Examination of Witnesses (Questions 200
- 219)
WEDNESDAY 3 MARCH 1999
MR PAUL
LINCOLN, PROFESSOR
ANDREW TANNAHILL
and DR JOHN
KEMM
200. If their role is to produce information
on what constitutes a healthy diet then the corollary to that
is you should have a role in what constitutes an unhealthy diet.
Would you agree?
(Professor Tannahill) They have a role in the
protection of health——
201. There is an awful tendency to concentrate
on what is healthy, surely that means they have to say what is
unhealthy? If they are going to define one part of the compartment
as healthy, surely they have to define the other part as unhealthy?
(Professor Tannahill) I think one of the important
opportunities for the Agency actually is to start working on what
is healthy because if we constantly use as a frame of reference
individual diseases, then you can get mixed messages. There would
be great value in my view to addressing it in health terms by
setting out what does constitute the sort of balance of eating
that gives the best opportunity of good health. So I think we
do need to look at both sides, the promotion of good health across
a broad front and the prevention of particular illnesses.
202. What about the education of children?
Should it, in some way, form part of the National Curriculum?
Is there a role in influencing what goes into school lunch?
(Mr Lincoln) Clearly, I think, everything we have
said would strongly support that. Certainly in terms of setting
standards, in terms of healthy eating and healthy food. It would
seem entirely logical it should be a function of the Food Standards
Agency.
(Professor Tannahill) There is no, as such, National
Curriculum for Scotland, as I am sure you are aware, but there
is guidance.
203. It is defined somewhat loosely.
(Professor Tannahill) There is curricular guidance.
We, in the Health Education Board for Scotland, have a schools
programme, and we are trying to stimulate the implementation of
the health promoting school concept in Scotland. So the information
and advice produced by the Food Standards Agency would no doubt
be of help to us in looking at the healthy eating aspects of health
in schools.
204. Can you think of any targets that the
Agency could usefully adopt to allow its work in the field of
health promotion to be measurable? If you would rather do this
in the form of a note, because I am going to ask you for some
other information, I would be quite happy.
(Professor Tannahill) I would be happy to mention
again the targets set out in the Scottish Diet Action Plan. I
have indicated that I would hope that the Food Standards Agency
would consider these at an early point. I have already indicated,
though, that in terms of eating for health and education related
to that, the position of the Health Education Board for Scotland
is that it believes that that should remain with the Health Education
Board for Scotland. So that would not be, in our view, the principal
role of the Food Standards Agency. Returning to the issue of Scottish
targets, they are targets for the whole of Scotland to achieve
by concerted effort, and all of us who are involved in trying
to achieve them can then look at targets for the particular roles
we have to play within that.
205. On the subject of foods for which health
benefits are claimed, some often spuriously, do you think there
is a role here for the FSA?
(Dr Kemm) Again, this is clearly a matter which
is subject to legislation and regulation. I entirely agree with
your underlying problem; certainly most of the claims are spurious
and one sees people spending money most ill-advisedly. I would
welcome a strong lead from the FSA to ensure that that sort of
practice was discouraged.
Mr Moonie: Thank you.
Mr Brand
206. Do you think that the Food Standards
Agency will make your job easier or will your activity make the
job of the Standards Agency easier?
(Dr Kemm) I think one of the main difficulties
that we have to overcome in this field is that there is a perception
that the experts all disagree, and that there is no understanding.
That is clearly a false perception, but the presence of a trusted
source of information so that we could then work to transmit those
messages would make life a lot easier. Therefore, I think, in
the field of nutrition, the key achievement will be destroying
that myth that nothing is known about food and getting across
that, in fact, we have a very good idea of how one should eat
in order to improve your chances of health.
207. So you see the Food Standards Agency
as the lead agency, and you promulgate messages?
(Dr Kemm) Yes. We have touched on this already,
but if——
208. But I am not clear about what your
answer is.
(Dr Kemm) I am sorry.
209. It is to do with this multiplicity
of advice; it may be consistent advice, but if I need three leaflets
before I buy my turkey burger, I am not going to get it right.
(Dr Kemm) The message is at two levels. One is
the scientific level, which clearly tends to use rather complex
language and is covered with caveats and reservations and all
those sorts of things. That is the proper message for communicating
to scientific and technical audiences. That is, I think, what
we need to have clearly agreed. Then they have to be translated
into the sort of messages which are easily transmitted and helpful
to guide the man and woman in the street. It is that translation
and transmission which, I think, is the key job of agencies such
as the HPW and our fellow agencies.
Mr Brand: Indeed,
but the original message is the responsibility of the Standards
Agency. I would be surprised if it allowed you to translate it
and take on a role of its own in what you do. I am trying to get
some clarity on who is actually going to be accountable for the
end product. We have had lots of questions on targets, and they
ought to be common targets, but somebody ought to be accountable.
