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Westminster Hall
Thursday 10 February 2005
[Sir Nicholas Winterton in the Chair]
Obesity
[Relevant documents: Department of Health White Paper, Choosing Health: Making healthy choices easier (Cm 6374); and Obesity, third report from the Health Committee, Session 2003–04, HC 23, and the Government's response thereto (Cm 6438).]
Motion made, and Question proposed, That the sitting be now adjourned.—[Miss Melanie Johnson.]
Mr. Deputy Speaker (Sir Nicholas Winterton): I ask the robust Chairman of the Health Committee, the hon. Member for Wakefield (Mr. Hinchliffe), to open our proceedings.
2.30 pm
Mr. David Hinchliffe (Wakefield) (Lab): Thank you for that build-up, Mr. Deputy Speaker.
I want to express my gratitude and that of the Health Committee for the opportunity to debate the report, which was produced some time ago; there have been many developments since. I also want to apologise for the length of my speech; a good deal of mischief occurred in connection with the publication of our report, and I want to deal with the relevant matters in detail. I appreciate, too, that there is likely to be a Division in the House in less than 50 minutes.
Mr. Deputy Speaker : Perhaps I can be of assistance. I understand that a further Division in the main Chamber will take place at 2.45 pm.
Mr. Hinchliffe : I begin with the usual thanks to a range of individuals who were involved in the inquiry. First, I thank everyone who submitted written evidence or gave oral evidence to the Committee; that was helpful and much appreciated. The Committee also appreciated the efforts of those who arranged our visits during the inquiry and contributed to our discussions. I record particular thanks to our specialist advisers for the inquiry, Dr. Laurel Edmunds, Professor Ken Fox, Professor Gerard Hastings, Professor Phil James and Professor Tim Lang. They gave the Committee excellent support and advice.
I want to thank the Clerk's Department scrutiny unit, too, for its analysis of the economic costs of obesity. The unit's support for the Committee and its thorough work are much appreciated; it is a relatively new development and its work is helpful in our deliberations.
I also thank the excellent Health Committee staff; we are well served by a tremendous group of individuals who provide us with excellent back-up. I want to make particular mention of Dr. John Benger, who, at the time of the inquiry, was the Clerk to the Committee but has since moved to another post in the House. I am particularly grateful for his support on the inquiry and
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on many others over several years. I know that my colleagues on the Committee want me to pass on their good wishes for his career.
The Committee's report inadvertently confused the responsibilities of the Advertising Standards Authority and the Independent Television Commission. The reference in paragraph 111 to the ASA's approval of an advertising campaign for Wotsits should have been a reference to the ITC's approval. The ITC has now been subsumed into Ofcom, and I have written to the ASA about the matter on the Committee's behalf.
Shortly after publication of the Health Committee report on obesity in May the sketch writer of The Guardian described me as the
As svelte is not a word commonly used in the west riding of Yorkshire, I sought advice about its meaning from my constituency secretary, who is multilingual, having been born in Belgium. She advised me that svelte is a term commonly used to describe the waistlines of French women. I took some comfort from that.
The Daily Mail sketch writer subsequently described me as "a chip butty man", and matters took a marked turn for the worse towards the end of last year when the sketch writer for The Times described me as
For one or two members of the Health Committee, our lengthy obesity inquiry was a challenging and painful journey. One member, who is here today, lost the best part of 2 stone and described the process as life-changing. For the tubbies on the Committee, perhaps the only crumb of comfort from that traumatic journey was the ability to measure our body mass index and to proclaim that none of us was obese—well, not quite.
The fact that some of us are horizontally challenged was one factor that led to the Committee's decision to conduct an inquiry. There was also the overall concern that, until quite recently, the public health agenda has to some extent been confined to the political back burner, with what some would describe as side-show events—such as foundation trusts and choice directives—taking centre stage. In the past couple of years, the apparent message from a cross-party perspective has been that the modernisation and refinement of our curative acute hospital sector is the way forward in health, rather than returning to a preventive approach rooted in a radical and vigorous public health policy.
The fact that politicians are usually happier in the comfort zone of hospital sector activity might have led to most of us failing to notice the gradual development of what the chief medical officer described not long ago as the "health time bomb" of obesity. Although the health of the nation targets in 1992 were for fewer than 6 per cent. of men and 8 per cent. of women to be obese by 2005, Department of Health evidence to our inquiry showed that, by 2002, just under 23 per cent. of men and 25 per cent. of women were obese.
