The Architecture of Health

It could have been the bizarre menu of foods available to you on ‘treat day,’ from garlic pudding and ‘fluffy ruffs,’ to mystery meat, hoisin crispy owl and discount foie gras, or during-dinner mints topped off with a 20-cheese omelette. Maybe it was the clearly out-of-touch presenter, unfamiliar with video cameras and websites.

Or perhaps the secret to the immense online success of the BBC’s Butterfield Plan comedy skit was the bizarrely ascetic diet it mandated for the rest of the week, from breakfast of a single toasted cornflake covered in low-fat spread to ending the day with a bowl of ice cubes covered in artificial sweetener.

What might not be evident to the millions of people who have had a laugh at the Butterfield Plan, however, is that standard eating advice given out in cities across Europe may look just as alien as ‘mystery meat’ to many of those who receive it. In Birmingham, almost half of the 1.2 million residents are younger than 30. It’s also massively diverse, with a population that speaks about 90 languages from around the world.

The city understands that failing to attune its food policy to the needs of these varying demographics can have very un-funny consequences. “We have got massive issues with diabetes, particularly childhood obesity, which affects health through your whole life,” warns Heather Law, Senior Programme Co-ordinator of European and International Affairs at Birmingham City Council.

Diverse diets

Asking a family used to crispy, sizzling and earthily sweet Caribbean dishes to switch to a slice of gammon with boiled cabbage is an obvious non-starter. However, suggesting more traditional spices in the place of salt, or grilling rather than frying food may be a good way to see quick gains in health that communities who enjoy such dishes can easily take on. Asking a teenager to forget about burgers and chips could be a lost cause, but suggesting the zero-sugar version of a soda, or swapping the oily chips for roast potatoes – that might just work.

In one of Birmingham’s Sikh temples, a few simple suggestions were enough to cut the fat and salt content of food being served in half while only slightly changing the character of the food. “Through Food Trails,” Law explains, “we looked at recommendations for healthy sustainable diets appropriate for Birmingham’s diverse communities. We looked at what eating well means for them.”

The suggestion of cutting out meat, a key step to making diets healthier and more sustainable, met with “a lot of cultural sensitivities.” However, encouraging people to cook more traditional dishes that for many backgrounds, for example East-Asian communities, are less likely to contain meat can be an effective way of provoking change.

Un-healthying healthy food

For some people, even using the word ‘healthy’ is a turn-off, conjuring images of pale, tasteless foods. “So, rather than talking about healthy diets, for example, we should focus on taste and what’s a good tasting meal,” Law outlines. That is why getting the point of view of the people who food policy is designed for is an essential part of Birmingham’s approach. Without this stem, it simply will not work.

The city took the national Eatwell Guide, as a starting point. This guide is important for local policy as a document packed with good advice produced on the basis of stringent scientific research. “But then,” remembers Law, “we spoke to people that represent the communities, and learned how they engage with people.”

Tips from these representatives included avoiding talk of education, speaking rather of ‘raising awareness,’ and to avoid being patronising at all costs. “They’ve worked up some good recipe books,” Law remarks, “The agenda is obviously how to create a healthy meal, but it’s not presented in that way.”

The EU-funded Food Trails project marked the beginning of a new food movement in Birmingham. Since then, the city has built on the success of this project and introduced a new Food System Team with Public Health to lead on the development of a local strategy for healthy, sustainable and resilient food policy. The Food Trails project has allowed the city to get input from other European cities and experts, and the strategy is also rich with insights from other groups working within the city.

A municipal subcommittee called the ‘Creating a Healthy Food City Forum’ has been a central vehicle of this engagement. “They’ve got stakeholders across the city, including voluntary organisations like The Active and Wellbeing Society, an organisation called Incredible Surplus that distributes excess food to charities, and the Food Justice Network. We’ve been able to corral lots of different voices in the city and distil it into the information in the strategy,” Law says.

Death sentence

It’s not just your background or age that affects your eating choices. It’s also the shape of your city. The fact that in the US, many people on death row who are afforded a last meal of their choosing opt for basic fast-food staples like a hamburger and chips is as curious as the reason is disheartening: they are usually restricted to food available within a short distance of the prison, meaning that their options may well be limited to restaurants like McDonalds or KFC.

While distribution of food across Birmingham is not as bleak as this, poor access to healthy food is a contributing factor to a striking difference in mortality rates across the city, which the city council finds intolerable.

