Examination of Witnesses (Questions 1
- 19)
MONDAY 23 APRIL 2001
MR NIGEL
CRISP, MR
ROBIN YOUNG,
SIR MICHAEL
BICHARD, KCB, MR
WILLIAM RICKETT
AND MR
GEOFFREY PODGER
Chairman
1. Today the Committee is taking evidence on
the Comptroller and Auditor General's report on tackling obesity
in England. It is a unique occasion, the first time, certainly
since I have been Chairman, that we have had five departments
appearing before us together. It shows the importance of cross-sectoral
or joined-up government to address the issue we are dealing with
this afternoon. We welcome Mr Crisp, Permanent Secretary at the
Department of Health and Chief Executive of the NHS which takes
the lead in formulating the policy on this considerable public
health risk. I should also like to welcome the Accounting Officers
of the four other major players across government, Sir Michael
Bichard in his appearance after his valedictory, Mr Young, Department
for Culture, Media and Sport, Mr Podger, Foods Standards Agency
and Mr William Rickett from the Department of the Environment,
Transport and the Regions. Welcome to all of you gentlemen. Let
me start with Mr Crisp. The report tells us that there has been
a doubling of the number of obese people in this country at the
time when in Europe there has been an increase of between 10 and
40 per cent. Why are we so much worse than the rest of Europe?
(Mr Crisp) The first point is that this
is a worldwide issue and is really a very significant worldwide
issue and no country yet has an approach to dealing with it which
seems to be delivering.
2. But we are the worst by the look of it.
(Mr Crisp) No, if you look at the figures here it
also relates to where the starting point was. If you look at the
figures in one of the appendices you will see that even if we
have come up, we are still behind Germany in terms of the prevalence
of obesity and considerably behind the United States. This is
a problem, particularly for the more affluent societies, though
it is also in the developing world. We have seen a big increase:
we are now more in line with some other countries. We seem to
be following the same process as the States and that is why we
need a very active set of measures to tackle it.
3. You have not really given me a cause for
this.
(Mr Crisp) The cause of obesity is very much about
change in lifestyle, it is about the over-mechanisation of modern
life, people being much more sedentary, a diet much more rich
in energy dense foods, changes in the way in which food is eaten
away from the home, far more snacks and soft drinks and indeed
alcohol. There is a whole series of things to do primarily with
affluence and changes in lifestyle which are affecting us as they
are affecting other countries. We may have started from a lower
base than some of our European neighbours, but we certainly have
a significant issue.
4. That will be pertinent to the methods you
adopt to deal with it. The C&AG estimates that it costs the
National Health Service at least £½ billion to treat
the consequences of obesity every year. Paragraphs 2.26-2.27 suggest
that figure is actually conservative and that it is probably more
than that. To what extent does this encourage you to give greater
priority to the issue of obesity than perhaps you have in the
past?
(Mr Crisp) Obesity is implicated in a whole series
of very major diseases and you pull out the cost there. It is
partly the cost but also the effects on people's health which
are also brought out in this report, both of which mean that we
do need to give it a significant priority and, as the report also
says, that is happening now. We have it within the NHS Plan, probably
most significantly and in a most developed way in our National
Health Service Framework for coronary heart disease which has
moved on a bit since the time the research for this report was
done but we do have within that a requirement that by April 2001,
in other words now, every health authority should have a strategy
for plans for dealing with being overweight and obesity alongside
some of their other plans for health. We are tackling it in the
same way as we are tackling smoking and other issues which cause
ill health.
5. You say that the target is for now. Has it
been achieved?
(Mr Crisp) We do not yet know. We do have an evaluation
which is being started by the Health Development Agency to look
at what health authorities have put in place and we shall be able
to look at that over the summer. It is not a question of ticking
a box and saying you have a strategy.
6. Others may press you a little harder on that
but let me move on to some specifics. The report identifies wide
divergences in the way GPs deal with this problem. What action
do you propose to take to ensure a more consistent and evidence-based
approach by them?
(Mr Crisp) There are three elements there. You mentioned
the evidence-based approach. Firstly, we do need more research.
It is not yet clear absolutely what works or what combination
of factors works, so more research is needed and that is happening.
The second thing which is happening is that we need to do more
work on providing guidelines and advice for people as we know
what works; there is some work going on around that. The third
and most significant point is what I have already alluded to,
which is that health authorities need to have plans in place for
tackling being overweight and obese and that the main people who
will be delivering that part of the strategy will be through primary
care. It is a two-part approach: one part is the approach to prevention
which is primarily with schoolchildren and fit adults; then the
approach to people who are having problems or who are already
obese needs to be led in the first place through primary care.