Dr. Howard Stoate (Dartford) (Lab): It is fair to say—and it is certainly the belief of a friend of mine, David Haslam, who chairs the National Obesity Forum—that the obesity time bomb has already gone off. We are now
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waiting for subsequent bombs: a huge explosion in diabetes and heart disease, and the lives of many sufferers of obesity being shortened by up to nine years. That is of great concern to us all.
Mr. Hinchliffe : My hon. Friend is absolutely right, and I shall return to that point in a moment. I pay tribute to the work that he does in the House on a range of health issues. We have a joke that he is the chairman of the all-party group on all-party groups because he is involved in so many, dealing with some very important issues. I wish that he was back on the Health Committee, because he was an excellent member of it.
In addition to the figures that I just quoted, the Department of Health's evidence to our inquiry showed that by 2002, some 43 per cent. of men and 33 per cent. of women were overweight. The same evidence from the 2002 health survey for England showed that one in 20 boys and one in 15 girls were obese, and that one in five boys and one in four girls were overweight or obese. Witnesses to our inquiry said that current trends suggest that about one third of adults will be obese by 2020. If the rapid acceleration of childhood obesity in the past decade is taken into account, the prevalence of obesity in children is predicted to be more than 50 per cent. by 2020.
At least two—probably three—Members present can articulate better than I can the health risks of obesity; indeed, that might form part of certain contributions today. I do not intend to expand on the detailed evidence to the Committee on the various factors that contribute to an average reduction in life expectancy of nine years, but I will underline the Health Committee's estimates of the economic costs, which are worthy of consideration.
With the help of the Clerk's Department scrutiny unit, we established that the direct cost of treating obesity in England in 2002 was between £46 million and £49 million. The cost of treating the consequences of obesity was between £945 million and £1,075 million. The indirect costs of obesity were £1 billion to £1.1 billion for premature mortality, and £1.3 billion to £1.45 billion for sickness absence. The total estimated cost of obesity in 2002 was between £3.3 billion and £3.7 billion. Our report cautions that that should still be regarded as an underestimate.
Our report noted that the analyses were of the 20 per cent. of the population who were already obese. It states:
"If in crude terms the costs of being overweight are on average only half of those of being obese then, with more than twice as many overweight as obese men and women, these costs would double. This would yield an overall cost estimate for overweight and obesity of £6.6–7.4 billion per year."
Regardless of the health implications for the individual, the economic consequences of the obesity epidemic are frankly staggering. Some have argued that they pose a direct threat to the future viability of our entire health care system.
Against that background—and in view of the seriousness and importance of our key messages—it was a matter of great regret that the comprehensive analysis of causes and solutions that our report offers was narrowed down in some sections of the media to a
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controversy over our reference to the evidence received from Dr. Sheila McKenzie, the consultant responsible for an obesity service for children at Royal London hospital. Our report faithfully and accurately records her written evidence when it states:
"Despite only being in existence for three years, her service had an eleven-month waiting list. Over the last two years, she had witnessed a child of three dying from heart failure where extreme obesity was a contributory factor. Four of the children in the care of her unit were being managed at home with non-invasive ventilatory assistance for sleep apnoea: as she put it, 'in other words, they are choking on their own fat.'"
I want to deal in some detail with the circumstances that led to one sentence of Dr. McKenzie's evidence—concerning the three-year-old girl—being taken out of context and being used by certain vested interests to attack me, other members of the Committee and our staff and advisers, and to rubbish our overall conclusions. In making these remarks, I have no desire whatever to add to the distress already caused to the family of that child, but I believe that they ought to be aware of exactly who has used their daughter's sad circumstances and for what purpose.
I want to go back to events surrounding the date of publication of our report. Members of the Committee will recall that it was due to be published on 27 May last year. On 25 May, at about 10 pm, I was telephoned by a journalist from the BBC Radio 4 "Today" programme, who informed me that he had obtained a draft copy of the report and that his programme intended to run it as the lead item the following morning. My strong appeals for him to respect the embargo fell on deaf ears, and I obviously refused his invitation to participate in the programme the next day. However, on 27 May—the date of the report's publication—I made clear my views on the "Today" programme's total disregard for our embargo to the interviewer, Mr. John Humphrys.
