Government: where does nutrition policy come from?

In order to answer the question in the title, I will spend a little time simply describing structures within Government Departments in the UK which deal with nutrition, and how they interact with other Government Departments and Divisions and outside agencies. However, there is a simple and short answer to the question. Policy on any issue in a Government Department is determined by Ministers. Each Government is elected at a General Election. and in the run up to that Election, many issues will be debated in the public arena. There will be little doubt in the minds of the public about the general philosophy of the Government that has been elected, and indeed of its specific intentions in a number of areas. Although there will be many areas which have not been debated in public, it is understood that the general philosophy of the Government will apply to those areas as much as any other. Consequently, nutrition policy in general, like all other policies, is determined in the light of a philosophy directly determined by the outcome of the electoral process. Nevertheless within that general philosophy many practical details exist. In respect of these details Ministers decide on policy in the light of advice. Advice to Ministers in the field of nutrition has been forthcoming ever since there was such a field. In its most formal guise, such advice takes the form of a report from the Chief Medical Officer to Ministers. However, there is an extensive structure of civil servants beneath the Minister which contributes to less formal advice. In the Department of Health there are two parallel lines of hierarchy, headed by the Pcrmanent Secretary, comprising on the one side the administrative divisions and on the other the Chief Medical Officer and his profcssionals. Within that structure there exists a focus for nutrition (Fig. 1). The Nutrition Unit is a small group of professionals: doctors and a nutritionist. This professional branch and its analogous administrative branch work together as a single unit. They are responsible for liaison with senior colleagues, with other divisions in the same Department. and with other Government Departments which may have an interest in nutritional matters. In an area like nutrition, as in any other specialist scientific field, access to the knowledge and expertise of the scientific community is necessary. This is provided by the Committee on Medical Aspects of Food Policy (COMA; Fig. 2). The function of COMA is to advise the Chief Medical Officer, and its structure is flexible enough to respond to changing needs. At any one time its ad hoc sub-committees and panels reflect areas of current concern. For instance, the major review currently being undertaken on recommended daily amounts of food energy and nutrients was a response to a perceived need for a new look at this aspect of nutrition. Once COMA existed, the Nutrition Unit, which services it, became the natural focus for input into the Department on nutrition matters, and links to a more or less formal extent have now been established between the Unit and most bodies with an interest (Fig. 3). There are a number of influences on policy development. First there is the essential database of the scientific literature. This is the bedrock of COMA’S advice. There are