It is no good the Head of the Food Standards Agency saying "Well,
we gave them the scientific advice, it is just because it was
translated in tabloidese by the Health Education Authority that
it has lost its impact". We have had two bits of evidence
from Ministers which have been very interesting: Jeff Rooker was
saying "No change, all we are doing is hiving off a bit from
MAFF and setting it up as a separate agency". Mrs Jowell
seemed to imply that there was a wider aspect to it, although
she was not prepared to go very far. A lot of us in favour of
the Food Standards Agency are only in favour because it is an
opportunity to actually sort out some of the incredible complexities
and relationships as to who does what and, perhaps, reduce some
of the national and international conferences for all the agencies
before they draw up their nice piece of paper that I may eventually
see in my supermarket.
Chairman
210. Can I just say, adding to the point,
that the debate we have had, Peter, has been on this issue about
whether the Food Standards Agency should be food protection as
opposed to promotion. Do I gather that what you are saying is,
in effect, that promotion is an issue for other bodies and not
for the Food Standards Agency? Would all three of you comment
on that?
(Professor Tannahill) The promotion of health,
as far as I am concerned, is something that involves a wide, multi-agency,
multi-sectoral effort and by the public itself—action at
all levels. I do not think, therefore, that it would be ideal
to say that health promotion is just that organisation's role
and such-and-such a thing is just that other organisation's role;
we are all involved in the business of promoting the health of
the public and we all have parts to play. My reading of the Food
Standards Agency is that there is a real potential for the Food
Standards Agency and the national health education and promotion
agencies to have complementary roles, thereby making life better
for each other, but, above all, contributing effectively to the
promotion of the health of the public. Within that we can all
evaluate and monitor the performance of our individual projects
and our own overall performance towards our strategic objectives
that reflect our own roles in these areas.
211. Do you agree with that, Mr Lincoln?
(Mr Lincoln) Yes, we do think it is a complementary
role. We do think the Agency has a role in promoting health and
protecting health, and I go back to the points I made at the start
of the meeting: it is the promotion of health through the particular
interpretation of health protection which is very complementary
to the role of the wider Department of Health and the United Kingdom
health promotion agencies. That clarity is required, otherwise
I think it will get challenged through the very nature of the
work of the Agency. It may well be a lost opportunity not to clarify
that. Otherwise it may just be safety considerations only. I think
the provisions of the broader scope should be entertained at this
stage.
212. Dr Kemm?
(Dr Kemm) Yes, certainly I would be very sad if
my remarks were interpreted as meaning that I did not want them
to be heavily involved in the promotion of health. I think the
slight difference may arise around communication, where I think
that there are skills and opportunities available to the agencies
which it would not be helpful to duplicate. I am sure that there
is a very productive and co-operative relationship to be had there,
rather than overlap.
Chairman: Could I
thank you all very much for giving evidence to this Committee?
Hopefully, when our report comes out, which will not be too long
now, some of the things you have said today will be reflected
in our views about the proposed legislation. Thank you very much
indeed.
Examination of Witnesses
DR MIKE
RAYNER, Head, British Heart Foundation,
Health Promotion Research Group, JEANETTE
LONGFIELD, Co-ordinator, National
Food Alliance, were examined.
DR MIKE
RAYNER and JEANETTE
LONGFIELD
Chairman
213. Good afternoon. Can I welcome you both
to the Committee? I wonder if I could ask you, just as a matter
of record, to introduce yourselves, please?
(Dr Rayner) I am Mike Rayner, I am Head of the
British Heart Foundation Health Promotion Research Group, which
is based in the Department of Public Health at the University
of Oxford. I am heading a small research group. Our primary interest
is in the prevention of cardiovascular disease and devising effective
methods for preventing cardiovascular disease. I am also, I should
say, a trustee of the National Heart Forum and of the National
Food Alliance, of which Jeanette Longfield is the co-ordinator.
I am here today speaking in my own capacity, I am not representing
any other body, I am saying what I think, myself, personally.
So we may disagree!
(Ms Longfield) I shall kick you under the table
if you do that! I am Jeanette Longfield. I am co-ordinator, currently,
of the National Food Alliance, which is about to change its name
because we have just merged with our sister alliance, the Sustainable
Agriculture Food and Environment Alliance, and we are going to
be called "Sustain: the Alliance for Better Food and Farming".
We will have about 90 or so national member organisations when
we finally do the count. There are about 70 organisations in the
National Food Alliance membership and about 40 in the SAFE Alliance
membership, but there is some overlapping membership, so we have
not worked out how many members we have got yet, but it will be
about 90. They are all non-profit-distributing, non-governmental,
non-commercial organisations. I am sorry that is a bit of a mouthful,
but there is not a very easy way to explain what the sector is—it
can be called a voluntary sector, public interest sector or civil
society sector. I think you may get the gist.
214. Thank you. Could I just ask you, for
a start: would you think the Government has diluted the potential
effectiveness of the proposed Agency by emphasising its role in
food safety rather than nutrition?
