Rarely can an organisation have been set up with such high expectations as the Food Standards Agency (FSA). Launched in April this year, the FSA's role and remit is wide. Protecting public health in relation to food is its main aim. Over the next few years the Agency will establish itself as part of the fabric of the UK political system; the first government department to be set up since devolution and with executives in, and board representatives from, each country of the UK. Almost uniquely, the Agency is headed not by ministers, but by an independent board. Will the FSA touch the food lives of all UK consumers? More particularly, how will it begin to identify and tackle the food needs of poorer consumers?

The FSA's remit is broad: safety issues, like genetically modified (GM) food; enforcement of food rules (the Agency sets the standards for local authority environmental health and trading standards officers); information and advice to consumers, other government departments and industry; as well as responsibility for the Meat Hygiene Service.

Fulfilling the public expectation that it would be truly independent, open and operate from 'plough to plate', the FSA has much to do. It has started as it means to go on by holding board meetings in public, launching a website and holding meetings with the public. The Agency's debates will take place under the glare of the public eye. No doubt public concern will keep some issues high on its agenda – GM for instance. But what about more Cinderella subjects, and dare I suggest it, Cinderella consumers? What of food poverty and those consumers who, because of their inadequate incomes, have particularly pressing food needs?

Food poverty ought, by virtue of its effects, to rank high on the Agency's agenda – or more properly, on the shared agenda of the FSA and the Department of Health for nutrition is the joint responsibility of these two government departments. And although inequalities and the disease aspects of nutrition are specifically Department of Health responsibilities, the FSA has a vital contribution to make on food poverty, not least through establishing the evidence base both for policy making and in ultimately defining what works and what does not work in terms of intervention. There are increasing numbers of projects and schemes, locally and nationally, which aim, directly or indirectly, to improve dietary health: food co-ops, cook and eat schemes, community cafes, breakfast clubs etc. The issue is which work best? In what circumstances? And crucially, would other policies be more effective?

For the first time since 1936 a national diet and nutrition survey of people on low incomes with be carried out.

The FSA will monitor the nutritional status of the nation through dietary surveys and act upon the findings, advising other government departments and consumers directly. Some of the clearest findings of diet surveys relate to socio-economic differences, but incredibly there has been no national survey of nutrition and diet in low-income households since the Second World War. We do have nutritional data on low-income households, but we know that it does not sufficiently capture the extent and depth of food and nutritional status of households at the bottom end of the income spectrum. Now, for the first time since 1936 the FSA will carry out a national diet and nutrition survey of people on low incomes. Doing a survey will not abolish food poverty, but it is a historic opportunity to define, once and for all, the nature and extent of the problem in the UK.

Food poverty is, of course, a multi-facetted problem. It is partly about sufficient income; it is also about access to shops, knowledge and confidence in food skills, as well as the promotion and advertising of food. The FSA will have a role in determining the comparative importance of these factors. Knowing more about this will be crucial for designing appropriate interventions. It will also indirectly begin to measure achievements in reducing child poverty. Put bluntly, if children really are lifted out of poverty we should begin to see improvements in their diets.

However, there are also more hidden aspects to the food/deprivation interface, issues to do with the social distribution of risk. Nutritional status is related to income (the poorer you are the worse your diet), but poorer people are also more likely to suffer infectious intestinal disease. The FSA's commitment to reduce food poisoning by 20 per cent over the next five years could, therefore, benefit the poor more than the better off.

There is also the issue of exclusion from making informed choices. Research done by the FSA shows that many consumers find food labels profoundly unhelpful. Nutritional 'labelling' is particularly confusing. Many food claims are hype (or worse) masquerading as information and they may impose undue anxiety on the poor and vulnerable. We know that families on low incomes may often buy heavily promoted branded foods as a way of keeping in contact with mainstream consumer culture. The Agency is reviewing food labelling and will be making its recommendations in the Autumn, but clearer, more understandable labels and fewer misleading claims will particularly help the most vulnerable consumers.

The FSA also has a role to play in better communicating food risks. I believe that this will differentially benefit poorer consumers. There is anecdotal evidence, for instance, that anxieties about pesticide residues coupled with the erroneous belief that organic foods are 'more nutritional' are forcing many consumers to avoid non-organic fruit and vegetables, particularly for their children. The better-off may be able to afford to increase their food spending to allow them to eat their minimum five portions of fruit and vegetables a day through organic produce; the poor certainly cannot. The blunt truth is that there is no nutritional advantage to organic produce and the health advantages of eating more fruit and vegetables vastly outweigh the possible increased exposure to any pesticide residues. We have to get that message across loud and clear.

