Director of Public Health Annual Report 2018: Healthy places

Both the quality and the quantity of food and drink that we consume are important factors in determining our health. Poor diet contributes to 30% of all early death and disability in the UK. A poor diet increases the risk of becoming overweight and obese, developing diabetes, suffering from heart disease or stroke and increases the risk of a range of cancers, fractures in later life and complications during pregnancy that may result in poorer outcomes for the baby.

In the South East of England, poor diet contributes to nearly 70% of disability and early death associated with heart disease, nearly half of disability and early death for diabetes, and more than a third of early death and disability due to stroke.

Obesity is one of the main results of eating an unhealthy diet. Since the early 1990s, across England, there has been an increase in the proportion of adults considered overweight or obese, rising from 47% in 1991 to 61.3% in 2015/16. Obesity results from an energy imbalance between the amount we take in and the amount we expend. Our bodies are excellent at efficiently capturing energy from the food we eat and conserving it. As a result, weight management programmes focus primarily on the amount of food we eat compared to the amount of exercise we take. However, evidence suggests that people underestimate the amount of calories that they eat by as much as 1000 calories per day.

Obesity is becoming an issue at earlier ages. Being overweight or obese in childhood greatly increases the risk of being an unhealthy weight in adulthood. Furthermore, by affecting people at an earlier age there is an increase in the length of time that the individual is overweight or obese and therefore at greater risk of developing complications.

Consuming too much sugar can cause weight gain and increases the risk of conditions like diabetes, heart disease, high blood pressure and dementia and is also one of the main causes of dental decay. Soft drinks (excluding fruit juices) are the largest single source of sugar for both adults and children providing 29% of the total sugar intake in children aged 11-18 years.

For every additional sugar sweetened drink consumed per day, the risk of developing high blood pressure increases by 8%, whilst the risk of developing heart disease increases by 17%. Drinking sugary drinks is also one of the main causes of dental decay in children. One in four children aged five and 12 years have dental decay and this is associated with a range of negative impacts. If everyone in England achieved the recommendation of only 5% of energy intake from sugars, the estimated savings to the NHS would be between £396-576m per year.

Eating a diet high in saturated fats is a major contributor to higher levels of cholesterol. Reducing saturated fat intake can help reduce cholesterol and it is estimated that if cholesterol levels were 10% lower across the whole of the UK, there would be approximately 25,000 fewer deaths every year.

Eating a diet high in fruit and vegetables reduces the risk of heart disease and stroke by as much as 30%. Switching to a diet high in fruit and vegetables, replacing fatty foods, has also been shown to reduce blood pressure by as much as medication.

The environment and communities in which people live affects their access to healthy affordable food and influences their eating patterns.

Food bought from out of home food outlets is generally considered to be less healthy than food prepared in the home, with higher levels of sugar, fat and salt. In addition to this, portion sizes bought from out of the home food outlets tend to be larger.

Currently, over a quarter of adults (27%) have at least one meal per week that is bought from an out of home food outlet, either from a takeaway or restaurant. Research suggests that increased access to unhealthier food retail outlets is associated with increased weight in the general population and increased obesity and unhealthy eating behaviours in children living in low income areas. There is an association between the density of takeaway food outlets and areas of deprivation with higher densities of takeaway food outlets in more deprived areas. This issue is exacerbated by the trend towards purchasing fresh food from out of town or edge of town super markets rather than local providers. This has resulted in the phenomenon known as food deserts, which are more common in deprived communities.

Evidence suggests that increased access to outlets selling healthier food is associated with improvements in diet and adult weight. There is also evidence that providing healthy affordable food in schools is associated with improved healthier food sales, dietary behaviours and better nutrition.

There are nearly 200 fast food outlets in Buckinghamshire. However, this is likely to be a conservative estimate with some shops and restaurants also selling fast food. The highest density of fast food outlets (number of outlets per 100,000 people) is in Wycombe (64) followed by Chiltern (50) and Aylesbury Vale (49.8). South Bucks has the lowest density of fast food outlets (39.4). This compares to an average density across England of 88 fast food outlets per 100,000 people.

Community gardens and allotments offer a range of health benefits. Locally grown foods on personal and community allotments and gardens are predominantly fruits and vegetables. Growing food locally has been shown to support people to have a more balanced diet and achieve the recommended five portions of fruit and vegetables per day.

Gardening also offers opportunities to take exercise and is a great way to get outdoors and be active.

Depending on the level of exertion, gardening and working on an allotment count as moderate or vigorous intensity physical activity as well as strengthening exercises. This means that gardening and working on an allotment can help adults achieve the recommendation of 150 minutes of moderate intensity physical activity and lower the risks from conditions such as heart disease and stroke.

A common reason for people not to have a healthy diet is that they are unsure what food to eat as well as lacking confidence in preparing healthier meals.

Growing your own food has also been shown to increase food and health literacy, overcoming these barriers and enabling people to improve their diets. This is particularly important in childhood and schemes teaching children to grow food in a community garden or allotments have shown improvements in food literacy and reductions in overweight and obesity.

The mental health benefits of allotment gardening include lower levels of stress and depression through being immersed in nature, engaging with the natural environment and viewing green space. Community allotments can be used as ‘horticultural therapy’, and have been shown to support people with chronic pain, dementia and long term mental health conditions.

There are a number of wider benefits from allotments and community gardens including the opportunities to socialise. Allotments have long been an important aspect of British culture as a community asset, providing a different type of meeting point than other amenities such as leisure centres, shops, food outlets and town centres. Use of community allotments has been linked to lower levels of social isolation and more community networking. Community allotments have been shown to increase social networks within communities, especially in groups at high risk such as socially excluded groups, substance misusers and people with long-term physical and mental health conditions.