(Ms Longfield) I have not heard a single member
organisation, either of SAFE Alliance or the National Food Alliance,
say that they wanted the new body's remit to be restricted to
food safety. In fact, the whole point of our being an alliance,
as we are, is to try and take a holistic and integrated view of
the food chain, from stable to table, seed to supermarket, or
the various ways you can use to describe it. I think that all
of them are very keen for the Agency to take that very broad and
holistic view and not to focus on food safety, even though all
of them do recognise that food safety is very important. So nutrition
would be included, but, also, issues to do with environmental
sustainability, ethics—the whole range of issues that people
are concerned about with food.
(Dr Rayner) As I said, my principal interest is
in the prevention of cardiovascular disease. I am very concerned
that the Agency takes a broad view of food safety and food standards,
so that it takes an interest in the prevention of chronic disease
in general. I think some figures here are important. If you look
at the number of cases of New Variant CJD each year, it is still
less than around 10. Cases of food poisoning are in the hundreds
or less than hundreds, but we are talking about around 30,000
premature deaths from cardiovascular disease due to poor diet
in this country. So we are talking about a huge problem in relation
to poor diet, and cardiovascular disease in particular. Actually,
if you add on the cancer deaths, we are talking about roughly
the same numbers of cancer deaths in this country due to poor
diet. So we are talking about 60,000 deaths a year due to poor
diet, from cardiovascular disease and cancer in this country.
I really want the Agency to not just focus on food-borne diseases
but also on chronic diseases and poor diets.
215. It is envisaged that that is, effectively,
going to be a joint responsibility and that the Department of
Health will have the responsibility in those areas. Do you think
that is the right way of doing it?
(Dr Rayner) I understand that, obviously, the
responsibility for nutrition will still be somewhat split between
the Department of Health and the Agency. So be it, really. I still
think the Agency should take a leading role in trying to reduce
the numbers of premature deaths from cardiovascular disease in
this country.
(Ms Longfield) One of the things that people have
criticised our organisation for is saying that we want the Agency
to take a very broad view of it, and they have said "Don't
be ridiculous. The Agency cannot possibly do everything."
However, I do not think the Agency has to do everything;
I think it must take that very broad and holistic view but then
to say "This Agency or that Government Department should
be doing the work on it". Just because it can see the broad
picture it does not mean it has to do everything in that picture.
Some agency, and from our perception the Food Agency is it, has
to take that broad view, because otherwise you get gaps opening
up in food policy where nobody is doing anything because everybody
thinks that somebody else is doing it, or overlaps or conflicts.
That has been going on for far too long, and I think now is an
ideal time for the Agency to take that broad view and make sure
that those gaps are filled, but not necessarily by itself.
Mr Brand
216. If I understand you correctly, you
see the Agency as having the lead responsibility in both your
field and Dr Rayner's field. Were you in when the Health Education
Authorities were giving evidence?
(Ms Longfield) I just caught the end.
(Dr Rayner) I heard some of it.
217. Clearly they take a different view.
I would very much like both of your opinions as to what, with
the present proposals, as the legislation stands, we are adding
to what is currently happening? We have a lead agency, which is
the Health Education Authority. What will a Food Standards authority
add to the issues that you are concerned with?
(Dr Rayner) The Health Education Authority, to
my mind, is the Health Education Authority; it is about health
education; it is about providing people with advice and, sometimes,
information about how to make healthier food choices. It has not
really, up till now at least, been particularly involved in health
promotion, which is creating a better environment in which people
can make healthier food choices. So it has not done much at all
on issues regarding food labelling, food advertising, food standards—in
terms of standards for school meals, for example—and it
has not done anything in terms of much broader issues like taxation
on food and agricultural policy. It has had to concentrate, as
its name suggests, on health education, which is, primarily, about
providing advice and information to the public. I am hoping the
Agency will take a broader view of what is required in terms of
improving people's diets and in terms of nutrition by looking
at some of these issues, like food labelling, which the Health
Education Authority has not done much work on.
218. If I understand you, Mr Rooker's interpretation
of what is proposed, which is hiving off MAFF activity, giving
it independence and, therefore, capability, really does not add
a lot to the programme you would like to see carried out.
(Ms Longfield) I think it would. For example,
there have been occasions in the past where sections of MAFF and
sections of the Department of Health have produced information
leaflets on the same subject. What the Agency could do is take
the view about what information needs to be provided and decide
which is the best Agency to do it.
219. I am sorry, the Health Education Authority
could be doing the same thing quite independently.
(Dr Rayner) It is not powerful enough.
(Ms Longfield) It is not powerful enough, I think
you are right, but also, insofar as co-ordination between the
different departments is supposed to work, maybe it was not working
well enough and it needed somebody to bang heads together, and
maybe the Agency could do that. Or it might decide that, actually,
the production of particular kinds of leaflets was something that
neither of them should do, and something else completely different
should be done. So I think that we would want the Agency to try
to stop that duplication of effort which has certainly happened
in the past, and, possibly, even to say "Look, some of these
activities are not all that helpful for anybody to do. Could you
stop, please, and do something else? That would be the value,
I suppose, that it would add.
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