Examination of Witnesses (Questions 1401-1419)
29 MARCH 2004
RT HON
MARGARET HODGE
MBE, MP, MS MELA
WATTS, RT
HON TESSA
JOWELL, MP AND
MR PAUL
HERON
Q1401 Chairman: Colleagues, can I welcome
you to this session of the Committee, the final session on our
Obesity Inquiry. It seems to have been going a very
long time but it has been extremely interesting. Can I particularly
welcome the Secretary of State and the Minister, and their colleagues.
We are most grateful for your co-operation with this inquiry.
We had hoped to have a session involving yourselves and the Public
Health Minister but for various reasons, which we understand,
it will not be possible. We are grateful that you have been able
to attend. I wonder if you could each briefly introduce yourselves
to the Committee.
Tessa Jowell: I am Tessa Jowell,
Secretary of State for Culture, Media and Sport.
Mr Heron: Paul Heron, Head of
the Sports Division within Culture, Media and Sport.
Margaret Hodge: Margaret Hodge,
Minister for Children, Young People and Families.
Ms Watts: Mela Watts, Curriculum
Division within the Schools Directorate at the Department for
Education and Skills.
Q1402 Chairman: Secretary of State, you
have done 7,000 steps today already, which is 1,000 more than
me.
Tessa Jowell: 8,561.
Q1403 Chairman: Excellent. Put your feet
up for an hour or two! Can I begin by asking you some questions
about the location of public health. I ask you particularly because,
unusually, you are in a position where you have actually been
the Public Health Minister. I recall that when we looked at public
health one of the issues that we were concerned about was the
appropriate location of the public health function, bearing in
mind that public health as an issue crosses so many government
departments and so many initiatives. I am conscious that certainly
in recent times you have been making a lot of statements that
have relevance to public health. Do you have any views now different
from those you had when you were the Minister responsible directly
about the location of public health in government and, also, how
departments can work together better than has been the case in
recent times?
Tessa Jowell: I do not think I
do, Chairman. Certainly when I was Public Health Minister, which
is now four or five years ago, I felt that it was extremely important
to engage the whole of government in the positive promotion of
health. I think that if you look at what we have done as a Government,
and were it described in public health terms, it would be an extraordinarily
proud record in relation to child poverty, pensioner poverty,
promoting greater road safety, quite apart from the very strong
thrust of public health policy coming from the Department of Health,
and all the work that is being done now led by Margaret in DfES
through SureStart right through to making sure that young girls,
particularly vulnerable young girls, have high levels of education
which will cause them to aspire to be more than mothers when they
are too young to be mothers. All these, and there are many more,
those are just some headlines, are areas which represent progress
in public health. I think that what we have seen over the last
five years is a flowering of that ambition, that this would become
a defining theme for the Government as a whole.
Q1404 Chairman: In the last four or five
months I have been very conscious that you personally have come
out with some important statements in relation to public health.
Is that because of your frustration at the lack of progress on
issues such as obesity? There has been some surprise that you
have taken the lead on the issue of obesity and you have made
statements that some may agree with, some may disagree with. Is
there a reason why in the last four or five months you have taken
a particular interest in this area?
Tessa Jowell: I am not in the
lead on obesity, John Reid, the Secretary of State, is in the
lead on obesity and questions about obesity are reflected very
extensively in the Public Health White Paper, but I head the department
that can make a very important contribution to the battle that
we are all joined in now against the rising tide of obesity. What
I have sought to do, and I think John and I have tried to work
with Melanie in a complementary way in relation to this, is to
focus on the fact that one of the causal factors for the increase
in levels of obesity has been the fact that while calorie intake
has remained relatively stable—I stress relatively stable
and I know that the FSA in their most recent report have cast
some doubt on the estimated average calorific values because of
the extent to which obese people tend to under-report how much
they eat, but that taken as part of the work in progress—what
has received much less attention is the fact that activity levels
have substantially reduced. We have seen a substantial reduction
over the last ten years in the number of children walking to school
and a corresponding increase in the number of children going to
school by car. Also we have seen the evidence of the intractable
difficulty of getting adults to be active at a level that is going
to safeguard their health. My answer to your question is to say
that public health now, as in the days when I was the first ever
Public Health Minister, requires a whole government response;
a government response which is led by the Department of Health
but draws on the respective contributions of each department,
as in the case of my own department, without which a strategy
to tackle obesity will not be effective.
