Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 440-460)



  Q440  Mr Burns: Not at all. I was just interested in what you said, if I heard you right, about the safety record of the American school bus system.

  Mr Osborne: I was talking about road casualties in general. The yellow bus does have a good safety record.

  Q441  Mr Burns: Absolutely.

  Mr Osborne: In terms of the broad picture of transport and making roads safer for kids when they are outside of school as well, the States is not a country that we should be looking to for solutions.

  Q442  Mr Burns: Is there not a problem in America that I suspect there are far greater distances that have to be walked to get to school than there are in this country because, generalising, our towns are more compact than American towns and cities and we have more schools with the three mile rule on school transport whereas in America, just from anecdotal evidence, it would not be feasible even in fairly small towns for the children to walk to school because of the sheer distance?

  Mr Osborne: I think the statistics I have seen show that journey distances are greater in the States, but not significantly greater. The three mile rule that we have applied to free buses varies between states and cities. In Atlanta, which is the most sprawling city now and one of the fastest growing, it is a half a mile limit, so if you live more than half a mile you get free bus transport. You can imagine what the cost of providing that is and school bus budgets in the States are under tremendous pressure now. Local Governments are saying to communities, "Do you want to keep the number of teachers you have or do you want to cut your yellow bus service", which is causing big ructions. It is complicated, comparing with the US. Equally, they have a tradition of obeying speed limits more in that country, so to some extent you would say that it might be easier to walk or cycle there. They have very strong enforcement of speed limits outside schools. You would think there would be more walking and cycling going on but the yellow bus may have taken those journeys away and may be stopping them from happening.

  Q443  Mr Burns: You would not necessarily think there would be more walking and cycling because it does not take into account the character of the American people.

  Mr Osborne: No. It is a very car borne society. I think we need to do everything we can in our power to stop us going in their direction and look more to our European partners.

  Q444  Jim Dowd: Atlanta, of course, is the home of Coca-Cola and we are going to see them later. Just on the bus thing, before I go on to my final question. The bus issue is really to get people to stop using cars, it is being addressed from that point of view. As I say, this is where one policy imperative may cut across another. It is to get cars off the road and to get kids out of cars into buses rather than to use it as a basis of encouraging them to walk.

  Mr Osborne: That is why I think we need to approach it with a great deal of caution. If you can show that yellow buses do take car journeys and do not take walk journeys at the same time then it is a great thing but I have great concerns as to how new bus schemes will be managed. Clearly the bus operators' motive is to fill their buses; they may not particularly care where those passengers come from.

  Q445  Jim Dowd: Another area of public policy which receives a lot of attention is the question of setting targets by government. Is this an area where the setting of targets would be appropriate? If it is, what should they be and what linkages need to be established to ensure that they are delivered? That is a question for all of your individual organisations.

  Mr Almond: In terms of schools, I think if we ask schools to increase participation rates by two per cent, that is a very reasonable target. I would call it a challenge rather than a target. I think they prefer a challenge. It would be 2% for every year. If we did that we would start to make a substantial contribution to the Government's initiative of 70% people more active by the year 2020, which is not fantasy, it is a possibility if we look at a whole range of options. Two per cent in schools is very manageable and very reasonable.

  Mr Lincoln: I think it is very important to have the targets for the specific things, such as the risk factors, promoting the levels of physical activity and healthy eating. That is important as a national goal because clearly targets do drive change is the experience that comes to us. It is very important to have standards so you are not dictating to people at local level exactly how to operationalise those, and some of those standards we have referred to today in the evidence we have given.

  Ms Longfield: I am just a bit nervous about targets because there seems to be evidence from other policy areas that people engaged in trying to meet the targets focus just on them and everything else gets dumped, or there may even be perverse outcomes happening in other areas. It would be a shame if that happened. We need to look at what the evidence is from other policy areas, or even similar policy areas, to see how targets have worked in the integrated sense to make sure that not only are they doing what we hope they will do in the area that we are focusing on but they do not do damage somewhere else inadvertently. That is the only concern I would have.

