Wednesday November 28 2001 - Metropole Hotel, Llandrindod Wells

Monday 25 March 2002

Minutes of the Nutrition Strategy Steering Group on Wednesday November 28 2001

Present:

Phil Morgan, Chair
Professor Pickard
Dr Paul Walker
Mrs Su Mably
Dr Jane Ludlow
Dr Jeremy Corson

Secretariat:

Lorna Thompson
Hilary Neathey
Viv Stein
Jayne Griffiths
Nia Collier

1. Chairman's introduction

Phil Morgan thanked everyone for attending the fifth meeting of the steering group. Apologies were received from Joy Whinney , Allan Davies, Theresa Owen, Keith Davies, Chris Llewellyn , Ginny Blakey , Claire Wilkinson, Mariella Borg and Claire Paisley.

Even though only a small contingent of the steering group could be present, this meeting was critical in terms of reviewing outcomes from the workshops so far and in moving the agenda forward after Christmas.

2. Minutes of 27 September

The minutes of the last meeting were agreed.

2.1 Matters arising

Item 2.1.

FSA Wales has invited secondary school pupils to come up with projects on the theme of healthy eating that demonstrate use of the BNF CD-ROM. Substantial prizes will be awarded to the winners.

Professor Pickard suggested feedback on each applicant school could be of interest to National Assembly Members as well as presenting an opportunity for the Agency to promote itself.

Phil Morgan agreed and suggested the Assembly Minister for Education and Lifelong learning might be invited to participate in the judging process.

ACTION: Secretariat

Wales Centre for Health

It was important that the role which the Wales Centre for Health might play in relation to nutrition,. it was agreed that David Seal would be invited to address the steering group at its next meeting on 25 January 2002. Chris Tudor-Smith would also be invited to attend to talk about revised Better Health Better Wales health gain targets and the Assembly's health surveys.

Action: Secretariat

Phil reported on joint FSA/DH meeting on 22 November, which looked at the effectiveness of a range of interventions developed to encourage children to eat a healthier diet. There were a variety of presentations on the projects in the morning session, with the afternoon given over to workshop discussions to address what more might be done to improve matters. The Bangor University Food Dudes project findings compared favourably with other interventions aimed at increasing the consumption of fruit and vegetables amongst young children.

Professor Pickard's plans to set up a networking system to enable concerns on nutrition issues to be fed into the Advisory Committee for Wales meetings have taken a backseat for now given the on - going nutrition strategy work.

Steering group members were handed a copy of a paper produced by Claire Paisley reviewing current Welsh survey and surveillance methods.

3. Review of workshops

3.1 Priority groups

It was recognised that arriving at an overall consensus on priority groups was going to prove difficult, given that there would be spokespersons for most priorities who could each argue their case.

This had prompted Professor Pickard to devise a simple matrix representing key variable data together with that fed back from the workshops, such as population, age groups matched against factors such as lifestyle, sex, ethnicity, low income etc. A simple tool such as this had the advantage of illustrating to interested parties the relationship between the different aspects and would validate the steering group's rationale for determination of the key priority groups.

Everyone seemed to be in favour of applying this concept and Phil Morgan agreed to consider further how it might be used to best effect in refining the priority groups to be targeted for action.

The extent to which non - mainstream nutrition issues such as the relationship between oral health and nutrition should be reflected in the strategy itself was then discussed. It was recognised that having good teeth was a pre-requisite to a healthy balanced diet and was an issue raised at the first workshop. Professor Pickard highlighted the fact that the British Nutrition Foundation Task Force report on the evidence base and impact of fluoride on oral hygiene is unequivocal: if fluoride is not present and high quantities of sugar are consumed as part of the diet then dental health is likely to be affected.

Although strictly speaking an issue for Health Departments, it was agreed that the relationship between nutrition and oral health certainly justified a reference in the strategy document, it being an issue of particular relevance to lower socio - economic groups.

Dr Jane Ludlow commented on a similar parallel between folate deficiency and social class. In the current debate on the issue of mandatory folic acid fortification of flour, in her view, not enough emphasis was being made by the pro fortification lobby to the role of folate in reducing heart disease. Other lifestyle factors such as physical activity also needed to be drawn out in the strategy.

In summary, Phil Morgan reminded everyone that it was important to remember that the strategy needed to embrace all issues that had a bearing on nutrition even though it would ultimately for others such as the National Assembly to decide on policy action.

Given that the two workshops generally endorsed infants, children, young people and low income and vulnerable consumers, this left the remaining priority groups i.e. pregnant women and women of children -bearing age, and middle-aged men to be decided upon.

It was accepted that there was compelling evidence to support the view that nutritional status during pregnancy was critical to health during later life. Pregnant Mums were seen as a captive audience since they were more likely to maintain behavioural changes in diet beyond their confinement. Whilst there were a number of initiatives already targeting this group they did not appear to be co-ordinated.