Q1405 Chairman: How do you view the issue
of departments actually contradicting each other in respect of
this policy area? One of the concerns we had when we looked at
public health before was that there are many different strands
of public health policy, and you will fully understand that, for
example housing and transport have a key role to play in public
health, as we all know, but what we have seen in recent times
is in one instance from your department, and in another instance
the Minister's department, messages were sent out, and I am thinking
of the Cadbury's initiative, the Walkers crisps' initiative, which
were contradictory to what I would have thought would have been
the main thrust of government policy. You are aware of the examples
that I am referring to presumably, we have talked about these
on several occasions in this Committee. How do you get away from
this idea of one department contradicting the other? Can you ever
get a strategy that is actually singing off the same hymn sheet?
Tessa Jowell: To deal with the
broad point, of course it is important that government departments
work together in a way that mutually reinforces each other's efforts
so that you have a policy which has the value added of interdepartmental
co-operation. I know that is what John, through the Public Health
White Paper exercise, is seeking to achieve, and I am quite sure
that he and Melanie will do that. You know that in the business
of government there will always be discussions and differences
of view, the important thing is that we never get to a point where
a policy pulls one against the other. You are absolutely right
that there are examples that you can draw on both where that synergy
has been achieved and others where it is much more difficult.
I would actually take issue with you in relation to Cadbury's.
What we have to bear in mind is that it touches the nature of
our approach in educating children about the importance of healthy
eating, the importance of exercise and the different values in
what they eat. Cadbury's have made a substantial contribution
through what is called the Get Active campaign. There are those
who take the view that any association of any commercial interest
with any health campaign is undesirable. I do not take that view.
Sport in this country is not in a position to be able to turn
away sponsorship that can provide facilities and equip teachers
to be better at promoting sport and activity. Without making any
further judgment about the Get Active campaign, it has represented
a considerable investment in sport and activity in schools. What
is important is that we separate and understand the risks of that
in relation to somehow getting children hooked on chocolate to
the exclusion of everything else. I would prefer to work in a
context where children grow up understanding the importance of
healthy eating, have an internal understanding of the importance
of a balanced diet, what constitutes a balanced diet, and not
in a way that can be unrealistic, protected from the kinds of
pressures that any child will be subject to when they go out and
spend their pocket money, but understand that it is absolutely
fine. Paula Radcliffe eats a bar of chocolate before she runs
a race. If you get the children understanding the link between
calorie intake and calorie burn then you will begin to get children
who are literate in understanding the importance of physical activity.
I think that we need to take a pretty measured view of the conclusions
that we draw about sponsorship. The gains where they are to be
made in relation to health will be very clearly understood, but
let us also understand what may be lost from facilities which
without that investment simply would not go ahead.
Q1406 Chairman: One or two of my colleagues
want to explore that point in detail. My reason for raising it
was not specifically to look at those examples but to press you
on whether, as somebody who has been in the unique position of
being Public Health Minister, you feel the structures of government
over the past five years since you were in Richmond House doing
that job have changed in a way that enhances interdepartmental
working on public health issues such as obesity? Do you feel there
have been positive improvements in the way that departments are
working together, that you can focus on an objective shared across
each department?
Tessa Jowell: Yes, I do. I very
definitely do.
Q1407 Mr Jones: Minister, some of us
would feel that the example that you gave about Paula Radcliffe
eating a bar of chocolate is singularly inappropriate in the issue
that is before us because, of course, to an athlete or someone
who expends a huge amount of energy, eating the odd bar of chocolate
is no difficulty, in fact it is an asset, and that is why the
companies that would promote products such as Lucozade, and show
that product associated with an athlete, wish to give the impression
in the minds of children in particular that if they eat this food
or drink this drink they too will become athletic. It is a completely
false message because the vast majority of people will not do
this. You appear not only to be endorsing the message but promoting
it, doing the exact opposite of what the role should be in terms
of health gain. How do you answer that challenge?
Tessa Jowell: By refuting it.
I think that if you read the speeches that I have made on this,
if you read the challenge that I have laid to the advertising
industry, the answer to your question would be very clear. I do
believe that food companies, advertisers, have a very important
role to play in promoting precisely those kinds of messages about
healthy eating, about a balanced diet, and are uniquely placed
to do so. I have challenged them to do that and I await their
response.
Q1408 Mr Jones: Would you not say that
is rather naíve? Would you think that the advertisers'
responsibility is to promote their product, not to promote any
general message, it is the Government's responsibility to promote
the health message?
