Over the last seven or so years, for a variety of personal reasons, I have seen more of the insides of hospitals than I have wanted to. I am not alone in this at my life stage of course. Those visits have lead me to pay attention to the retail outlets in hospitals in Scotland and Wales. Together with the wall of smokers outside the doors, the retail outlets often add a sense of unhealthiness to hospitals – and that’s before the perennial issues about patient food. They retail foods high in saturated fats, salt and sugar in the main.
In Scotland there have a sequence of public health measures aimed at population level impacts. Some of these began controversially, but have come to be seen as world-leading and pioneering (e.g. the smoking ban). Others have had a long legal fight to implementation (e.g. minimum unit pricing of alcohol) and major research on effects is underway. Forced changes to retail alcohol promotions and hours of sale and tobacco displays all have added to a sense of purpose/control (depending on your view).
A little under the radar, but in my view, very important and interesting has been the attempt in Scotland to improve the healthiness of retail stores in Scottish hospitals. As indicated earlier, it does seem crazy that places that are meant to make people better, are often promoting the very products that made them ill in the first place (in some cases) or which don’t help people lead healthy lives or behaviours. The choices available to hospital staff also can cause issues.
The Scottish Healthcare Retail Standard (HRS) was introduced in 2015, comprising a set of mandatory requirements for retail outlets in NHS healthcare premises in Scotland. HRS required that a substantial and specified proportion of food and drinks on sale must meet nutritional criteria and that only products meeting nutritional criteria could be promoted. This is not a ban but a rebalancing of the offer in store and its promotion. Full implementation came in March 2017 after a run-in period to allow changes.
The University of Stirling (Institute for Social Marketing colleagues and myself), ScotCen Edinburgh and the University of Dundee were involved in the evaluation of the implementation of HRS; the overall NHS Health Scotland report is available here. We have just had published a more detailed paper examining retailers’ experiences of the implementation of HRS and its impact on food and drink product ranges and promotions (so details at end of post).
We find that implementation was in some cases challenging but in all cases was achieved. There was a rebalancing of the product range and of promotions. Demand for healthier products rose above prior expectations. Some issues of supply were initially found, but overcome. HRS did act to stimulate supply, retailer and consumer change, add to the healthier choices available and reduce unhealthier options. A new baseline was set for expectations. Retailers could have benefitted from clearer support and consistency at an early stage of implementation, but all achieved the standard demanded.
The HRS and this paper are important, both in healthcare settings and more widely. As we have argued before, the retail in-store landscape is not neutral and retailers can and do act as social engineers. As discussions ramp up about policies to better develop healthy lifestyles, so schemes such as HRS may have lessons for the wider retail sector and its behaviours as well as for healthcare sites elsewhere than Scotland. How do we utilise the influence and power of retailers to reduce harm? HRS may be one method worth thinking about.
Details of the Paper and its Availability
Stead M, Eadie D, McKell J, Sparks L, MacGregor A and AS Anderson (2020) Making hospital shops healthier: evaluating the implementation of a mandatory standard for limiting food products and promotions in hospital retail outlets. BMC Public Health, 20:132
Paper available here: https://doi.org/10.1186/s12889-020-8242-7