During the following week, I was again interviewed by Mr. Humphrys to answer allegations, made in a "Today" programme report, to the effect that the Health Committee had been wrong to refer to the case of the three-year-old, who had allegedly died from a genetic disorder and not from heart failure where extreme obesity was a contributory factor, as we had been told by Dr. McKenzie.
Interestingly, less than an hour after that interview was broadcast, I was telephoned at the Commons by a prominent journalist from the "Today" programme who had detailed knowledge of the background to that morning's story. He wanted me to know that he strongly wished to dissociate himself from the story. At his request, I am not referring to him by name, but I did share his identity in confidence with other members of the Committee at its next meeting.
Anyone who has been around the House long enough will be aware that "Today" programme stories are frequently picked up by other media outlets, and this one ran—
2.45 pm
Sitting suspended for a Division in the House.
2.55 pm
Mr. Hinchliffe : I was saying that anyone who has been around this place long enough is aware that the "Today"
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programme's stories are frequently picked up by other media outlets. The story that we are discussing was run by numerous other radio and TV programmes and newspapers—in several instances uncritically. I believed then what I believe now: I was right to state that while I regretted any distress to the girl's family, the Committee had faithfully recorded the evidence that was given. Perhaps my mistake was not to reveal publicly until now the fact that the "Today" programme item was not even believed by one of its journalists, who was privy to the background detail of the story.
I do not have time today to refer to many of the newspaper articles that followed on from the "Today" programme piece, but some are worthy of particular note. The Daily Mail, on 10 June, described me as a liar and said:
I am not sure which is more inaccurate—calling me new Labour or calling me a liar.
It is particularly worth noting that that piece, like those in other, more respected, papers such as The Independent, states that the Committee claimed the three-year-old "had died of obesity". We did not claim that. We referred to Dr. McKenzie's written evidence, which stated that the girl died from heart failure, where extreme obesity was a contributory factor.
The following weekend, on 13 June, The Mail on Sunday ran a lengthy article on our report. It was written by Tom Sanders, who apparently is a professor of nutrition and dietetics at the university of London and head of the research division of nutritional sciences at King's college, London. He is the central figure of this affair and I understand that he was a key source for the "Today" programme story. His article accuses the Committee of
To suggest, as Mr. Sanders does, that we made deliberate use of the girl to obtain publicity for the report is utterly disgraceful. Such was the media interest throughout the inquiry that our concern for much of the time was how to avoid press coverage of our deliberations. At one point, we had a formal inquiry on leaks to the press from the Committee. Significantly, the Committee's media release accompanying the publication of the report made absolutely no mention of this girl's case and, as I recall, neither did my introductory statement at our press conference.
Mr. Sanders went on to write that the girl
"died of a rare genetic condition rather than bad parenting, lack of exercise and the promotion of junk food, as the All-Party Committee, chaired by Labour Backbencher David Hinchliffe seemed to imply".
We implied nothing of the sort; we made no comment on the case. He said that we
"had failed to get to the nub of what is really a pretty simple solution; be more active and eat less".
That left me with the opinion that his copy of our report must have had several pages missing; we covered that point in great detail.
Surprisingly, on 19 June the British Medical Journal carried a similar piece by Mr. Sanders in which he also implied that the overall direction of our report was
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somehow influenced by the pharmaceutical industry. His critique of our report in The Mail on Sunday article and in the piece for the BBC website is incredibly unfair and flawed. It has no evidence to substantiate the claim that the Committee had been
When a member of the Committee staff telephoned Mr. Sanders to ask what his evidence was to support that wild assertion, he stated that the International Obesity Task Force, of which one of our advisers, Professor Phil James, is chair, receives some funding from drug companies. Mr. Sanders seems to have entirely ignored the fact that the Committee's recommendations on drug treatments for obesity are very cautious and occupy only a tiny proportion of the report.
Bearing in mind the fact that, by then, the Health Committee had already determined that the influence of the pharmaceutical industry would be the subject of its next major inquiry, I imagine that the drug companies were as surprised and bemused as we were by that assertion.
Mr. Sanders' general analysis that the Committee focused too much on food and not enough on passive activity levels is absolute nonsense: they are given equal prominence. The fact that he disputes our scepticism about the reliability of food survey data suggesting reductions in calorie intake shows how far removed he is from the scientific consensus.