7. Paragraph 18 of the Executive Summary notes
that much of the cross-government work to promote physical activity
is targeted at schoolchildren, which is very evident from Part
4 of the report. What are you doing to promote the health benefits
of physical activity across the whole population? Adults really
rather than just schoolchildren.
(Mr Crisp) We have an inter-ministerial group working
specifically on physical activity for children. We are waiting
for some of the information to come from that group before we
make a definitive decision as to how we would move forward with
the recommendation which is in here about providing a strategy
for all ages around physical activity. There is some learning
to do from the children's activity but perhaps at this point I
could bring in colleagues to flesh that out.
(Mr Young) Certainly from the sport point of view
we have deliberately focused on schoolchildren, not least because
it is there that we can have most control because how they spend
their time is less voluntary. Whereas in the twenty-first century
you cannot tell adults what to do and how much exercise to take,
with schoolchildren you can have a try at least at doing that.
We have deliberately focused our attention on improving sport
opportunities and exercise opportunities for young people in schools.
The Government's sports policy as a whole goes much wider and
deals with the enhancement of sporting facilities for use by all
ages. We focused new additional money and attention on sport in
schools but for example in previous sessions here I explained
the Sports Council and Lottery funding scene and the huge improvement
in sports facilities throughout the country that has caused. We
are not restricted on adults but Ministers have definitely focused
quite deliberately on schoolchildren.
(Mr Rickett) There are strategies for encouraging
walking and cycling across all ages; they are not targeted just
at schoolchildren though some measures are targeted at schoolchildren.
It is worth noting that the General Household Survey shows that
walking is by far the most popular leisure activity for adults.
There is scope.
8. Paragraph 2.15 raises the question of barriers
to participation of some groups and they talk about poverty and
fears about personal safety. What are you doing to deal with that
in some of these areas?
(Mr Young) From the DCMS point of view—not that
this is an unjoined-up answer—we ask the Sports Council
in particular to monitor use of sports facilities by a number
of groups who hitherto have considered themselves shut out or
discouraged, including women's and ethnic minority groups, the
poorer members of society, who hitherto have made less use of
public sports facilities than other groups. We have set them a
particular task of monitoring use of our new facilities and all
facilities by those groups which will unfold as they report back.
(Mr Rickett) Our strategy is to ask local authorities
to bring forward local walking strategies and cycling strategies,
taking account of personal security issues like good lighting
on pedestrian routes and so on. We have issued guidance on "Personal
Security Issues in Pedestrian Journeys" to help local authorities
and guide their activities.
9. Let me move on to the question of youngsters
at school. What progress has been made, Sir Michael, by your Department
to meet the stated aspiration of at least two hours physical exercise
a week for youngsters?
(Sir Michael Bichard) The statistics show that the
time spent within the curriculum on PE has probably reduced a
bit, but the time spent outside the curriculum has increased a
bit. Earlier this year the Prime Minister committed the Government
to an entitlement for every child to have two hours a week. That
covers time spent in the curriculum and outside the curriculum.
We are working with other departments on how that can best be
achieved. There has been a very substantial investment in initiatives
like schools sport coordinators where we expect to have 1,000
in place by 2004. One hundred and twenty million pounds are going
into that. There is another substantial investment in sport, Champions,
which is well-known sports people going to schools not to preach
excellence but to encourage people to participate and raise the
level of participation up to two hours a week. We are also investing
with DCMS in a very substantial programme of multi-purpose arts
and sports facilities across the country. A good deal of work
is going into it but I accept that we have yet some way to go.
10. Do you have figures on how far and how fast?
(Sir Michael Bichard) We do have figures on how much
time children are spending within the curriculum on PE. At Key
Stage 1 it is one hour and 20 minutes, at Key Stage 2 it is one
hour and 35 minutes, at Key Stage 3 we are up to two hours and
at Key Stage 4 it drops down. One of the problems at Key Stage
4 is that some of the older children have not been keen to be
involved in the rather more traditional team events. We are therefore
giving schools and teachers a bit more flexibility as to the kind
of provision they make available for older children.
11. I am sure others will pursue that further.
Let me move on to the DETR. How successful do you think the Department
has been in ensuring that local authorities participate fully
in making it easier to walk and cycle? You mentioned this briefly
earlier but how successful do you think you have been with local
authorities?
(Mr Rickett) It is a requirement of the Local Transport
Plan process that local authorities should produce local cycling
strategies, local walking strategies, in partnership with other
agencies and with bodies like schools, health authorities and
so on. The local transport plans that they have produced all include
these strategies and there is evidence of partnership working.
There has been a history of increasing partnership working, starting
perhaps with road safety and air quality, now moving more into
physical activity. The Department collaborated in the publication
of a document called "Making T.H.E Links", the transport,
health and education links, to try to bring home to local authorities
the importance of bringing these activities together.
