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A spoonful of sugar?
With a number of large retailers agreeing to cut the proportion of sugary drinks they sell in their hospital shops in England, Health Business looks at the measures in place to limit sugar intake in hospitals. Plus, Jonathan Hart, chief executive of the Automatic Vending Association, answers some questions
As worded by NHS England chief executive Simon Stevens, ‘a spoonful of sugar may help the medicine go down but spoonfuls of added sugar day-in, day-out mean serious health problems’. On 21 April, NHS England announced that leading retailers, including the likes of WHSmith, Marks & Spencer, Greggs, the SUBWAY(r) brand, Medirest, ISS and the Royal Voluntary Service, would be voluntarily reducing the amount of sugary drinks they make available in hospitals.
The scheme was launched after a consultation heard other sugar cutting options including the introduction of a fee or the implementation of a ban on sugar-sweetened beverages on NHS premises. The initiative involves reducing the total volume of monthly sugar-sweetened beverage sales per retailer, per NHS outlet, reaching a target of 10 per cent or less of total volume of drinks sales for the whole month of March 2018 and continuing thereafter and in future contracts.
The news comes after widespread concern over the effect sugary drinks are having on the public, with sobering calculations from the National Diet and Nutrition Survey revealing that four in 10 teenagers drink a bathtub of sugary drinks every year.
Rising levels of obesity
Official figures have shown that the prevalence of obesity among adults in England rose from 4.9 per cent to 25.6 per cent between 1993 and 2014, with nearly a third of children aged between two and 15 classed as overweight or obese. In addition, the Faculty of Dental Surgery has warned that sugar consumption is also one of the main causes of tooth decay in children, with tooth extractions now the leading reason for hospital admissions for children aged between five and nine.
Indeed, the food products sold in NHS locations can send a powerful message to the public about healthy food and drink consumption. NHS premises receive heavy footfall from the communities of which they are a part, with over one million patients every 24 hours, 22 million A&E attendances and 85 million outpatient appointments each year.
The UK central government buying standards good practice guidelines dictate that all sugar sweetened drinks should be in packs no bigger than 330ml and no more than 20 per cent of the drinks purchased by the organisation may be sugar sweetened. No less than 80 per cent of the drinks in the vending machine may be low calorie or no added sugar (including fruit juice and water). Since sweetened drinks (unlike some foods) have no nutritional value, the government has put in place a particular crack down on the selling of sugary liquids.
In the UK, there are well over 500,000 machines vending around seven billion items per year. The problem of course, is that currently the majority of machines are usually dispensing processed, basic and sugary food products.
NICE guidance directs that local authorities and NHS organisations should ensure that any vending machines in their venues that are used by children and young people offer healthy food and drink options. However, it is wise to consider that unhealthy eating and drinking is not just a problem for patients and the general public, but for employees working in the environment, a recent survey found obesity to be the most significant self-reported health problem amongst NHS staff, with nearly 700,000 NHS staff estimated to be overweight or obese.
NHS England has noted that there is no single policy which will provide the solution to reducing sugar consumption, but rather a need for a variety of population-level interventions which focus on improving healthy behaviours, to ultimately reduce the burden of obesity and create a health-promoting society.
Governments and health systems around the world, including in Mexico, Hungary and Australia, have already implemented fiscal policies on sugar. Meanwhile hospitals in New Zealand and dozens of organisations in the US have banned the sale of sugar-sweetened beverages on hospital premises altogether.
Official statistics from the Automatic Vending Association’s (AVA) 2016 UK Vending Industry Census has shown that: the UK vending industry turnover has increased by two per cent to £1.53 billion; the number of open-site cashless transactions per month has doubled in 2016; and 39 per cent of cold drinks sold in 2016 were low sugar/diet or water.
Jonathan Hart, chief executive on the AVA, talks to Health Business about how vending machines on healthcare premises are adapting to help stem the UK’s obesity crisis and why simply banning sugary products in vending machines will not transform the public into a health-promoting society.
What value do you believe vending machines hold within the hospital environment?
“Vending offers a 24/7, secure, unattended retail option for establishments that operate around the clock such as hospitals – providing an essential service to employees, patients and visitors. Whether it be in A&E or in staff areas, vending machines provide an easily accessible option for those needing something to eat or drink, often at short notice.”
Vending snacks are an easy, convenient way of grabbing food on the go. Many would argue that it is this type of ‘fast food’ which is contributing to the rise of obesity and associated health conditions such as diabetes. How would you respond to such arguments?
“There are obviously a number of factors that contribute to these complex issues .Vending is often used as a scapegoat but only accounts for a very small percentage of retail food provision in the UK. However, despite the relatively small contribution from vending or unattended retail points, as an industry we continue to work to provide meaningful solutions and, most importantly, choice for consumers.”
In light of the news that the NHS and leading suppliers have joined forces to cut surgery drinks over the next year, what specific measures is the AVA looking to put in place to support the work of such food stores?
“We are continuing to work with our members to raise awareness of the issue of healthier vending. Only recently, we put together some guidance (See Vending: Lower Sugar Salt Fat and Calorie Products) for members to encourage them to consider healthier options when it comes to stocking items in machines.”
The regulation of vending machines has occurred widely in both schools and hospitals - do you believe there is more venders could do ensure their products are beneficial to public health?
“Consumer tastes are changing, there is no doubt about that. But these changes are behavioural changes, which take time to happen. New products are appearing all the time which have less sugar, salt and lower fat and as these products become more and more popular with consumers, so they will be increasingly reflected in the content of vending machines. At the same time, we have been working for many years with University College Birmingham on a module for its Culinary Arts Management students called the Culinary Product Development Challenge. Working closely with these food product developers of the future, the module challenges them to create alternative, healthy snacks that are calorie controlled and are an essential addition to existing vending products. This is reflection of how vending is changing and will continue to change to help people eat more healthily.”