Tessa Jowell: It is their job
to promote the health message as well. The other point that you
have got to factor into your conclusion is that there is a very
high level of public interest and public concern about obesity
now, in part due to the work of this Committee, and there is a
level of interest in the impact of advertising on children, the
nature of children's diets, that there has never been before,
so the industry itself is now under very great pressure, and pressure
that, if they do not respond to it, will translate itself into
consumer preference for other kinds of products. I do think that
we are at a point where it is possible to engage with the industry.
I am optimistic about the outcome of that engagement. I think
that if we can get the industry to implement at a level which
is level with our enthusiasm the importance of healthy eating,
get those messages across to children, that will be a far more
effective way of doing it than anything that I or, with respect,
any Members of the Health Select Committee might be able to do
in terms of public persuasion.
Mr Jones: We are well aware of our limitations.
Chairman: Some more than others!
Q1409 Mr Jones: When you speak of outcomes,
earlier you gave a list of what the Government has done in terms
of health gain and it was a list of noble issues but it was not
a list of outcomes. The key outcome that concerns this Committee
is the outcome in terms of rising levels of obesity that we already
measure, we already know and the trends are extraordinarily worrying.
The health experts tell us that it is the biggest health problem
facing generations to come. We know the direction in which the
outcomes are going now and it is not a direction that we want
to see. We were given some very interesting information when we
were in Denmark recently and compared graphs of health, fitness
levels and obesity levels for a generation of children today and
a generation of children 20/30 years ago. The graphs showed something
quite interesting. The top quartile of the fittest children 25
years ago compared with the fittest children today—this
is in Denmark but we suspect something similar would occur in
this country—showed the fittest children today were fitter
than the fittest children 25 years ago. The huge problem was the
rest of the graph, particularly the lowest quartile, where they
were much less fit. That would indicate to us that a policy of
promoting sporting achievement does not touch those sections of
the public or the children who are most in need of health improvement.
Tessa Jowell: I think that is
right and were we only to promote sport rather than healthy activity
participation more generally, if we were only to promote elite
sport, championship sport, then you are absolutely right, I do
not think that our ambition to use sport as a way of arresting
the increase in the rate of obesity would be very successful.
That is why over the last three years we have radically changed
the function and focus of Sport England. Sport England's overriding
role now is to promote participation. The means by which participation
will be promoted will be through the work of the Regional Sports
Boards. We have just had the first Regional Sports Plan published
from the South West. Doug is from a constituency in the South
West. I commend it to you. It is the first of a series. They set
targets, for instance, like getting 5,200 people a month involved
in physical activity. They will do this through a number of different
ways, very small local pilot projects that recognise rural and
urban, but essentially solutions which fit the region, the demography
and the geography of the region. Our strategy is certainly to
promote sport and to promote sporting achievement, but the strategy
in relation to obesity is much more focused on building levels
of activity, hence our adoption in Game Plan of the half an hour,
five times a week recommendation which is now also endorsed by
the World Health Organisation.
Q1410 John Austin: There are none of
us around here who would deny that there has been a reduction
in physical activity, particularly among children, and none of
us would deny that increasing physical activity, particularly
among children, is going to have a beneficial health impact. You
seemed to be implying in your earlier statement, and when you
did your Radio 4 interview, that the key issue was getting exercise
levels up, rather than tackling the nutritional issue. In the
light of what Jon Owen Jones was saying, is that not misleading
given that proportion of the population which is at risk at the
moment, that there are different habits amongst different sections
of the population and those who are consuming high fat, high calorific
diets are not those who are running the marathon with Paula Radcliffe?
Tessa Jowell: That is absolutely
right. I am here to talk to you about what I and my department
bring to the table in terms of solutions. Of course nutrition
is important, and Margaret may want to say something about nutritional
standards for children in schools. In order to understand obesity
and in order to put in place an effective strategy for tackling
obesity we have got to recognise its multi-faceted causes which
require a range of different solutions. One causal element in
the increase of obesity is the fall-off in levels of exercise
so we need to get people more active. Another factor appears to
be, but we cannot attribute scale to it—this is from the
FSA—that advertising has an impact but it is difficult to
assess precisely what the impact is. Then, of course, diet and
the changing balance of diet also has an impact. As Public Health
Minister, I was always concerned, as subsequent Public Health
Ministers have been, about the social class inequalities in this.
Social class inequalities apply in relation to obesity as they
apply in almost every other aspect of morbidity.
John Austin: Would you accept that by
and large you cannot get people up to levels of activity sufficient
to actually eliminate the over-consumption of calories? You and
I are finding it difficult to get up to 10,000 paces a day and
we are motivated.
