Examination of Witnesses (Questions 540-559)
6 NOVEMBER 2003
DR ALAN
MARYON DAVIS,
MR JOHN
GRIMSHAW, PROFESSOR
CHRIS RIDDOCH,
DR SUE
CAMPBELL CBE AND
MR TOM
FRANKLIN
Q540 Dr Naysmith: They are just registering
their brand.
Dr Campbell: They are; I understand
that.
Q541 Dr Naysmith: That is not the
same at all because you are in the position of putting before
children—and it does happen elsewhere in huge advertising
campaigns—by putting things into schools that you really
want to educate the children about from a balanced choice.
Dr Campbell: Correct.
Q542 Dr Naysmith: One or two lessons
on diet are not going to compensate for the fact that you have
a big advertising industry doing plus things in schools which
say this is a good company, helping us a lot, we should buy their
products.
Dr Campbell: The Cadbury project
is being very, very well monitored independently of both that
company and ourselves. When that evidence is available I think
you may be proved to be right and I may be proved to be wrong.
What we do know is that some of those brands are trusted in the
home and the way a message you or I might want to send would not
be viewed in the same light at all. Some of these are trusted
products and that is part of working through whether you do these
things with integrity, or whether you are merely doing them for
commercial ends.
Q543 Dr Naysmith: They are obviously
just doing it from commercial angles. There cannot be any other
reason for it; they would not do it otherwise.
Dr Campbell: Of course there is
a commercial gain for them, because that is their business. I
believe you can marry that with a real intention to make a difference.
I have accepted and refused, as Chief Executive of the Youth Sport
Trust, a whole range of different commercial opportunities to
work with companies based on a very careful assessment as to whether
or not what you are doing is actually helping to deliver the right
messages to the right people. Maybe I have got some of those wrong,
but I have yet to not have demonstrated to me through independent
research that sometimes those brands speak to kids in ways we
cannot.
Q544 Dr Naysmith: Perhaps that is
the problem.
Professor Riddoch: I was also
going to mention Nike because they funded research at Loughborough
University to try to get more girls to enter sport. There is no
evidence of this but to me, if you are in the commercial world
of exercise or physical activity that is a healthy behaviour.
Diet is potentially not a healthy behaviour. It is the food companies
which you have to look at very critically as to what their true
motives are. I cannot see too much wrong with a physical activity
or a sportswear company coming into a school.
Q545 Dr Naysmith: No, I am not talking
about that. I am talking about creating an obese population. There
is all sorts of evidence that obese children become obese adults,
as we know.
Dr Campbell: Except we know that
calorific intake is not going up. We know that, the evidence is
clear. The calorific intake is not going up; if anything it is
slightly declining and obesity is escalating.
Q546 Dr Naysmith: Are you talking
about the average calorific intake not going up? For sections
of the population it is going up hugely.
Dr Campbell: You obviously know
more than I do. I will not comment on that.
Q547 John Austin: On the commercial
side, there is a world of difference between Nike and Pepsi-Cola
and Walkers Crisps, for example. Surely if the desire is to lower
calorific consumption, it surely cannot be a good thing for kids
to drink three or four cans of high sugar content fizzy drinks
a day. The habit of snacking on high fat, high salt content foods
like Walkers crisps cannot be a good thing. It may not be a bad
food in itself, but several packets a day and several cans of
full fat Coke a day is bad for health. Therefore having the availability
of those vending machines in the schools is too an important an
issue to be left to the discretion of individual heads or governors.
Just as we ban cigarette advertising within the curtilage of schools,
should we not be saying there should not be vending machines selling
these products in the schools?
Dr Campbell: There is a difference
between advertising and vending machines and programmes which
are sponsored or course related sponsorship. The answer to your
question would be yes, I do not think there should be vending
machines in school. That is a separate commercial issue for me
and I would agree with you. I also do not think there is a person
sitting here who would say three packets of crisps or three cans
a day is a good thing. Of course we do not. What we have to do
is try to help young people understand that and make those choices.
Q548 John Austin: We do not help
them if the vending machine is sitting there in the school.
Dr Campbell: I could not agree
more; I do not agree with that at all.
Q549 Dr Naysmith: The original question
was about a company suggesting that the school could get facilities
for the school, say computers or recreational facilities, by saving
up things like wrappers from sweets or crisp packets and bringing
them into school or taking them to the supermarket and getting
a computer for the school in return. Is that a good thing or a
bad thing? That was the original question. We got onto vending
machines because I did not phrase the question particularly carefully.
Dr Campbell: The research around
those programmes and our early indications around the Cadbury
thing is that actually people do not eat more chocolate, they
change brands. That would be the same.
Q550 Dr Naysmith: It is what they
say about smoking.