The middle-aged men target group caused the most unease and it was suggested that applying the matrix method might serve as a way around this. In this way, this group might be highlighted for action in the low income and vulnerable category, for example.

4. Target setting

Phil Morgan highlighted some of the main key target outcomes to come out of the workshops thus far, as follows:

• Short term: increase fruit and veg consumption; monitor sales through retail sector research
• Improve knowledge base -develop food preparation skills
• Long term: improvements in diet -related health

Some creative ideas captured from the workshops included setting up credit unions; food co-ops and local initiatives such as creating specialist community dietitians/nutritionist posts to co-ordinate local action.

The steering group discussion then focussed on how best to meet the needs of health professionals. The steering group recognised that much of the responsibility for managing pregnancy has now passed from GPs to community midwives.

The role of GPs as a source of advice on nutrition issues was now questionable. It was agreed that there was a need for some basic, straightforward education resources for health professionals.

The BNF publication 'Nutrition for Nurses' for example offered practical advice to dietitians/nutritionists. Whilst information needed to be available to meet the needs of different groups there was a case for producing something more generic in nature.

Jeremy Corson remarked that the whole issue of health promotion was often regarded by health professionals as imposed and that there was a need to invest in health promotion via public healthcare.

The steering group recognised the need to integrate the strategy with public health developments in Wales such as Better Health, Better Wales revised health gain targets; the NHS Review Task and Finish group work, and specifically the work of the public health review group, involving Professor Stephen Palmer of UHW.

5. Survey methods

If the Food Standards Agency, National Assembly and other bodies are to develop effective policies including those to reduce inequalities and social deprivation, it was important that robust baseline data on the diets and nutritional status of consumers was available.

Claire Paisley had produced a paper reviewing the adequacy of current health surveys . In many cases sample sizes of UK surveys have in the past failed to include sufficiently large sample sizes to allow for regional analysis. Claire's paper also considered the most appropriate dietary survey methodology.

Popular methods such as personalised diary keeping of dietary intake were complex and often unreliable. Blood samples, particularly of people in hospitals and care homes, were seen as critical to detect absorption levels of vitamins which are often poor in the elderly.

There was also a place for indirect data collection to see if dietary habits, particularly of those on low income, were changing. Collection of till receipts was one method for measuring supermarket sales of fruit and vegetables. It was well known that the main supermarket chains through their loyalty card systems hold vast amounts of data on customer purchasing habits. Phil Morgan remarked that the British Retail Consortium had indicated when they met the Agency's Advisory Committee for Wales recently that they would consider allowing FSA access to this information. Ideally, we would have this disaggregated to show what was happening at local community level.

Any new purpose built dietary survey covering our priority groups would need to be designed carefully and be comparative with previous survey tools.

Until now neither the views of the retail sector nor the food producers had been captured to any extent by the strategy process. The Secretariat would invite representatives of the retail sector and food producers to the steering group meeting planned for 12 March in Cardiff. This would be an opportunity to consider options for research; what Welsh consumers are eating; the reliability of such data and enable issues of advertising and marketing of healthy foods to be touched upon. Separately, Phil Morgan agreed to approach a local PR and media relations company with whom the Agency has links to explore how we might influence and work with the media to get across our public health messages.

Action: Secretariat

Finally, steering group members recognised that without firstly establishing the baseline or 'status quo' it would be impossible to measure the impact of any action. However, once agreement had been reached on where to focus the most effort within the strategy, this would precipitate the need to review the available data to identify what further research might be needed. It was agreed to consider commissioning a range of further work. Ideas included the appointment of a researcher to monitor purchasing and consumption habits; a purpose deigned survey (along NDNS lines) covering all priority groups- but recognising that this would be an expensive project, so it would be advisable to run a pilot first; and using GP' spotter' surgeries.

6. Forward planning

Phil Morgan ran through the programme for the day on 3 December. He was reassured by the good response from the education sector and thanked those who had agreed to act as facilitators/scribes on the day.

He then turned his attention to aspects of forward planning starting in the New Year. All agreed that at least one conference should be held in North Wales and that it was important to broaden out the invitation list. An outline timetable was drawn up as follows and is at Annex A.

7. AOB

Professor Pickard handed out a copy of the latest BNF report on the antioxidant properties of selenium and showed how the BNF's education newsletter opened out as a colourful poster for schools. This was agreed by all to be an innovative and practical idea for science or food technology teachers.

Su Mably mentioned she had seen a draft of the NAW's physical activity strategy document, which contained useful research and would be of particular relevance to the work of the steering group. It was not known whether this document was officially available and since neither Jo Clarkson nor Ginny Blakey was at the meeting they would be asked to comment.

Action: Secretariat