12. Do you have any quantitative measure of
how much has been done by local authorities?
(Mr Rickett) It would be quite hard to produce a single
quantitative measure. We have done surveys of how far their strategies
refer to joint working and it is a requirement of the guidance
that they report annually on what they are doing and that should
give us more information about how far they are actually working
in collaboration.
13. We may ask for data later but I shall come
back to you on that one. Mr Podger, the point was made very well
by Mr Crisp at the beginning that a lot of this comes down to
the sort of food people eat today, high energy food basically.
What is your agency doing with respect to the way food is marketed
and labelled?
(Mr Podger) The point you raised earlier about adults
is particularly relevant. Adults who want to choose may in fact
find themselves potentially defeated by labelling in actually
exercising that choice. For that reason the Foods Standards Agency
has a variety of initiatives which are currently ongoing which
are designed to promote on a voluntary basis more helpful labelling
for consumers in this country, but also to feed in to the revision
of the European Community law which governs this area in the hope
that will actually allow consumers to have access to labels which
are more meaningful to them. I doubt it will have escaped the
notice of any of the Committee that if you look at something which
is currently labelled according to European regulations, unless
you are a nutritional expert it is extraordinarily difficult to
understand what is being said. I should say—and they should
be praised for this—that UK retailers in particular have
already introduced simple diagrammatic indications, for example
of what proportion of your daily fat intake is contained in a
particular product. We have encouraged the retailers to do this.
We have a working party looking at clarity of labelling which
will be reaching its conclusions this year, but also we are very
much in touch with the European Commission who are in general
sympathetic about the need to reform the nutritional labelling
rules at the Community level so they are actually meaningful to
ordinary people.
14. Just as an ordinary consumer I notice that
advertising things as 80 per cent fat free is a euphemism for
20 per cent fat. Can you discourage that?
(Mr Podger) Yes. We do have voluntary guidance with
the industry and we do specifically discourage exactly that kind
of labelling which is worse than meaningless and in our view is
actually positively misleading. We strongly deprecate that. Frankly,
it is an issue of perpetual vigilance. Let me say that the food
industry are not unresponsive, but inevitably from time to time
they see commercial opportunities arising. It also worth making
the point which is very relevant to this, that the Agency is also
very concerned about the labelling of products which may be high
in fat or sugar, but which are alleged to have some additional
health advantage because they are fortified with vitamins and
which we would perceive as being very misleading to consumers.
Mr Steinberg
15. May I say that I have read a lot of reports
over the last three years on this Committee but I think when I
read this report I was more cynical about it than any other I
have read? I do not deny that the Government have a role to play
in this: obviously they have. Those who are fat and obese, other
than some who are actually ill, mentally perhaps, I do not know,
are really to blame because they indulge, they do no exercise,
they sit on their backsides and just get bigger. Why is there
such a movement to do something about it other than the fact that
it costs such a lot of money? I suspect that if it did not cost
such a lot of money, I would say let them get on with it.
(Mr Crisp) From the health point of view it is the
money, but if you take a single example, which is Type 2 diabetes,
we think 70 per cent of that would be preventable if it were not
for the levels of people being overweight and obese. That is a
very considerable issue in health terms, let alone just economic
terms. That is for people who are already obese.
16. We have half the population overweight and
one in five obese. That is their fault, is it not?
(Sir Michael Bichard) If we believe that the education
system, for example, is there to help people to a position where
they can enjoy life, a healthy life and a decent quality of life,
then at least in their school years we have a responsibility to
help them to understand and the choices which will assist them
in that and that really is what the problem is.
17. Is it not a fact that the vast majority
of people eat too much, they indulge, they do not do any exercise
and basically it is their own fault?
(Mr Rickett) That does not mean that the Government
should not take any interest in that as a public policy issue.
In terms of transport, clearly people have been driving their
cars more. As car ownership rises we have seen an increase in
people travelling by car and less by bicycle, foot or bus and
it fits with our transport objectives to try to do something about
that. It also fits with our objectives of trying to create better
places for people to live.
18. Is it not up to people to do something about
it?
(Mr Rickett) Absolutely; yes. The public policy issue
is about providing people with choices and information so that
they can make sensible choices.
19. We will continue this theme. I am very suspicious
about this dial as well; very suspicious. If I am reading it correctly,
I am 28 BMI, which is two from obese. If this is the formula which
is being used to calculate who is fat and obese, then frankly
it seems to me that the vast majority of people who are talked
about as being fat and obese are not actually fat and obese in
the first place.
(Mr Crisp) May I suggest that on page 15 the bit which
is more worrying than that dial is chart 6 which actually shows
that at round about 28 your relative risk of dying prematurely
goes up sharply. That is the bit which worries me rather more
than that chart. That is the issue for us in the Health Service.
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