  Q446  Mr Burstow: If I could pick up, first to pick up on this point about cross-cutting or joined-up work that Jim was exploring just now. One area particularly, apart from the Department of Health being seen as having a role in this, is whether or not the Treasury has any role. I was wondering if Mr Lincoln might be able to tell us anything more about whether he sees a role for the Treasury and, if so, what.

  Mr Lincoln: From the more general point first of all, I think it is important that there is Cabinet level co-ordination because we are talking about the early origins of chronic disease which are public health time bombs and already have huge social and economic implications, so therefore I think it is a Cabinet level issue. We know there are responsibilities for all different government departments, the DCMS, Department for Transport, et cetera, et cetera, and there is a role for the Treasury to look at the tax regimes in relation to food taxes. At the moment, for example in the VAT regime, where I think there is a moratorium on any extensions to VAT at the moment under the current Government, there are clearly anomalies and I think if you were going to design a VAT regime you would not necessarily do it the way that you have at the moment because there are anomalies, we would argue, in terms of encouraging healthy eating looking at the nutrient base. There are some foods which you would argue should have VAT added to at the standard rate which currently do not, and there are others which you would argue are quite healthy, like fruit juices, that do have VAT at the standard rate which you would take off. I think it would be very good if the Treasury were to look at the VAT regime and try and design it as an instrument which has some health basis. Obviously that would be very, very useful. There is lot of talk at the moment about "fat" taxes, there are other descriptions given—calorie taxes, nutrient taxes, marketing taxes—there are different interpretations of these, and again it probably would be worth exploring for a number of reasons. One is to see the impact those taxes would have on the consumption of particular types of food which one is trying to discourage but one has to be very careful and the jury is still out on this. We are doing some work on this with the Institute for Fiscal Studies at the moment to look at what would be the impact of those taxes. Would it be what we call regressive in terms of making it much harder for poor people, for example? So you have got to weigh all these things up. There clearly needs to be some more work done on this, some modelling, looking at price statistics, the regressive nature, and all the rest of it, but it is certainly worth looking at.

  Q447  Mr Burstow: What is the schedule of the work that you are doing currently in terms of is it likely to report in time for this inquiry to have the benefit from it?

  Mr Lincoln: We are expecting to draw the initial work to an end in the next month so we will certainly be able to share that with you. It is really to add to the discussion because there is a lot of uninformed comment about food taxes and it is very early days. If the Treasury is to do anything, in the short term it could clearly look at the VAT instrument and the criteria that underpin that from a health point of view.

  Q448  Mr Burstow: You mentioned anomalies, forgive me if I missed it in the evidence you supplied. Is there any source we can go to that would enable us quickly to be able to see the sort of anomalies that you describe?

  Mr Lincoln: We can supply that as part of the analysis that we are putting together at the moment.

  Q449  Mr Burstow: Can I move us on to another area which partly picks up on the point we were discussing earlier around conflict of advice that is coming in, the different sources, and the very intense commercial pressures that come in. We had the evidence given to us a while ago of the health education authorities spending a pound on promoting health messages and 800 quid being spent to send messages that possibly confuse that. Looking at it from that point of view, given all those pressures, is there any realistic prospect that in 20 years' time we will not be holding another of these inquiries to find out why the problem has just continued to get worse? Are we going to make any real difference? What are the steps that would really make a difference or are things going to continue to get worse?

  Ms Longfield: They will continue to get worse if we do not do anything. If we carry on doing what we are doing now, you are absolutely right we will be sitting here in 20 years' time saying, "Isn't it awful?" What is realistic and what is politically possible is obviously politically determined and we can shift and change that by putting pressure onto policy makers to do some of the things that they should be doing that are not being done. So for example there are 85 national organisations which now support Sustain's campaign to protect children against junk food advertising. You can explore the taxation issue and you do not have to it in a way that is going to be designed necessarily to reduce consumption. For example, I do not know if you are going to be looking at some of the examples in America but in some states in America they have a one cent tax on soft drinks. That is not going to discourage anybody from drinking soft drinks because it is so small but it does generate a huge amount of cash which is probably going to be of interest to the Treasury. You can earmark that and I know that the Treasury does not like that very much but again there are parallels in the tobacco field for using that kind of cash to try to counter-balance the negative influences of very large companies with very large marketing budgets. You can do all kinds of creative things if you have got big lumps of cash. One of the things that is bad about the public health movement certainly in food and partly activity is the image is so awful, it is worthy, it is dull, it is sensible shoes, it is just awful. If you have got the money and can buy the talented marketing people, you can make it just as sexy and gorgeous as the non-public health stuff, but you need the cash and you need the talent and somehow you have got to work out where we can get it from. I cannot think of any other place to get it from apart from some sort of taxation.