Mr Burns: Speak for yourself!
Q1411 John Austin: The kid who eats a
Mars bar is not going to go off and run six miles to burn it off.
Tessa Jowell: They will do if
they have got the opportunity to do so and if they have got the
opportunity to do so taught by somebody who is competent and specialist
in facilities that are modern and appealing, they absolutely will.
All the evidence of our specialist sports colleges and the school
sport partnerships shows that this is working.
Q1412 John Austin: I do not want to get
into the argument about whether there are good foods and bad foods
or less good foods if you eat them in quantity, but I come back
to this association with some of the food products which we know
are contributing to the obesity epidemic, whether it is through
snacking or chocolate consumption or whatever. Associating a healthy
activity programme with a product whereby kids would have to eat
170 chocolate bars to get their school a basketball, which would
require 90 hours of active basketball playing to burn off, do
you not accept that is not a good association, to associate high
calorie foods with sport and exercise activities?
Tessa Jowell: No, I do not accept
that it is necessarily a bad association. It depends. Rather than
bringing children up in a world where they are denied access to
any chocolate, any biscuits, any of the things that children customarily
eat, I would rather see children growing up understanding that
they should balance the bar of chocolate they eat with a banana
or with apples or a salad or whatever. If children grow up like
that they are far more influential over their own lives than if
they are brought up in some completely unrealistic protected environment
that means that when they are 15 or 16 and that protective environment
is no longer around them, they do not know how to eat. Teaching
children how to eat, what is balanced, what is good for them,
what they need for what purpose, is terribly, terribly important.
That should be the focus rather than somehow outlawing the chocolate.
This is the way that you can get children to eat in moderation.
Q1413 John Austin: Would you accept that
it is at least as important to address the issues of nutrition
as it is of physical activity?
Tessa Jowell: Yes, of course I
do.
Q1414 Mr Burns: Will you accept that
it is a two part solution to the problem and that is a healthy
diet and proper exercise which is the equation. A healthy diet
from time immemorial does include some foods that might not be
considered healthy, but if it is a balanced healthy diet it does
not matter. You have mentioned chocolate, rightly, and you associate
sweets and chocolate with children and to my mind it would be
crazy to ban children from eating chocolate. What is important
is to make sure that the parents are educated enough on dietary
requirements and exercise so that they do not eat it to excess.
Would you agree with me that if there is a healthy diet and an
exercise regime, quite frankly there is nothing wrong with schools,
for example, benefiting if the manufacturers of chocolate or crisps,
or whatever it is, are prepared to put something back into the
system, into equipment for schools or whatever, with a message
about healthy eating and exercise and rather than being counterproductive
that moves the whole thing forward?
Tessa Jowell: Broadly I would
accept that analysis subject to the messages about healthy eating
being proper messages, not part of the small print on the back
of a wrapper. It takes us back to the way in which the products
are marketed, the way in which they are promoted and so forth.
It would be very easy indeed, and this is always a risk in this
kind of area, to do something because there appears to be a lot
of public pressure in the absence of a very clear understanding
of its impact, but to feel that doing it is somehow enough of
itself. The important thing is to put in place a strategy to tackle
obesity which is underpinned by the evidence of proportionality
and the evidence that the measures taken are going to work. I
think in relation to our understanding of our diet, in relation
to our understanding about exercise, we are on secure ground.
In relation to television advertising, as I have said on a number
of occasions, I have asked the media regulator—Ofcom—to
look again at the robustness of the existing code. They are working
with the FSA and they will give me advice in the summer. Then
I think we will be in a better position, I hope on the basis of
evidence, to determine a conclusion on that particular aspect.
Q1415 Mr Burns: Can I just ask the Minister
for Children, given that she is within the Department for Education,
so I think it is particularly relevant to ask her, what is happening
to encourage and ensure that school children and young people
in secondary schools are getting a reasonable level of exercise
through games? What is being done in those areas particularly,
mostly inner cities, places like London, where the facilities
for sport are either non-existent or not as good as they could
be?
Margaret Hodge: This is a very
good example of joined-up working between the DfES and the DCMS
in this particular instance because we have a joint programme
of over £1 billion over this spending review period ending
in 2006 when we are investing not just in facilities, and particularly
facilities in schools in deprived areas, but we are also investing
in creating links between children and the activity that they
undertake in schools and clubs. We are investing in the training
of teachers and in partnerships. There is a huge amount of activity
going on to encourage—
Chairman: I am conscious that other colleagues
hope to ask this in some detail later on. I will be happy to bring
you back in later, Simon, is that okay?
