Examination of Witnesses (Questions 1360-1379)
11 MARCH 2004
MS MELANIE
JOHNSON MP, MS
IMOGEN SHARP,
MS DANILA
ARMSTRONG AND
DR ADRIENNE
CULLUM
Q1360 Mr Bradley: You must have been
thinking about it for some time; it has been on the agenda for
some time.
Miss Johnson: It has obviously
been on the agenda for some time, yes. That is why we have asked
the Food Standards Agency to look at things. Ofcom are also doing
work for Tessa in relation to the advertising codes and how those
are working. We want to have a look at the thing when it is all
back together and we have the results of all the pieces of work.
Q1361 Mr Bradley: What is your thinking
on it?
Miss Johnson: I think my job is
to listen and to look at the evidence that we are receiving from
others about this. Of course there is an issue about food and
children and there are of course issues about where children get
their food from, what sort of food it is and what makes them interested
in having certain foods or not having other foods. Of course those
are all key issues, but in terms of the detail of what both the
Food Standards Agency board will say when they have considered
this, what advice I will receive in the light of that, what the
Ofcom work will amount to when that comes forward too as a contribution
to this and what people will say to us as part of the White Paper
process, I would like to look first to see what others are saying
about this rather than to form a view myself at this particular
stage about the right way ahead. I think we have, as a government,
prided ourselves very much on evidence based policy making and
on looking to see what actually works and in this context what
works is a very difficult question. What will actually make a
difference? I alluded to it earlier on and I think it is one of
the key questions facing us on obesity: what will actually help
people to do different things in their lives because ultimately
whatever you say about the issue that is what it comes down to.
It comes down to a lot of people doing something different in
their lives, whether it is children or adults. I think therefore
that we need to think very carefully about what support, what
framework, what changes will actually make the difference and
enable people to make those changes and—as I am a parent
myself I know full well how difficult it is—what will help
parents to actually give their children a healthier diet.
Q1362 Mr Burns: Can I go to the specifics
on that? You have been discussing advertising and you mentioned
children towards the end of those last comments. There has been
a considerable amount of criticism in the whole area of advertising
to children of foods containing high fat, sugar and salt levels.
I am sure you are aware that Tottenham Hotspurs, for example,
are working with McDonalds; Sunderland have accepted sponsorship
with Coca-Cola and McDonalds; you have Gary Lineker and Walker's
Crisps; you have the Football Association itself which has been
singled out for criticism because of the way it is involved in
many areas of advertising sponsorship with foods aimed at the
children's market (although not exclusively). Do you condemn those
sorts of deals and think that they are counterproductive to the
efforts that you are trying to advance to improve the health of
children and adults and reduce obesity and fat levels?
Miss Johnson: That is exactly
the same question, with respect, that I have been trying to answer
for some time in response to repeated requests about this. It
is the same question about what level of promotion of food to
children is acceptable or not. It is part of that same question
and it is that question on which we have asked for all this work
to be done. We are awaiting the advice from the various bodies
that are doing it and we have not got our own advice yet to add
to that, nor have we heard what people will say as part of the
White Paper process. You are reformulating the same question,
in essence, that has already been put to me and which I have answered.
Q1363 Mr Burns: You have answered, but
I was hoping for a more definite answer like a yes or a no. I
was hoping that you would emulate the example of your colleague
in government at Culture, Media and Sport, Richard Caborn, who
has given a very much "yes' answer to supporting the Cadbury
GetActive website with his endorsement.