  Q450  Mr Burstow: Any other comments on this?

  Mr Lincoln: Yes, I think it is very important to have investment in social marketing, for example, in the ways that have occurred for tobacco over the years where you are altering social norms through a whole variety of measures. In terms of healthy eating the public are confused when you look at surveys and things like that. You have to be altering the whole environment over time, creating an activity culture, changing the matriarchal food culture, and there is very little investment in that at the moment. It is the poor relation in terms of the big risk factor determinants of the chronic diseases.

  Q451  Mr Burns: On this question of tax I can see the logic of what you are saying and where you are coming from on it, I just question whether it is workable insofar as if you put a tax on certain types of food—and I imagine it would be soft drinks, it would be crisps and that sort of thing—would that not be particularly regressive on less well-off families in the country where they would see they were being penalised rather than stopping them from buying those products? Secondly, on using the tax mechanism to try and stop people from smoking most of evidence seems to suggest that it has achieved two things: one, the Treasury has got significant more amounts of money from it, which fortunately now goes to the NHS; and, two, there has been a massive increase in smuggling into the country because of different pricing policies on the Continent.

  Ms Longfield: I am not up-to-date on tobacco policy but my understanding is that tobacco taxes taken over the long term have worked. There is a problem now with smuggling, you are quite right, because of lower prices on the Continent and so on. I am sure my tobacco policy colleagues will tell me that the solution to that problem is to put the prices on the Continent up—

  Q452  Mr Burns: That is not going to happen. I also question you saying that the tax policy has worked.

  Ms Longfield: My understanding is that the econometric analysis that has been done shows that the tax mechanism has worked in reducing consumption of tobacco, alongside a whole range of other measures and so on and so forth. I am sure that evidence can be provided to demonstrate that is the case. In terms of it being regressive there are two arguments. One relates to tobacco or indeed any public health measure, and that is people on low incomes have poorer health, die younger and are sicker so the argument that they need better health and more focused measures is a strong one. You can argue that making cigarettes so expensive that many people give up—and indeed many people on low incomes have given up—is precisely the extra help they need to have better health.

  Q453  Mr Burns: Let us not get onto tobacco but I do think that the premise of your argument now is factually faulty. I think what the evidence shows is that people make sure that they have got the money to buy those cigarettes and they may do it in a variety of ways, one of them that they will go to supermarkets which sell them at a cheap price and they will buy them from smuggled sources or they will miss out on other areas where they could be spending their income to fuel their addiction.

  Ms Longfield: I need to get my colleagues from ASH to send you information about that as well.

  Mr Burns: Let us hear from someone else as well.

  Chairman: The Committee did draw conclusions not dissimilar from what you are arguing and my recollection, Simon, is that you were party to signing up to them.

  Q454  Mr Burns: If we are going to talk about tobacco there is a slight difference because we can draw whatever conclusion you like, but if you look at the figures for Treasury revenue and you look over recent years at the decline in the numbers smoking, it is not that significant. If you actually live in the real world with people who smoke, you will find that most of them either transfer to cheaper products or they roll their own cigarettes or they go to supermarkets where they are sold at cut price or they will try and buy smuggled cigarettes because you are dealing with an addiction.

  Ms Longfield: Anyway, back to food.

  Q455  Mr Burns: That is what I asked about five minutes ago.

  Ms Longfield: The other thing that you can do is not have the tax at a level that is intended to affect consumption levels. I was going to say there are two types of tax, there are all kinds of tax, but in this area you can say either you put a big tax on it, like tobacco, which is designed to reduce consumption or you can put a very small tax on which is not designed to affect anybody's behaviour at all because it is only a penny or something and because of the sheer volume of sales that generates a huge amount of revenue with which you can then do something and it does not affect anybody because the level of taxation is so small.

