Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 420-439)



  Q420  Mr Burstow: My son climbs trees and all sorts of things on the way to school.

  Mr Lincoln: I think it is both. I think you have got to encroach on the structured time as well as making use of the extended time.

  Ms Dalmeny: I think probably the advice that your school has given out is partly to do with the great deal of confusion among teachers and teaching staff about what it is that the consensus science is supporting. A lot of the teachers who contact us say they have had completely conflicting information from all sorts of sources—including the media, including discussions with parents—about what constitutes a healthy diet, about what individual items contribute to a healthy diet, what kinds of physical activity and what amount of physical activity is the kind of thing we should be encouraging. That idea of consistency of message for the public health approach is terribly important. I am going to come back to my bugbear which is to do with commercial messages, encouraging the consumption of particular foods for health and those being given to schools, for instance things like Snickers bars being promoted as a very good thing to eat before physical activity. That information was sent out by the Football Association and approved by the Medical Council to lots of different football academies around the country. This kind of message is the sort of thing that gets through, it has got the marketing budget, it goes directly to the people who are working with young people and that is the kind of thing that can undermine people's confidence that physical activity and good food are terribly important for young people.

  Q421  Chairman: On that particular example, was there a commercial tie up somewhere between the Football Association and that company?

  Ms Dalmeny: Yes, a financial transaction.

  Q422  Chairman: What a surprise!

  Mr Lincoln: I would like to go back to Dr Naysmith's point which was about supporting people who are worried about children in schools. I think we have to concentrate on the fact that we will have to do something about the obesity environment in the schools and I come back to the point about vending machines and their inappropriate marketing and all the rest of it. That is not supporting those children or the parents who are trying to support those children or the schools. We have to be very sensitive to that.

  Q423  Dr Naysmith: My area of questioning really was about the damage to confidence of the youngsters who are obese or certainly overweight and what the adults they may come into contact with can do to help them so as not to make they feel even more damaged.

  Mr Lincoln: I totally agree with that, but the environment is a crucial factor. I have details of a vending machine in Scotland where for every carton of milk sold there were 900 fizzy drinks sold. If the choice is there that is what is actually going to happen. A simple policy would be to say that if you have the vending machines then let us have some healthy options in them because you can still income generate from it.

  Q424  Dr Naysmith: It is not just in schools. When we were in Yorkshire last week we came across an overweight lad who had tried to join a rugby league club and he had been more or less told by the people running it that it was not worth bothering about, there was no point and he might as well go away and do tiddlywinks rather than think about becoming a member of that club. How do we address that kind of attitude?

  Mr Almond: We have to educate the sporting clubs to recognise that it is not just elite young people they want because in reality they will probably go for well-developed young men or women who are going to be good for a number of years, but everybody else catches up eventually. What they should be having is a policy for all children and making opportunities available to them because they might find some of the little tiny rabbits down there become exceptionally good runners and rugby league could benefit from those.

  Q425  Chairman: I was very surprised at this example as I am a rugby league supporter and with your accent I would imagine you know a little bit about the game.

  Mr Almond: I went to see the Bradford Bulls on Sunday.

  Q426  Chairman: It concerned me that this lad had had this experience and I was very surprised to hear it as I am somebody who believes that sport is generally inclusive. I think the Bradford Bulls felt that that was an unusual example. It struck me that most clubs could have turned that kid into quite a useful prop forward.

  Mr Almond: They could have done.

  Q427  Chairman: It made me think about the emphasis on excellence in every sport now. Have you any thoughts about the way in which we are tending to develop excellence? We are looking at participation and particularly the health benefits of participation for kids who like this lad may never actually make it.

  Mr Almond: I think you have hit the nail on the head. Excellence can be the buzz word and people want to find the best children that they can mature and develop into fantastic players, but if they are going to invest in that then lots of other children are going to be pushed to one side. I think clubs have got to have an inclusive policy because unless they have an inclusive policy they are going to miss out on a tremendous amount of talent and I think a lot of talent in this country is wasted because of this emphasis on getting them early and teaching them and I think they miss a lot of very good young children. The declining numbers in schools is going to perpetuate the fact that there is going to be more and more competition by sporting clubs for a smaller number of people and if they are going to be more aggressive in that approach to excellence that would be a shame. What we need to do is encourage them to have an inclusive policy which takes on as many children as possible and some clubs still do that because I think that is in their interests. They are also going to be spectators, participants. There is massive potential there if they take an inclusive policy.

