Food in its many manifestations allows us to explore the global control of health and
to examine the ways in which food choice is moulded by many interests. The global
food market is controlled by a small number of companies who operate a system that
delivers ‘cheap’ food to the countries of the developed world. This ‘cheap’ food
comes at a price, which externalises costs to the nation state in terms of health
consequences (diabetes, coronary heart disease and other food-related diseases) and
to the environment in terms of pollution and the associated clean-up strategies. Food
policy has not to any great extent dealt with these issues, opting instead for an
approach based on nutrition, food choice and biomedical health. Ignoring wider
elements of the food system including issues of ecology and sustainability constrains a
broader understanding within public health nutrition. Here we argue that public
health nutrition, through the medium of health promotion, needs to address these
wider issues of who controls the food supply, and thus the influences on the food
chain and the food choices of the individual and communities. Such an upstream
approach to food policy (one that has been learned from work on tobacco) is
necessary if we are seriously to influence food choice.

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