  Q456  Mr Burns: But is there not a danger on your latter argument, that you put it at a relatively small level, one then begs the question why do it and go through the political grief of doing it?

  Ms Longfield: To get the money.

  Q457  Mr Burns: All right, get the money. What we see—I will be fair now—from successive Governments is when they put taxes up to get the money, as you say, it does not usually go to a targeted area that may be for the general well-being, it gets submerged in general government spending because the Government is cash strapped and needs it for things that they consider politically far more sexy than telling you that you should not eat certain levels of fats, sweets or whatever.

  Ms Longfield: I absolutely agree that if you are going to do it it needs to be hypothecated, and I know that the Treasury hates hypothecation. Nonetheless, if it was going to happen, that is what you would have to. There are precedents for that in other countries and it seems to work. I think it would be worth giving it a try.

  Mr Burstow: I want to just clarify something because I was asking you a question which was really is this a counsel of despair, can we really do nothing, and you have given us your view on that and we have had an exchange about tax. From all the witnesses, could we get from you if you were giving advice to the Prime Minister now, what would be the top three actions you would recommend to the Prime Minister ranging from soft advice to hard fiscal measures that should be taken to tackle obesity? This is your opportunity to have your say to the Prime Minister about what should happen. It would be very useful if you could tell us what the top three actions would be.

  Q458  Chairman: I am anxious to try and conclude by 12.30. You are on the spot, Ms Dalmeny.

  Ms Dalmeny: Can I be on the spot a bit later, thank you.

  Mr Osborne: I will focus on the issue of moderate physical activity on the way to school. If we are going to promote more walking and cycling for daily journeys we need to be reducing speed limits in urban areas to 20 miles per hour as a minimum, changing the rules of the road to give much greater protection to people who walk and cycle. I think we should be giving serious consideration to shifting some of the budget that is going into road building programmes away from that and into sustainable transport schemes because we can demonstrate the best value that that represents.

  Mr Lincoln: I would say the number one priority is controlling food marketing to children and looking at the different means of doing that.

  Mr Almond: I think we need a national framework that becomes a driver for schools, the whole area, because at the moment there are no drivers they can use, so they can simply ignore it. That is my first one. The second thing would relate to the School Sport Co-ordinated Programme and the one we have missed today is a SureStart programme. We need to mainstream SureStart in terms of nutritional advice and physical activity to parents because there has been a massive reduction to one hour a day of young people being active. We have got to address that as a starting point. I would put SureStart as my second one. The third one would be we have to move towards a professional career group for physical activity practitioners, there is none at the present moment. There are nutritionists, physiotherapists, we need something to be able to deliver physical activity.

  Q459  Chairman: That is a very interesting point. You are talking about a new professional basically?

  Mr Almond: Yes.

  Q460  Chairman: That is a very interesting thought.

  Ms Longfield: Like my colleague, Paul Lincoln, I would ask government to introduce legislation to protect children from junk food marketing. I would ask schools to be inspected by Ofsted on their whole school policy approach to health, which would include food and physical activity. I would look at using the tax systems in imaginative ways to raise some money so that we can counteract the negative image that public health has got and make it something funky and gorgeous.

  Ms Dalmeny: I will pin my first flag to controlling marketing to children of unhealthy foods. My second flag will be pinned on nutritional standards for any foods associated with health claims, sponsorship, schools, school meals, educational materials, "five a day" claims. The Food Standards Agency is doing excellent work on looking at nutritional profiling for food, which I would urge you to look at, and the EU Health Claims Directive would also make a considerable contribution in this area. Thinking in blue skies ways I would look at making healthier foods more sexy, bringing it up-to-date, so launching a big cultural campaign for people appreciating good food.

  Chairman: Thank you very much. Do any of my colleagues have any brief final points? If not, can I thank our witnesses for a very interesting and useful session. One or two of you mentioned sending further material to us and we are very grateful. If subsequent to the session you have got any further thoughts or issues that you did not mention, we would be very happy to hear from you. Thank you very much, we are most grateful to hear from you.

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