Dr Campbell: You cannot compare
chocolate with smoking. You are vilifying something here which
I have to say is part of my daily diet. What we have to come back
to is that at the end of the day what is creating obesity is that
the amount of energy going into the body is not getting expended
in the way it used to. We are less physically active, so we do
have to say that to tackle this we have to have a major drive
to get young people physically active and we have to help them
make good choices about what is a balanced diet. I think that
is something we have to stay committed to.
Q551 Chairman: You referred earlier
on to the issue of the employer, companies, the workplace, which
I was very interested in picking up. In the States—I was
trying to remember where—we were told of a particular local
company where at around mid-afternoon each day the chief executive
leads the staff in a walk. They go round a few blocks and back
in. I was thinking we could try it here. It would be a chance
to have a word with the Prime Minister now and again. Do you have
any examples of that nature within the UK or any thoughts on what
companies are doing or could do of relevance to this issue?
Dr Maryon Davis: Yes, there are
many things. Starting with simple things like whether bike racks
are provided and whether there are regulations about how many
bike racks there should be per employee. I am not sure about that,
though others will probably know. Clearly you need to have some
regulation about that so that it becomes something which is not
a voluntary thing, but something which has to be provided. I have
cycled here today. I tried to park my bike outside the front door
of Portcullis House and was told by the commissionaire person
to go away, it was untidy.
Q552 Chairman: We will do something
about that.
Dr Maryon Davis: That is one thing:
provision of bike racks. Another one is shower facilities so that
people who come in in a hot sweaty condition can make themselves
feel decent again. That is crucial. Something about the notion
of siting the stairs where they can be easily seen; when people
stand there waiting for the lift, they can see that actually there
is a staircase there and they could use the staircase. You can
expend an awful lot of energy each day just rushing up and down
stairs in the office and people do not do that; a few notices
around to remind people to use the stairs. The idea of having
organised sessions is okay. There is a danger of it being health
fascism and that is a slight worry. There are examples around
where companies have taken that view. The Japanese were notorious,
were they not, for having exercise sessions every day or probably
several times a day? There are many things which could be done
in the workplace and we should be trying to push that.
Q553 Dr Taylor: I hope that Dr Maryon
Davis did not tie his bike to a lamp post because the local council
actually has a team of people to go around removing bicycles which
are parked like that. It strikes me as absolutely awful. I want
to move on to the role of the Department of Health and coming
back to primary care. Talking to my own primary care trust the
local strategic health authority has only two priorities: to reach
financial balance and to meet targets. What incentives are needed
for primary care trusts to promote physical activity to get them
looking at the whole question of obesity? You mentioned that smoking
cessation is funded. Is there anything in the NSFs to make GPs
record weights of patients and get interested in those?
Dr Maryon Davis: There is a massive
amount of work which can be done to try to embed this much more
into the NHS and into delivery of health. Firstly, yes, it is
certainly there in policy, in the coronary heart disease national
service framework, in the diabetes national service framework,
mental health and older people in particular. There is an element
in there about promoting physical activity and there is stuff
about healthy eating. It is there in policy. You are right, health
improvement in general tends to get marginalised and this area
does in particular because of course the pressure on health authorities
is to balance the budget but also the waiting times and waiting
lists, those are the things in the premier league of must-dos
for health authorities. Smoking is in there in that premier league,
interestingly, but the obesity thing, diet and exercise, are way
down the bottom of the list, almost falling off the bottom. It
does probably get marginalised. One thing we should like to see
to help to address that, to provide the incentive, is to make
sure that indicators around promoting exercise, indicators around
promoting healthy eating, reducing obesity, are much more embedded
in the performance assessment framework for these organisations.
At the moment chief executives jump up and down if you talk about
smoking cessation; they get very anxious. Would it not be good
if we could get them to jump up and down just as much around what
they are doing about exercise, what they are doing about healthy
eating?
Q554 Dr Taylor: I think it was Professor
Riddoch who said that it should be GPs who are weighing children
and adults as well. Is there any legal compulsion on GPs to record
these things? They get brownie points for recording blood pressures.
Is there any way this could be made more attractive?
Dr Maryon Davis: There is a great
opportunity in the pipeline right now. As you may know, a new
contract is being worked through with general practice and as
part of that there is the quality and outcomes framework. There
are going to be much more formal ways of recording certain aspects
of lifestyle concerned with chronic diseases like heart disease
and diabetes, blood pressure, chronic bronchitis, etcetera. What
we can do, through our quality framework, is to make sure that
firstly the measurements are made, secondly that it is properly
recorded into a proper framework and it is fed back up through
and analysed so that we can see what is happening. There is a
great opportunity for improving all that.
Q555 Dr Taylor: Are there any strategies
for sport co-ordinators linking with public health doctors?