Miss Johnson: We have already
discussed that and I think what is important to say on the question
of foodstuffs in circulation and children, one of the things that
I have done since I have been in the job is to call the food industry
in and say to them on the question of salt—we are only starting
with salt; we propose to work through fat and sugar likewise—that
salt is a hidden killer, we are all taking too much salt in our
diets (and that includes children who are taking in far too much
salt). What we therefore need to do is to have a rigourous programme
for reducing the salt in our foodstuffs, particularly in processed
foods (of which we all eat a lot more than we used to) to reduce
that on a programmed basis over the next few years. I am looking
in that regard for reductions across the board because I think
otherwise we will end up perpetuating and worsening many of the
health inequalities which face us if we do not get a change across
the piece. Those who are otherwise well educated and have time
to consider these things—and maybe money as well—will
be able to buy the low salt or whatever options and will decide
to do so and a much greater number of the population will not
be as switched on to eating a lower salt diets so we need to bring
about change across the piece. I think that is one of the things
we need to keep a focus on.
Q1364 Mr Burns: So you think that your
efforts and your aims would be advanced and enhanced if Tottenham
Hotspur, Sunderland, Manchester Unit, the Football Association,
Gary Lineker, did not take part in advertising or being sponsored
by organisations and individuals that children and young people
look up to as role models?
Miss Johnson: I think that a lot
of the work that is being done in the sporting world is very constructive
and they can maximise the constructiveness of the work that they
are doing.. You have cited some examples on potentially one side
of the argument; there is a side to be said on the other. I was
at the Riverside Stadium in Middlesbrough last week talking with
them about the programmes that they are running there with young
people in Middlesbrough to actually get them in, to get them more
physically active and to actually promote things like no smoking,
for example. We have to see what the potential is and I think
we have to focus on getting as many people to do productive things
and that is the way ahead. The more we can get both our young
people and, indeed, a lot of our adult population to identify
very closely with things like football clubs, they could be a
real force for good and many of them are already doing very good
things.
Q1365 Mr Burstow: I want to come back
to what we were talking about just now in respect of the work
being done by the Food Standards Agency and the consideration
they have given to this matter today, in the papers that are being
considered by the FSA it sets out three options in respect of
advertising the whole question of the promotion of foods to children.
It sets out options A through C: action on adverts aimed at children
in respect of when they are shown (that is option A); option B
is action to address the relative amounts of advertising for healthy
or less healthy foods and the times at which these adverts are
scheduled; option C, actions to influence the content of individual
advertisements. The board is being advised to adopt a position
which is to support option B which they feel seems to be the one
most likely to address the issue of imbalance in what is being
promoted. If that is the conclusion they arrive at, would be you
satisfied? Do you think the parameters in which they are currently
operating to come to their views are adequate? Would you like
them to have left things out? Would you have liked them to include
other things in considering options?
Miss Johnson: I would like them
to consider the things today without interference from me to come
forward with their best considered judgment about what they think
should be happening and to give me a detailed description of why
they believe that that is their recommended course for taking
these things forward. I would want to consider that very carefully
in the light of the other work that is going on which I have already
talked about.
Q1366 Mr Burstow: Clearly that is as
far as we are going to get on that today. Therefore I would like
to ask something slightly different which is to pick up on something
else that you were talking about, which is your desire for all
of this to be driven by a base of evidence. One of the things
that was very clear in the report published by Derek Wanless a
couple of weeks ago was the dearth of evidence and, indeed, the
absence of a robust mechanism to properly garner the evidence,
a lack of robust systems for proper evaluation of projects and
a paucity of good data collection other than through self-reporting.
A series of specific recommendations were made around those issues.
Are those recommendations you are minded to act upon ahead of
the White Paper, as surely good reliable data is the foundation
upon which everything else is going to rest.
Miss Johnson: There is data in
some areas; there is less data in other areas. I think that the
work that Derek Wanless has done has been enormously helpful to
us in focussing on public health, in focussing on the gains that
can be had from doing public health much more widely and much
more strongly than we have been able to do it so far. I think
it is clear that we need to strengthen the evidence base but we
have said—and we have said to Derek Wanless at the time
of publication of the report and I know he is very pleased that
there is the White Paper process—that the White Paper will
provide a very good opportunity to have more discussion about
some of these evidence based issues as with the other questions
which he has raised. One of the things clearly is that we have
quite a lot of capacity out there in the field at the moment of
an analytical kind in terms of public health and public health
specialists and we want to make the greatest impact from that
that we can and also in terms of monitoring and evaluating programmes,
we do not do public health programmes without evaluation and monitoring
being in place. I think it is very important that we look at the
work we are doing and one of the things we want to see is what
actually will work best, how it will work best and how we can
best implement it and take it forward. That goes whether it is
the food in schools pilots or whether it is things we are doing
on no smoking or whatever it is; there is a whole plethora of
things there where we need to make sure that not only is the individual
thing being done to the best effect but also the joining-up of
all the programmes and the actions that are taking place has the
best possible impact.
