Guest Blog by Robin Millar, Acting Chief Executive, 2020health
Obesity is a complex issue – like health itself, it affects how we live our daily lives, the environment in which we live and work and how we feel about ourselves. In our 2015) report, “Fat Chance?” we noted that it was upwardly and downwardly mobile sections of society that correlated with obesity – not just the poorer and more deprived areas.
It is also emerging as a defining – and confounding – challenge for 21st century public services. A sickness model of health services struggles to cope when a ‘cure’ actually lies beyond its reach, before services are even involved.
We should not miss either the importance of this moment – or the opportunity that comes from acting now. The question is, does the release of the government’s new strategy mark a different, prevention led approach alongside a more coordinated public service response? Because it is only when we take hold of this bigger picture that we will begin to address the challenge.
In our 2014 report, “Careless Eating Costs Lives” we recommended establishing a permanent cross departmental government task force on obesity to flush out important and diverse perspectives on the problem – economics, social and environmental factors, health implications, media messages, sports and activity, food industry all have an influence. We also recommended that all new policies should be reviewed and assessed against an ‘obesity test’ – asking “how do these policies help to improve the nation’s health?”
The strategy did recommend a phasing in of a “sugar tax” but was otherwise silent on these, as it was largely on advertising and promotion.
However we do see points that are to be welcomed in it and point to a change of approach.
Schools for example, are a key battleground. 1 in 9 children enter primary school obese – too high in itself. But worse, 1 in 5 children leave primary school obese. The hour of exercise a day for primary school children is a good measure: it recognises the success of initiatives such as the Scottish “mile a day” and builds good habits for the future. But exercise is only one part of the puzzle.
In our report we also called for practical cookery skills and food education to be a part of the school curriculum for pupils up to the end of key stage 3 (age 14). The very effective EPODE approach originating from France, demonstrates the value of reconnecting children with the food system and food supply, by helping to instil a better understanding of what it means to live healthily.
However, this kind of consistent and thorough strategy is difficult in the UK educational system with a plethora of interested players. A further challenge for schools is fitting this into an already crowded timetable – “another priority”.
A TOUGHER STANCE
Many are calling for more punitive action – pulling hard on the favoured political levers of tax and legislation. However our empirical evidence shows that simply ‘pushing’ and legislating does not work particularly well. Further action should explore ‘nudging’ in appropriate ways and it is appropriate that more forceful action could be taken if the industry do not respond.
However, we believe that “Making health personal” means an approach that recognises personal responsibility for regulating our consumption – personal responsibility – and then supporting this through state legislation. The new Strategy attempts to strike that balance with a light touch. Taxes in 2018, giving industry a chance to act, will be reviewed in 2020.
With increasing localisation of decision making, there is also an opportunity here for Local Authorities and Health & Wellbeing Boards to work with communities and residents to introduce their own guidance for healthy towns and homes etc. We called for all HWBs to recognise the importance of nutrition and obesity through access to those professional specialisms, and explicit measures/specification in their JSNA to inform effective strategies to tackle obesity.
This might include reviewing licensing for fast food outlets to control the location and numbers of outlets in a local community. Particular on fast food outlets appearing to ‘favour’ spots close to schools. Or ensuring that walk and cycle ways joining communities enable more exercise as part of a daily routine of shopping or work.
In our report we highlighted and called for incentives for those who become active partners in their health by quitting smoking, reducing weight, walking a set number of steps etc. – and increased awareness, coordination and reach of the government’s ‘Healthy Start’ Voucher scheme
By the admission of some businesses, this strategy could have gone further – but it also marks an encouraging shift in approach. It is important we discuss responsibility: government could have done more, certainly. But it’s not just about what government can do, but what we must do for ourselves.
When it comes to our health – and weight – we can have a say in our own outcomes long before we become consumers of health services. This strategy must mark the start of that conversation.