Mr Burns: Okay.
Dr Taylor: Secretary of State, I think
we are all very relieved to hear you say that you agree that the
attack on obesity has got to be multi-faceted and I do not think
any of us are trying to outlaw chocolate. When we had Cadbury's
here some of the older ones of us were talking of remembering
chocolate as a luxury rather than as part of a staple diet.
Jim Dowd: I still do.
Q1416 Dr Taylor: I hope we still do.
The hard fact that has come across to us is that something like
2,000 steps will only burn off 100 calories. Does this not mean
that concentrating on increasing exercise is perhaps taking the
easy way out from really what we ought to be doing, which is tackling
eating habits and even marketing habits and trying to get the
food industry to promote and market the foods that are most healthy?
Tessa Jowell: Can I say with some
vehemence that the strategy that I hope will materialise from
this will be a strategy that embraces the whole range of policies
and interventions that will be necessary. It is not getting people
more active or getting them to eat more healthily, it is doing
both. That is what the aim is that we want to achieve.
Q1417 Dr Taylor: You may be emphasising
the exercise side perhaps more than the other side and I just
want to make sure that there is a balance.
Tessa Jowell: I talk about exercise
because that is my direct departmental responsibility. I am responsible
for running those programmes but I absolutely accept that you
weigh with equal balance the importance of a healthy diet and
exercise.
Q1418 Jim Dowd: I just want to come back
to this point about the commercial involvement. As I am sure you
are aware, we live in increasingly sceptical, not to say cynical,
times where whenever you involve the food manufacturers or processors
or the supermarkets in a project then people assume at the back
of their mind that the reason they are involved with it must be
to sell more chocolate bars or more crisps or whatever it is,
so it undermines to some degree the message they are attempting
to convey. We have taken evidence, and I think we are all pretty
clear, that we must involve the manufacturers and the retailers
as part of the solution rather than just as part of the problem,
but as soon as you do involve them people become very jaundiced
about why they are getting involved. Would a better approach not
be for them all to contribute to, say, a blind trust, say a healthy
lifestyles institute which although supported by commercial organisations
would not actually be directed by them and would have the power
to take decisions, along with money from other sources, to try
and encourage a healthier lifestyle, better attitudes towards
a balanced diet, activity, et cetera?
Tessa Jowell: I think the first
part of your question was absolutely right. They are spending
£452 million on advertising food. I would have to check the
figure but food promotion is a huge part of the overall advertising
market in this country. Of course they are doing it in order to
get product preference and to persuade us to buy their products.
I do not know whether you have put that question to them. I am
not going to answer for them but I would go back to what I said
earlier, that the important thing is young people, and all of
us who are going to be persuaded by their messages, are persuaded
by messages which do reflect social responsibility, a recognition
of their very powerful and instrumental role in persuading people
what they should eat and when they should eat and that they direct
that role positively to promote healthy eating and to promote
the kind of dietary balance that we all know is beneficial.
Q1419 Mr Amess: Our inquiry has already
had a huge impact. When we went to America we saw at first hand
just how serious this is. None of the 11 Members on this Committee
want to produce a report that gathers dust, we want to produce
a report that really does make a long and lasting impact. I have
the distinct feeling that the Government does know what needs
to be done but is somehow reluctant to upset anyone. Secretary
of State, in this interview that you gave to the Today
programme you made it very clear that you thought that food advertising
does have a detrimental impact on young people's diet. Given that
you feel that strongly, and I know you said you want to wait a
bit, why have you not done anything?
Tessa Jowell: The Food Standards
Agency are at the moment in the process of producing a report
which addresses precisely this question. When I did that interview
I was reflecting that it is a problem that our state of knowledge
is changing as we move from the Hastings Literature Review to
the Food Standards Agency's appraisal of that to their interim
conclusions which are now out for consultation. As I understand
it, they have proposed a rather similar route of action to the
one that I have advocated which is that there should be particular
focus on the advertising of healthier foods and promoting healthy
eating messages. It is frustrating for everybody. It is frustrating
for the media who report this with such an appetite and it is
probably, unfortunately, confusing for people at home, but I am
not going to take any decision on this until the summer, until
I have had two further pieces of advice. One is the Food Standards
Agency advice to ministers and, secondly, the advice from Ofcom
about whether or not the code that regulates broadcast advertising
to children is sufficiently rigorous in the light of the emerging
evidence.
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