Q1367 Mr Burstow: Are you saying that
Derek Wanless was effectively wrong in his conclusions around
the current capacity of the Department?
Miss Johnson: We welcomed Derek's
recommendations; we think they are very helpful and we would not
want to be arguing with the fundamentals of those recommendations.
Q1368 Mr Burstow: He said very clearly
that time for discussion was over and time for action was here.
Would it not therefore be wise to be getting on with the actions
that would enable you to have the fundamentals in place to have
that evidence. That is what he was saying in his report surely?
Miss Johnson: The context in which
he was saying that the time for talking is over was the thirty
years of discussion that there has been of these things. I think
we are talking about a short period of a few months of digestion
of that and the other work and the other issues that we have on
board that need to be tackled, and the work that yourselves are
doing and the work that others are doing on these related topics.
That is a very short period for digestion. As I emphasised earlier
on, we have not stopped acting or taking forward the work that
we have already got on stream; we are still very much pressing
ahead with that. There has been no interruption or even hesitation
to that work. We were agreed when we thought we needed a White
Paper on public health that we needed to take that work forward
and any existing work forward just as vigorously as we had been
before. All the work that is going on on the ground is happening,
but I think the power of the White Paper is to draw everything
together, to recognise where different stakeholders have a role
to play in this, where the individual fits, where government fits
in it and to actually produce a powerful answer as to how we are
going to take this forward into the future.
Q1369 Mr Burstow: Given the absence of
this hesitation and the on-going focus and energy that has been
put in, why is it that you are unable to give some indication
as to the timeframe for stabilising obesity? Surely if you have
these programmes and you are taking these actions, you should
have some idea at this stage of what you are aiming at. Why does
that require another period of digestion before you can come out
with those sorts of pieces of essential information which surely
should have been informing the actions that have been taken to
date?
Miss Johnson: Obviously there
is a target for increasing physical activity but that is not the
only part of the equation as we have been talking about this morning.
There is the food side of it as well. We may need to look at the
physical activity side of it again. What we want to do is to produce
something that is realistic, that is deliverable, that does meet
up with the problem and does engage people in the right way in
actually making it happen. If anybody has a good answer for the
question of how to engage many millions of individuals in actually
leading slightly healthier lives than they currently do which
is easy, then I have not yet heard it because I am looking for
it very actively. I think that is why we need the discussion that
we are having.
Q1370 Dr Naysmith: Mr Burns and Mr Bradley
were trying to get you to voice your opinions and you were clearly
saying that you were going to wait and listen to what everyone
else had to say. Given what we have this array of talent before
us—three experts in public health and presumably experts
in obesity flanking you—could I ask you what advice you
are getting from your top advisors about this restriction of advertising
business?
Miss Johnson: I have not received
advice as such on that. That is because we have the work being
commissioned by DCMS.
Q1371 Dr Naysmith: I mean just the people
who work in the Department, Dr Cullum, Ms Armstrong and Ms Sharpe.
Surely you are discussing it daily with them.
Miss Johnson: Discussing what,
sorry?
Q1372 Dr Naysmith: We were talking about
advertising and the potential restriction of it and how it might
be done and whether it was worthwhile. Since then, to be fair,
Mr Burstow has got a bit more out of you, but at that point you
were saying you were going to wait until everybody has reported,
the White Paper was out and had the discussions before you would
voice any opinions.