“We’ve got 69 wards, and the health disparity between the richest and poorest wards is quite stark, it’s about 10 years in life expectancy,” says Law. That means some poorer people can expect to die on average 10 years earlier than their rich counterparts. Taking Birmingham’s population of 1.2 million into account, this could equate to millennia of lost years of human life.

Planning for health

Birmingham City Council, and in particular, the public health team, is taking this very, very seriously. The city wants to change the face of its urban planning and architecture to make sure that people of whatever socioeconomic means have easy access to healthy and sustainable food. “We’re looking at planning tools,” Law explains. Through a new ‘Healthy City Toolkit,’ the city can carry out health impact assessments on any planning application or development plan.

“The kit has questions to help developers consider the health impacts of new developments and to support planners to do the same.” Law finds this tool particularly exciting “because it actually focuses on the structural issues and how we can tackle that from a whole-city approach, working across the council.”

The tool encourages thought about the availability of healthy and affordable food shops and restaurants, and other healthy businesses. It also asks users to consider green areas and trees, things that are known to have positive effects on the micro-climate, as well as on physical and mental health.

Exercise is another consideration, from the availability of public exercising infrastructure to whether the layout of the building, block or neighbourhood encourages people to walk and cycle or remain sedentary.

Food deserts

“We’re also looking closely at the business offer of food outlets,” Law says, “Are there lots of fast-food outlets close to schools, or how far are they from the school gates? Are they concentrated in certain areas?” The city is especially concerned with identifying ‘food deserts,’ areas where there are no food outlets at all that provide food that would correspond to the national Eatwell Guidelines.

Birmingham also wants to remove any barriers that may be preventing people from eating healthy and sustainable food, and businesses from serving it. The city wants to understand how easily people can adopt healthy food practices at home, and to help them out by connecting them to simple healthy recipe apps like Whisk.

It’s also in the middle of an analysis and consultation to understand the economic or other incentives that influence the decision of businesses to produce healthy or unhealthy food. Crucially, the municipality is also turning its eyes inwards, reassessing the types of meals are served through Cityserve, which is the provider of the city’s school lunches.

Through Food Trails, the city is hoping to go even further with its education system. “We’re thinking about a nutrient-dense sustainably-sourced diet curriculum including increasing skills, knowledge and use of beans, pulses and dark green leafy vegetables,” says Law, “That’s part of wider thinking about procurement and supply chains. So it’s really a systems approach.” The city is already working on education in the apprenticeship system, creating a health-literacy and wellbeing curriculum for apprentices.

Data block

All of these changes need to be fed with one vital ingredient: data. The city wants to get its hands on anonymised data about what its residents are buying, and what food is available to them locally at what prices. Unfortunately, the third parties that operate supermarket purchasing cards are refusing to cooperate with this cause, meaning that the city has to resort to less precise data-gathering methods.

Birmingham is working with other organisations, like the Mandala Project, that are also trying to get this data. In the meantime they’ve prepared a simple spreadsheet and are making a start the old-fashioned way, asking people in their Creating a Healthy Food City Forum to fill it in when they go to the supermarket with the cost of different products in different areas.

A champion at the top

Despite this hitch, Law considers Birmingham very lucky when it comes to its food policy work. “We’ve got a fantastic public health team, with political representation right at the top. Our Councillor Paulette Hamilton has recently won an award for all she does. So we have really strong support for this work. This is key when you’re trying to do anything in a city. You need that political backing.”

Councillor Hamilton’s recent electoral success as a local MP offers the perfect opportunity for her to take the lessons on food policy and systems thinking to a national level in the year following the launch of the UK national food strategy.

For her part, Councillor Hamilton is distraught that people still “struggle to access affordable, nutritious food.” As well as all the good work in the city, she’s lobbying the national government to bring in legislation to make it harder for businesses to push unhealthy food on people. And she knows as well as any that there is a business case for healthy food, liking to give the example of two young Birmingham students who turned an idea for sugar-free sweets into an €80 million business.

But Birmingham has its champions all over the city, not just at the top. Perhaps the most emblematic telling of how the topic of food plays across the local landscape, melding transversally with other facets of the city and embracing diversity while still suffering from dichotomy comes from former Birmingham poet laureate Roi Kwabena’s poem, ‘Birmingham, Capital of Culture:’

minted coins…fashioned precious stones jostle
aromas of once exotic now only tempting

cuisines galore
carnivals in the shadow of public art
an entire district dedicated to balti [curry]
Lunar society of scientific enquiry
Aston hall where royalty dined
Abolitionists, friends and metal smiths
confer as harvested chocolate is still prepared
sporting arenas and automobile engines fine tuned

female advocacy…trade unionism
justice, equality and liberty

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