover, the longer and heavier an individual drinks, the greater the risk of developing chronic health problems such as liver disease or cancers later in life.

As a caring society, we should do more to limit youth exposure to alcohol marketing. But how can we be sure that there is a connection between this and alcohol misuse?

A growing body of literature, including two recent systematic reviews (Anderson et al, 2009; Smith and Foxcroft, 2009), demonstrates an association between exposure to alcohol marketing and initiation or progression of alcohol use, as well as development of pro-drinking attitudes and social norms (Gordon et al, 2010; Lin et al, 2013). UK research suggests that alcohol brand recognition is common amongst young people as young as 10-11 years old (Alcohol Concern, 2012) with US studies demonstrating identification with desirable images in alcohol advertising in 8-9 year olds and brand-specific consumption in 13-20 year olds (Austin et al, 2006; Siegel et al, 2013).

Despite the heavy attention paid to price and traditional advertising, alcohol marketing is much more extensive and comprises price, product (image/branding), promotion (including advertising) and placement (point of sale and outlet density or distribution), defined as the ‘4 Ps’ or ‘marketing mix’. This means that availability as well as how a product looks or tastes can be of as much importance as how much it costs. The extensive nature of alcohol advertising, including through new media (e.g. sponsorship of social networking sites) means that young people are regularly exposed to alcohol promotion including many who are below the legal age to purchase alcohol.

A recent qualitative study in North East England among 14-17 year olds found that marketing seemed to play a key role in building recognisable imagery linked to alcohol products, as well as associations and expectancies related to drinking (e.g. having fun, drinking games, brand slogans or logos, drinks associated with certain TV shows, such as cocktails).

The solution

Restrict alcohol advertising in newspapers and other adult press, with content limited to factual information about brand, product strength and provenance, mirroring The Loi Evin model in France.
Establish an independent body to regulate alcohol promotion in the interests of public health/safety.
Review the use of new media to market alcohol with a view to limiting the exposure of ‘under age’ young people who frequently access key sites (e.g. Twitter, Facebook etc.).

The evidence

In terms of price restrictions only, recent research conducted in Canada over the course of eight years (where a minimum unit price has been implemented) suggests that a 10% increase in the price of most drinks led to a 32% fall in alcohol-related deaths (Stockwell et al, 2013). This international evidence is supported by UK modelling work which demonstrates the effects that setting a minimum unit price of 40p would result in (see below).

It is increasingly accepted that a fully joined-up public health response to tackle alcohol problems needs to include policy-focused interventions as well as individual-level input from health and social care practitioners (NICE, 2010). Individual and policy-level interventions are needed which can limit youth exposure to alcohol marketing whilst not curtailing producers’ legitimate right to market their products to adults.

Tweet @Social_Renewal using #Ideas4anIncomingGovt to join in the conversation.

Joining the dots: making healthcare work better for the local economy

Posted on 4 March, 2015 by Fiona

On Thursday 26th February Professors Rose Gilroy and Mark Tewdwr-Jones (Newcastle School of Architecture, Planning and Landscape) launched a collection of papers that they co-edited in association with the Smith Institute and the Regional Studies Association. Below is the latest in our Ideas for an Incoming Government series from Professor Gilroy, taking a look at the connection between health and the economy, and suggesting a way forward for public health delivery.

Who should take responsibility for improving the health of the nation? Is it the role of the NHS, or are we simply shifting responsibility by asking our health system to pick up the pieces (and the cost) caused by policy failures elsewhere? What is the real cost of poor health?

The Marmot Review of 2010 estimated that health inequalities cost the taxpayer over £30 billion a year in terms of lost productivity and associated welfare and health costs. Can we really afford to ignore this? A new joint report from Newcastle University academics, the Smith Institute and Regional Studies Association aims to address the issue of health inequality. Launched at Portcullis House, Westminster last Thursday, 26^th February in front of an audience of local government officials, researchers, representatives of the TUC, RTPI, NHS, The Design Council and lobby groups, the report – Joining the Dots: Making healthcare work better for the local economy – discusses the far-reaching consequences of poor health and the responsibility of employers, local planners, and new governance structures in taking a pro-health position that will help to tackle health inequalities.

From considering the social and economic determinants of health; the limitations placed on people’s lives from shrinking local investment in the supply and quality of public services; the need to consider the whole city as an arena for older people’s wellbeing and the struggle to overcome institutional and cultural barriers to make new legislation work, this collection of research challenges all sectors of British society to put health at the heart of its thinking.

The debate was chaired by Andy Love, Labour MP for Edmonton, with the report launched by myself and my School of Architecture, Planning and Landscape colleague Professor Mark Tewdwr-Jones, as co-editors of the report. David Buck, Senior Fellow in Public Health and Inequalities at the Kings Fund joined us to talk about the links between poor health, poverty and worklessness, while Professor Sarah Curtis of Durham University presented compelling evidence linking employment status to health outcomes. Professor Curtis emphasised the long shadow that regional unemployment casts across the course of people’s lives. Elsewhere, Deputy Lords leader Lord Philip Hunt considered the role of the NHS as an employer and reflected on the recent news that Greater Manchester will have devolved power over its local NHS spending, with huge potential implications for local accountability and a new, more holistic understanding of people’s health and social needs.

However, as several contributors argued, it is the ability of individuals and organisations to overcome the often complex local governance map and develop a joint vision and shared objectives that will lead to success in addressing the UK’s deep health inequalities.

The conclusion of this report is clear: too often we intervene too late and forget that health starts where we live, learn, work and play. The key to good health is to build preventative services in communities, helping us to take care of our families, our schools, our workplaces and our playground and parks. When considering national and local spending priorities, we must understand the need to make pro-health choices to tackle the scandal of health inequality in modern Britain.

View the full report via The Smith Institute. (PDF)

Tweet @Social_Renewal using #Ideas4anIncomingGovt to join in the conversation.

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