Now take standards of retail outlets. The FSA announced at its launch that, for the first time, it would set and monitor the standards of local food enforcement. We know through our research that independent shopkeepers, smaller discount supermarkets, butchers and market stalls are often regarded as less reliable, particularly in the areas of hygiene and freshness. Regardless of whether evidence would support this, it is important that all food outlets have similar high standards. For those who have limited ability to choose where to shop this raising of standards will be particularly helpful.

When it comes to establishing policies and issuing advice, the FSA is charged with acting proportionately. It must also ensure that its policies and advice are based upon the best available science. For much of its remit (setting 'acceptable daily intakes' of certain chemicals, for instance) that evidence comes from natural science. But food poverty is largely about social science. Food poverty and dietary interventions raise conceptual challenges to an agency, which is determined to be evidence-based. Put simply, what kind of knowledge counts? You do not find many randomised control trials in food interventions. Indeed, most of the interventions on food poverty (coming from the voluntary sector, small-scale, insecure, community-based projects) are often completely unevaluated. Other bodies, such as the Health Development Agency, play an important role in evaluation and the FSA will work closely with it.

The purpose of evaluation research is not only to find out what works best, but to help define what is the proper role of government in meeting the food needs of citizens. Clearly without some idea of the cost of the food element of basic goods it is impossible to properly allocate responsibility for preventing or relieving food poverty across the range of departments, agencies and local organisations.

There is not an apolitical way of defining any basic need, including food. Plant has argued that any level at which the claims to needs are to be met will reflect social values and democratic processes. [footnote 1] This is a moral question for political debate, not one which can be derived from a purely administrative approach. In fact, the FSA's commitment to openness makes it well placed to host that debate. But for effective debate two things need to happen: it needs to be open and it needs to be inclusive.

The FSA faces the internal challenge of achieving cultural change in fulfilling the board's aspirations to move towards much greater openness in dealing with food issues and moving from an exclusive to an inclusive attitude to consultation. The Agency announced at its launch that it recognised it needed better to take into account the food needs and views of consumers on low incomes, those least likely to join consumer organisations or campaigns. There are different models for doing this and the FSA will benefit from the outcomes of community mapping projects around the country. We have also appointing a designated officer to improve the Agency's responsiveness to more deprived consumers and communities.

In important respects, notably in fruit and vegetable consumption, the nutrition gap between rich and poor has increased, not decreased, over the last few years.

Action to stem or reverse these trends certainly requires an inter-departmental strategy, which could include national initiatives as well as local action, perhaps under health improvement programmes. The FSA is part of the inter-departmental working group established after the joint publication this Spring by the FSA and the Department of Health of the first national survey of the diets of school-aged children. This survey revealed the depth of the nutritional and physical activity problem among UK children.

Although the FSA's role in combating food poverty may not, on the face of it, be a leading one, in defining the evidence base for action and intervention and in monitoring the success or failure of policies to reduce food poverty its role will be very significant in bringing about change for the better.

But measuring the effects of food poverty is not just about finding out how much lower vitamin or mineral levels are in the bodies of the poor. It is also about identifying and characterising food's role in social exclusion. Including social, cultural and psychological aspects of food in our low-income survey (how often parents feel guilty about what they are able to afford to feed their children, how much hidden hunger there is, how boring poor diets are etc) may be difficult, but is arguably at least as important as measuring food intakes and blood nutrient levels. Capturing the former aspects of the food lives of people living on low incomes is more honest, for it tells the whole story. It also focuses on people as citizens not simply as consumers; and that in turn raises questions about sharing the national wealth and not just changing household's spending patterns.

Footnotes

1. Plant, R (1990), Citizenship and Rights in Thatcher's Britain, IEA Health and Welfare Unit, Choice in Welfare Series, No.3 [back to text]

Suzi Leather is Deputy Chair of the Food Standards Agency and Chair of the St Sidwell's Project in Exeter. A shorter version of this article appeared in the UK Public Health Report, Summer 2000.

Poverty 107, Autumn 2000