Examination of Witnesses (Questions 440-460)
18 SEPTEMBER 2003
MR LEN
ALMOND, MS
JEANETTE LONGFIELD,
MR PAUL
OSBORNE, MS
KATH DALMENY
AND MR
PAUL LINCOLN
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.
| 