Dr Maryon Davis: One of the issues
I mentioned earlier on about the lack of infrastructure is that
it is very patchy. For instance, I was talking only the other
day to somebody who is in South London, whose title is healthy
lifestyles co-ordinator. That is a good post. It is a joint post
with the local authority and the health organisation. There are
not many of those people around the country. There are a few,
but it is all very patchy. What we need are people like that who
will help to co-ordinate the work which is going on around physical
activity and healthy eating, but also have people who can actually
do the frontline stuff. So they need many more community dieticians;
there are not enough of those around and we need them for obesity,
but we also need them for diabetes and high blood pressure, etcetera;
we need many more exercise experts and trained physical activity
instructors based largely in the leisure service; we need more
of them too. What we need to set up is a properly organised system,
rather like the smoking cessation one I was mentioning earlier
on, so that it is embedded in there, it is not just a one-off,
it is not subject to "projectitis", here one day, gone
the next; it is a sustained service, a mainstream service for
physical activity and for healthy eating.
Q556 Dr Taylor: Local strategic partnerships
are supposed to exist for this very purpose. Are they doing that?
They exist, but again, very patchy. Are they engaging in this
sort of work?
Mr Franklin: Some are, some are
not. It is all highly irregular around the country and it is not
very well performance assessed around the country. You get it
working in some places better than others. Ditto with all the
regeneration work and the neighbourhood renewal work which is
going on, which is sometimes taken on board by the local strategic
partnership and sometimes is not. There are great opportunities
for regeneration, town planning and all that sort of thing—we
talked about them today—to really get some of the environment
side of this thing happening properly. It is not really very well
co-ordinated. A lack of co-ordination, a lack of infrastructure
and a lack of performance assessment. I have been a local authority
councillor as well for about nine years. During that period there
has been a dramatic change in the way that health has come into
the local authority agenda. That is really positive. There are
some good examples coming through. When the local strategic partnership
started off, sometimes you got people in the same room who had
never met before, local authority and health authority and so
on. It is really positive. A good example is Stockport where staff
from PCT have actually been seconded to the local authority to
work within their transportation team. That is brilliant and it
is getting the traffic engineers to be thinking about health for
the first time. For every new transport policy in Stockport, they
are thinking about the health implications of that policy. They
are creating a green corridor through the centre of Stockport
and people can use that for leisure walking but also for utility
trips as well. They are creating a green A-Z and thinking about
how they can use signage to encourage people to be more active.
That is a really good example to go to look at; others are at
a very early stage and we need to spread that best practice more.
Q557 Dr Taylor: So our report can
emphasise that.
Mr Franklin: Yes.
Q558 Dr Naysmith: The National Audit
Office reported in 2000 on obesity and said that there were lots
of good examples of cross-departmental working to combat obesity.
Is that your experience?
Dr Campbell: What I was going
to say was that I think there are some very good examples of local
good practice beginning to happen. I absolutely support the fact
that it is very piecemeal and very patchy. I do think it is critical
that the Department of Health comes to the table with some way
of incentivising this. It is not a prescriptive programme, because
that will not work. It needs to be locally developed, but it needs
to be incentivised to try to create and take this good practice
and make it common practice, but in a way which does not disappear.
We did that in schools for years. We came up with one initiative,
followed by another initiative, followed by another initiative.
It was like a revolving door: one came in and another one went
out. I do not know what the solution is, but we have to find some
funding mechanism and some infrastructure to make sure that what
we want to do has a pivotal point, whether it is the co-ordinator
that you described or somebody who takes responsibility for that
in every local area and then works through the strategic partnerships
and finds very different solutions locally. There is no one solution.
You need somebody with the energy, the time, the expertise to
do that and in fact no, we do not have that now. Although there
is a lot of good talk going on across departments, I still feel
that there is a way to go for health to play its full part in
delivering this agenda.
Q559 Dr Naysmith: One of the problems
is that if you get different departments all collaborating a little
bit on obesity or increasing activity, nobody is really in charge,
nobody ever takes it as their prime concern. How could we combat
that? Is it a question of appointing some kind of co-ordinator?
Either we are talking about across government or we are talking
about local initiatives, but there needs to be somebody, does
there not?
Dr Campbell: Yes. There is a cross-government
group called ACT, the Activity Co-ordination Team, which is jointly
chaired by DCMS and Department of Health. You are right, what
is happening under its umbrella is that people are looking at
how we join up all the initiatives which are there and that is
a very worthy and important thing to do. We have to go further
than that if we want to create the step change we are talking
about. If I may say so, it is about the Department of Health seeing
this as equally as big an issue as some of the issues that it
addresses and applying the same resource to it that it has applied
to tackling smoking and other key areas of health. I believe this
is now going to be the biggest issue in public health that we
have and we cannot sit by and think that by joining up all we
are doing, however good it all is, it is going to be enough, because
it is not.
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