Given that Mr. Sanders obviously felt strongly about our deliberations, and certainly knew about the inquiry, why did he fail to submit any evidence? Having failed to make any submission, why was he then so determined to rubbish and undermine our report in various ways? In his article in The Mail on Sunday, he is particularly critical of the advice obtained by the Committee in the inquiry, implying that its members had almost been led by the nose in the wrong direction.
It is a great pity that Mr. Sanders nowhere refers in his various published criticisms of me, the Committee, its advisers and our report to his real reasons for being so vigorous in his attacks. First, I am confident that part of his motivation was professional pique at not having been re-employed by the Committee as an adviser, coupled with a personal animus against other advisers, especially Professor Tim Lang, whom he attacks in one of his pieces. Secondly, and more importantly, Tom Sanders acts as an adviser and consultant to the food industry, and was obviously wheeled out to do a hatchet job on its behalf. It is a great pity that the journalists and media outlets who peddled his line did not take the trouble to check on his pecuniary interests first.
I apologise, Mr. Deputy Speaker, for dealing with this matter at such length, but in nearly eight years of chairing the Health Committee I have never experienced such a deplorable attempt to undermine our work and integrity.
I turn to the Government's response to the report, as it is appropriate to comment on how long it took them to respond. Obviously, the Committee was well aware that, following the publication of our report, discussions on the public health White Paper would result in some delay to the usual two-month response time, but it was some considerable time after the November publication of the White Paper that we finally received the specific response to the report.
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Having said that, I welcome the fact that the Government have listened to several of our key concerns. Colleagues will recall that at paragraph 181 of the report the Committee recommends that the Government should not only concentrate on informing choice, but "make healthier choices easier". That key tenet of the Committee's report was used by the Government as a subtitle to its White Paper, "Choosing Health: Making healthier choices easier".
The Government response acknowledges that the Committee's report was central to their White Paper, which identifies the reduction of obesity as one of their six priority areas. Important recommendations accepted by the Government include a cross-Government campaign to raise awareness of obesity; a review of the marketing and promotion of food, with the possibility of introducing tighter legislation if voluntary agreements do not work; and—one that I strongly welcome—the introduction of a standardised food labelling system.
We, across the Committee, welcome the Government's commitment to improving food labels and to introducing a simple coding system, which, as is noted in the new public health White Paper, would be promoted by the UK as a European Union scheme during its presidency. The excellent work already undertaken by the Food Standards Agency on nutritional profiling and the need for a simple "traffic light" system of labelling are to be commended and are in keeping with our recommendations.
Will the Minister assure us that the public interest in and demand for a simple traffic light scheme with integrated messages on the nutritional profile of all packaged foods will be the basis for action, even if, as now, major sections of the food and drink industry attempt to block or refute the validity and usefulness of that approach?
Having referred to Tom Sanders' tactics, I should mention something that I know is going on. It is important that the Minister is at least aware of it, and it should perhaps be addressed. Inside sources—people of credibility in the food industry—have told me of concerns that elements in the industry plan to target Mr. Jonathan Back over this issue. He was the FSA's originator of the profiling work, but he has now transferred to DG Sanco. I understand that elements in the food industry have decided to negate his work and to denigrate him personally as a key part of their strategy to have labelling fudged and to allow any old health claim to be accepted under the labelling scheme.
The one thing that I have learned from the inquiry is that there are lots of interested parties—lots of people with a lot of money—and some tactics have been underhand. I hope that the Minister will look into concerns about that, because we—I am genuinely speaking on behalf of the Committee—want the Government to be able to proceed in the way we discussed in the report.
Mr. Colin Challen (Morley and Rothwell) (Lab): The Committee's recommendations on food labelling are quite positive, but does my hon. Friend agree that there
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should be no loss of information and that existing information should be made clearer, not replaced by the traffic light system?
Mr. Hinchliffe: I certainly agree. The Committee's concern was that the size of the labels—never mind their complexity—makes them virtually useless to those of us who are middle aged and who cannot find their glasses halfway round the supermarket.
We need to address the fact that most people do not have the same detailed knowledge as my hon. Friend the Member for Morley and Rothwell (Mr. Challen) and one or two others, which allows them to understand the significance of the various components. It is quite possible for there to be a traffic light system, as well as more detailed information for those who want it, and many companies would accept that approach. The current arrangements, however, are meaningless.
The approach that we saw in Finland was accepted by the food industry and the consumer, and it appeared to work. I know that the Government are aware of what other countries have done. I hope that we can take account of the concerns that I mentioned about the tactics that will be employed against such an arrangement. I also hope that the Government make progress, and I genuinely commend the fact that they have gone along with this idea.