  Ms Longfield: I also think the sports clubs have a real responsibility to be very careful about their sponsorship deals. There is a distressingly large percentage of very high profile sports clubs that are sponsored by alcohol companies and who have sweet drinks as their official drink. Those are completely inappropriate associations when you are trying to support either excellence or participation. Joining those kinds of foods and drinks with that kind of sporting image is just wrong.

  Q428  Chairman: I would agree entirely with what you say. However, trying to get them away from tobacco sponsorship is not always easy to do. It is ironic that the Rugby Super League is sponsored by Tetleys, but the Autumn League Series against Australia is the "Don't drink drive" test, it is a cross-section of messages.

  Ms Dalmeny: I would agree with you that it is difficult with adult sports like that, but there are specifically children's education programmes with football clubs that are sponsored by the fatty and sugary types of products. We have had examples of free samples of the products being given out to kids who are participating in stuff that is organised by the school with the local football club. That is where there is something specific going on of linking the idea of the physical activity with the particular product.

  Mr Osborne: On your point about how do we help these children who want to do something, I think there is a danger in focusing too much on sport. The health guidelines on reducing your weight talk about one hour of moderate physical activity and that has been shown to be the most effective way of getting people's weight down. Sport does alienate an awfully large proportion of the non-obese population in schools as well. There is this important task of encouraging obese children to do things both inside and outside school in ways which do not raise the awareness of other children in the school, for example where someone is told to play football to lose weight. It may be embarrassing. It is about doing it quietly, whether it is the journey to school, what they bring to school in their lunch box and rewarding them quietly for that process.

  Q429  Dr Naysmith: The other area I wanted to explore a little bit is the question of involving and engaging children from ethnic minority backgrounds in sport. Is there an issue there? Is this something that we need to talk about?

  Mr Almond: There is an issue in terms of girls and young women. We have not won that battle yet. If you look at Leicester, which has a large population of ethnic groups, there are more people in leisure centres from ethnic groups than the white population. So they are taking exercise and they are recognising the value for men and women. I think what we have to do is to get the schools to recognise that there are cultural things to take into account, particularly for women and they must address that. There is a massive project run by the British Heart Foundation based in Leicester with over 10,000 ethnic children trying to reduce obesity levels and that project would be worth visiting so as to find out how they are doing it. They have been extremely successful in changing the cafeteria system at lunchtime after the children voted for fresh fruit and vegetables and staying away from chips and burgers. So there are a lot of interesting things happening there.

  Mr Lincoln: I think a lot has got to be done in raising awareness of the risks of these chronic diseases and their origins with communities themselves. The evidence is that there is still very low level awareness of the increasing susceptibility of those groups and that is important for those communities and supporting schools and young people.

  Q430  Dr Naysmith: I take Mr Osborne's point that it is not just sport. However, there do seem to be some areas of sport where there is much more engagement than others and I wondered whether that is an area we need to explore a bit further and make recommendations on. Athletics has lots of ethnic minorities involved but that is not the case probably in rugby union. There are young people of West Indian origin playing football but there are not many of Asian background. Is this an area that we need to explore further and make recommendations on?

  Mr Almond: We certainly need to explore it further. Athletics is an interesting activity because we have just done a survey and there were more veterans taking part in club competitions than young people. That has never happened before. More older people are taking part in athletics than young people as there has been a massive decline there. I think people like UK Athletics need to have a very careful look at how they can do that and ethnic groups may be one area to have a look at.

  Q431  Jim Dowd: Is that difference that you highlight more than a change in the population at large? We do have an older population and it is going to get older as the proportion of older people compared to younger people rises.