Miss Johnson: What we have done
is obviously discuss the fact that the initial findings that the
Food Standards Agency has is that advertising promotions do impact
on what children eat. They probably impact on what adults eat
too in the same way. We have discussed that, but we asked the
FSA to do the further work and in terms of specific proposals—which
I think is what you are talking about really—we have not
discussed any; none have been put up to me because what we are
doing is looking at the work that is going to come forward from
the FSA board. I am sorry about the timing; we are later than
we would originally have been anyway, but obviously the timing
means they have not had chance to discuss that today, let alone
for me to consider it.
Q1373 Mr Amess: I noted down what you
said earlier about the Health Select Committee's work. You said
that the Health Select Committee's work will contribute to the
debate. I think we started the debate; I think we are setting
the agenda and we certainly do not want to waste out time by having
this inquiry and taking witnesses unless there is some action.
Your Department's memorandum places more emphasis on food rather
than activity. Why was that?
Miss Johnson: I think there is
a balance here, as I said earlier on, and I think that that balance
is that both food and activity have significant roles to play
in solving the problem. However, the food work was started by
the Department much sooner and so potentially is more advanced;
there are certainly more strings of work in hand in relation to
food than there are on activity, but we have been rapidly catching
up on the activity front. The activity work from the committee
that Dick Caborn and I jointly chair will be taken forward on
the same timeframe as the Food and Health Action Plan work within
the White Paper framework.
Q1374 Mr Amess: I apologise if I missed
it, but the Department stated that the Chief Medical Officer was
expected to publish a report describing the evidence. This was
supposed to be last year.
Miss Johnson: I have not seen
it, but as I understand it I think there have been one or two
analytical problems related to that report which are about the
physically doing of the report, as it were. I think that report
will not be very much longer before it will be published.
Q1375 Mr Amess: It is a bit frustrating
because there is about a six or seven month delay.
Miss Johnson: Indeed. We all experience
frustrations from time to time. There is no particular reason
for it, if that is what you are seeking. The work has taken longer
than initially anticipated.
Q1376 Mr Amess: Has this delay anything
at all to do with the two other departments?
Miss Johnson: No, I think it is
purely internal in getting the right work done in the right way.
That is all, as I understand it.
Q1377 Mr Amess: Will we have it soon?
Miss Johnson: I believe it will
be published soon, yes. It is currently undergoing peer review,
so that is where it is in the process which, as you will appreciate
is the penultimate stage to publication.
Q1378 Mr Bradley: On the activity side,
you mentioned earlier about the need to encourage young people
and children to be more active for example by walking or cycling
to school. Obviously one of the problems of that are the dangerous
routes to school. What is the Department of Health's view about
encouraging safety with children cycling to school by them wearing
cycle helmets?
Miss Johnson: I know you will
be aware there is a Private Member's Bill looking at this very
subject at the moment. I am currently looking at that question
myself. I have only just recently had the papers from the member
concerned so I would not want to comment on the Bill if that is
what you are asking me to do. The majority of journeys taken by
car are less than three miles. There is a balance for any parent
in deciding whether it is safer for the child to walk or cycle
to school as against putting them in the car. That is the sort
of debate every parent probably has with themselves unless they
are living in a very under-trafficked area. There is always that
question, but quite a lot of traffic does seem to be caused by
people actually taking children to school or doing these very
short journeys. The opportunities are huge, I think, for actually
encouraging children to walk to school more and the benefits from
that will be on both fronts simultaneously and I know that that
is something the Department for Transport are actively looking
at and are very engaged in with schools and with ourselves.
Q1379 Mr Bradley: Just to press you a
little bit more, what is your instinctive reaction to whether
children should wear cycle helmets or not?
Miss Johnson: Instinctively as
a parent and a one-time cyclist, obviously wearing helmets is
helpful. The role of helmets in head injuries is a significant
issue. I am giving you my personal view in this regard because
I am not aware of what view the Department might have about this
question or whether, indeed, it would be particular appropriate
for us to have a view about it.
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