The Government have also made recommendations to ensure that efforts to reduce obesity are reinforced across the Government. That is a key point in our report, and we mention a Cabinet-level public health committee and health impact assessments of relevant policies, including non-health interventions. I warmly welcome the Department's acceptance of the broad thrust of our recommendations, as well as its acceptance of the idea that each primary care trust area will need a specialist obesity service.
The issue of childhood obesity was particularly important for the Committee, and we are pleased that the Government are carrying out a review of school meal standards. Indeed, I believe that the Department for Education and Skills has made an announcement on the issue. We warmly welcome that, because the issue is most important.
However, I must express some disappointment that the Government have not accepted our recommendation to increase the amount of physical activity that children do at school from two hours a week to three. We felt that our recommendation was very modest, and I hope that the Government will look at the initiative that is under way in the Brent area of London, which tries to ensure that children have an hour of activity of some sort or another at the end of every day. I warmly commend that scheme; it is a brave effort. The Under-Secretary of State for Northern Ireland, my hon. Friend the Member for Brent, North (Mr. Gardiner), has been heavily involved in pioneering the project and gave evidence to the Committee.
Dr. Ian Gibson (Norwich, North) (Lab): Let me say, as one Chairman to another, that this excellent report is welcomed by hon. Members on both sides of the Chamber and by people throughout society. However, what does my hon. Friend think about the issue of
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exercise as against over-consumption of food? Does he agree that they are of equal importance in tackling the dreadful problem of obesity?
Mr. Hinchliffe : If I display my pedometer, Mr. Deputy Speaker, my hon. Friend will see that I have taken nearly 13,000 steps so far today. He will also note that I am on the hefty side. We need to address the balance between the two areas he has mentioned. One problem—I might refer to it again in a moment—is that things can be overstated. For instance, one hears things like, "If you wear one of these, you can lose a lot of weight." I exercise at length every day, and I walk miles and miles at the weekend, but I probably need to address other aspects of my personal life to get back to how I was before I entered the House of Commons.
Mr. Keith Bradley (Manchester, Withington) (Lab): Think what you would be like if you did no exercise!
I return to the Government's response. We were pleased at the introduction of a public service agreement target to reduce childhood obesity—our report stressed the importance of introducing targets on obesity—but we feel that the target chosen, which was to
"halt the year on year rise in obesity among children under 11 by 2010 in the context of a broader strategy to tackle obesity in the population as a whole",
The Clerk's Department scrutiny unit prepared some background material on that target as part of an analysis of the Department of Health PSA targets, carried out for the recent public expenditure inquiry sessions. It pointed out that the target, rather than calling for a reversal of trends, simply calls for a plateau at 2010 levels. Between 1995 and 2002, the average annual increase was 0.8 per cent. The way the target is constructed means that childhood obesity could increase at that rate for another four years and then plateau, but the target would still be met. If the current rate of increase continued, it would result in a childhood obesity rate of about 19 per cent. Obesity rates could increase faster, and even level off at a higher rate, and the target would still be met.
The situation facing today's children was brought home to me on two occasions last year by events in my constituency. As part of the healthy schools initiative, I was asked to present various play items during a primary school assembly. They included skipping ropes, but I was told that girls were having to be taught how to use them. Some children had requested seats to be provided in the playground; they appeared to have lost the ability to participate in active play.
On another occasion, I was asked to speak at an event drawing together various schools activities under the healthy schools initiative. As part of my contribution, I asked the children present, who were in the year 7 age group, to describe what they did when they returned home from school each day. The message was clear and totally consistent: "I go on my Playstation, I watch TV, I go on my computer, I text my friends or I have something to eat." When I pressed them further, I found that "something to eat" was usually crisps, chocolate or biscuits.
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Interestingly, Dr. Rory O'Conor, from the public health directorate at Eastern Wakefield PCT, considered the weight status of pre-school children in Wakefield between 1988 and 2004, and concluded that there is an increasing problem with obesity and being overweight, even with children as young as five years.
Dr. Gibson : Does my hon. Friend agree that this is not just a problem of overeating and indulging? Because of the obsession with the body, slimming and eating disorders—this is eating disorders awareness week—are a phenomenon often correlated with obesity. The social pressures on people to lose weight by dieting can lead to anorexia and bulimia.