  Mr Almond: I would like to think that those people in athletics who are post-60 ought to carry on doing it and I think that probably is a factor. You do not see it in other sports. You see it in swimming. You do not see it as much in games because they probably have had too many knee injuries, back injuries, arm injuries, etcetera. It is an observation. I do not think it is simply that. I think there has been a reduction in the number of children wanting to commit themselves just to taking part.

  Q432  Jim Dowd: I want to pick up what Ms Dalmeny was saying about the role of the commercial sector and the business pressures. We will be speaking to the manufacturers and the supermarket people later in the inquiry and we are very keen to hear what they have got to say. We are getting two distinct messages. One is yours, which is these are the familiars of Satan and we should have nothing to do with them. The other is that there is no solution to this without their active engagement. Is it not better—I accept what you say about what you would see as inappropriate—that they actually encourage responsible use of the product in a broader lifestyle than simply saying our job is to sell the product?

  Ms Longfield: I do not think they have a role in schools. I think that educational institutions are educational institutions and I do not think there is a role for commercial sponsorship, commercial engagement and commercial influence in schools. As for the engagement of industry in the wider environment, yes of course Government has to engage with manufacturers and retailers and producers of various sorts in trying to cajole, persuade, regulate codes of practice and so on to try to encourage them to run their business in a way that is both profitable and healthy. I do not think those efforts have been very successful to date. Engagement in the broader political context is right and proper, but I just do not think it is appropriate in schools.

  Q433  Jim Dowd: So where the snack manufacturers have had tokens to collect in order to get equipment for schools or where sweet manufacturers have been involved in encouraging activities in school, you would not agree with that, would you? There is nothing we could do to prevent that. If any individual organisation wants to pursue that there is nothing that can be done to stop it, but you would oppose it entirely, would you?

  Ms Longfield: I think there is something that can be done to stop it. I think it is the Government's responsibility to fund education properly.

  Q434  Jim Dowd: If somebody wants to do it they will be able to do it, no Government will be able to stop them.

  Ms Longfield: Surely it is within the Government's remit to say there are certain areas in our society where you will be protected from commercial pressures and surely schools is one. You could argue that hospitals are another. You may argue that there are other areas, I do not know. It is our collective responsibility. Surely to say to our elected representatives that there are places where we do not want to have commercial pressures is right.

  Ms Dalmeny: If a commercial company is promoting a product in a school what nutritional messages come with that? One of the things I have been looking at recently is the advice given on sugar consumption. Eurodiet, which is an European-wide academic network designed to translate scientific evidence into advice to people for the benefit of public health, says that eating sugar four times a day is about the right level to maintain the percentage level of sugar in the diet and to maintain healthy teeth. Mars says six times and Nestlé says six times. How is a school supposed to know whether or not the advice is correct? Do they have the nutritional knowledge or information to be able to say that that is inappropriate? Is anybody checking that the information that is coming with these commercial materials bears any relation to public health advice? If it were the case that society accepted that schools have to have this kind of commercial sponsorship, which I find very problematic, then there needs to be some system that says that some things are not appropriate and incorrect information is one of them. Another thing is the Cadbury's scheme which I know you have spoken about already in this inquiry. That was explicitly called an anti-obesity measure and it was endorsed by the Minister for Sport. Linking the high consumption of fatty foods and an anti-obesity measure in my book falls into this kind of category of incorrect information. Most people think it is okay to have a chocolate bar occasionally as a treat. How often is occasionally? What is a treat? Most chocolate bars that are promoted under that scheme are 200 or 300 calories and a highly fatty, sugary product. They do not deliver much else in terms of nutrition—not nothing else but not much else. What is the role of a 300 calorie snack in a young child's diet? Some of those products were aimed at six, seven and eight year olds. That information is not going to the schools and you are not going to get it from the company because it would say "Limit the consumption of these snacks", it would say "occasional", but it will not give a definition of what that means. Coming back to this problem of the physical activity outside school, the school has to be confident in what it means by healthy eating and good levels of physical activity and for that not to be undermined by a commercial imperative.

  Mr Lincoln: Basically the situation is industry has had a free-for-all, it is unregulated in all the formats, whether it is TV advertising or marketing to schools. We have to look at what has happened over the last 20/25 years. What we should be asking ourselves is what would we have done differently 20/25 years ago. Why are we in this situation? You have got massive increases in marketing to children by the industries and huge changes in the consumption of these particular types of foods that are high in fat, salt and sugars. It is an absolute priority to look at this and to look at appropriate modes of regulation, as is being done in many other parts of the world.

  Mr Almond: I agree with Jeanette and Kath, and also Paul, but I would like to make a suggestion on this. We are approached weekly at the university by food companies who want to associate themselves with physical activity and we have to say no, the British Heart Foundation will not accept that, and I think that is absolutely spot-on right. However, I just wonder if we are really going to invest in physical activity, because there is no real investment at the moment to do it, why could we not ask all of those food companies to invest into a blind trust which might be co-ordinated by something like the National Heart Forum and ensure that physical activity is seriously promoted, not apparently on the back of promoting a chocolate bar.

  Q435  Chairman: Do you think they would put money forward?

  Mr Almond: If we do not ask, we will not get it.

  Mr Lincoln: We also have to be aware about industry changing the nature of the scientific debate. They have to address the issue that they have a responsibility here and there is lots that they can do but little evidence that they have moved in those directions so far.

  Q436  Jim Dowd: I think when we get to see the manufacturers we will put precisely Mr Almond's point to them.

  Mr Almond: I think the Heart Forum would be an absolutely ideal broker.

  Ms Dalmeny: I think it might be useful to remember a phrase that is on the Cadbury's packets in relation to the token scheme, which is "Further purchase necessary". I think that is one of the key elements of that.

  Q437  Jim Dowd: You are not sponsored by Pepsi, are you, by any chance?

  Ms Dalmeny: No, I will put it away in case anybody misinterprets.

  Jim Dowd: Have the cameras caught that?

  Chairman: It was a visual aid before you came in, Jim.

  Q438  Jim Dowd: Mr Osborne, you mentioned the report yesterday—I have not read it in detail—on transport. One of the most puerile expressions thrown around government these days is "joined-up", an idiotic idea but clearly departments need to connect what they are doing. Do you feel that the mechanisms are strong enough between departments? A lot of issues relating to obesity are just seen as a Department of Health lead, yet it is Transport and others that need to deal with that. Do you think those mechanisms are strong enough?

  Mr Osborne: In terms of the school journey, it has been really very encouraging, the lead that Charles Clarke has taken in education. Hitherto, I think we have had only a slow recognition that they have a role to play, it has been very much a transport led initiative. I think that the recent document is a sea change in that it has got joint endorsement with education money behind it, which is excellent news. I think the NHS, the health sector, is one that we would like to see playing a greater role. The Primary Care Trusts are supposed to be looking at preventative issues as well as treating poor health and I think the progress is still slow, particularly the budgets that are being put into poor health prevention. That is where I think we would like to see some more progress. The Healthy Schools Initiative has been tremendously valuable bringing departments' work together and I would endorse that very strongly.

  Chairman: Paul, do you want to come in on that?

  Mr Burstow: I want to follow that on with something else in a minute.

  Q439  Jim Dowd: On that one point first. When you mentioned earlier that only the US has a lower proportion of going by bicycle to school, they do have a somewhat more sophisticated bussing system to school than we have here. There is pressure in this country for us to introduce a kind of US-style yellow school bus scheme. From what you said earlier, and clearly the Department of Transport are looking at that, would you say that should be resisted?

  Mr Osborne: Sustrans' view is that we want to approach the yellow bus with a great deal of caution. The way we see it in the UK, we have a high proportion of children walking to school, it is 50% here and 10% and less, and going down, in the USA. So 90% of them are either being taken by car or yellow bus. The other issue in the USA is they have a much poorer road safety record for child casualties than European countries, so quite why we are looking for our transport solutions to the USA when we have perfectly good solutions in Europe—Denmark, the Netherlands, Germany—and when our country is so much closer to them, I would not say politically but certainly in terms of geography and our set-up in terms of schools, I do not know. There is a real threat that yellow buses will not only attract children out of cars but they will take a lot of walk journeys and I am sure that has been the experience in the USA.

  Chairman: Simon, our expert on the USA.

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