Mr. Hinchliffe : In the work that I did before I came to the House, I had contact with young women who were a good illustration of that. In many respects, those pressures have worsened during the past 20 or so years, so my hon. Friend makes a valid point. Similarly, in a previous inquiry on mental health, the Committee drew attention to the gross lack of facilities available to take account of the problems that women have—young women, in particular—as a result of support being so variable in different parts of the country.
The comments made by the children whom I met last year confirmed so much of what was at the heart of our obesity inquiry. Alongside increasing physical inactivity, we have over the past 20 years seen significant changes not only in what people eat but in how they eat, with snacking and regular fast-food treats becoming commonplace. Wider societal changes, with both partners usually working, mean considerably more eating out and a much greater reliance on convenience food.
We were struck by the fact that we seem gradually to have lost the skill to prepare meals, and by the fact that healthy eating messages are totally swamped by the massive amount of advertising and promotion of energy-dense food, much of which is aimed at children. Given these profound and worrying trends, what can we do?
Mr. David Drew (Stroud) (Lab/Co-op): Paragraph 174 of the report deals with the healthy schools initiative. I am particularly interested in the local food chain element and reviving the idea that we can get food locally. We should try to get schools to think about the food chain once again. Many authorities still have their own county farms estates, but they never provide for the county councils or local authorities. If we could get schools to think about the food chain, we would be able to re-educate people so that they would get cooking. Does my hon. Friend agree that that is the way forward?
Mr. Hinchliffe : I fully agree. I remember visiting two schools during the inquiry, one of which was a primary school in my area that was part of the healthy schools initiative. The school had started gardening in the school grounds, and some children saw for the first time what vegetables look like when they are growing. Those children had never seen them before. The knock-on effect was a demand from the children for their parents to buy the fresh vegetables that they had become aware of, and in some instances a desire to grow their own food.
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I also went to a secondary school in Boston Spa near Leeds, which is one of the Government's sports colleges and which had transformed the attitude of its pupils to eating. It had, as I recall, made a connection with local food producers, as suggested by my hon. Friend the Member for Stroud (Mr. Drew), so that the youngsters could learn about the entire process of food production, rather than just seeing what was produced in the school canteen.
Concern has been expressed about school tuck shops selling food such as crisps and chocolates. Something else that struck me about Boston Spa was the sight of children queuing for a tuck shop that supplied only fruit—in other words, entirely healthy food. So, the idea that children do not want healthy food is simply not true. If it is available, they consume it. I was very impressed by that school.
To the Government's credit, there are tremendous examples of progress being made through the healthy schools initiative and other initiatives. We need to learn lessons from those examples throughout the country and apply them, because we can do much more. Much good work is being done, which is commendable.
I shall conclude by suggesting where we go now. My first and perhaps most important point, and arguably the most difficult to achieve, is that we must restore public health to the engine room of Government health policy. I hope that we are starting to do that with the public health White Paper. We must shift public health from its position on the margins back to the mainstream. I do not want to ramble on about what happened before 1974, but one or two of us remember public health committees and medical health officers who drove forward health initiatives in local government. We lost a lot when those people were sidelined in health authorities in 1974.
I do not underestimate how politically difficult all this is, because the success of public health measures can take many years to become apparent to the electorate. The benefit brought by current measures might well be reaped by a Government of a different party. I suspect not, but that could happen—many years from now. Spanking new hospitals are a much more noticeable manifestation of so-called progress in health, but it is not easy to convince the public that expenditure on the hard slog of preventive measures is a much better use of taxpayers' money, particularly when such measures are often portrayed as a politically damaging arm of the growing nanny state, as they often are in certain newspapers.
The problem of obesity is undoubtedly a key challenge for the Government in taking forward the public health White Paper, perhaps because more than any other health issue it requires many other Departments to include important public health considerations in their policies.
We pointed to the need to incorporate physical activity into everyone's daily life. We can all wear our pedometers, but our ability to achieve our 10,000 steps a day would be enhanced if the Department for Transport gave the pedestrian more priority than the motorist on occasion. If people could get across roads safely in some of our cities, that would help to encourage walking.
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Underlying my point about the resurrection of a public health strategy is an assumption that such a strategy must have at its core the ability to join up policy making. Our proposed Cabinet committee on public heath would, for example, ensure that the Department of Health had a strategic input to transport policy. We need to put an end to the embarrassing contradictions, such as when ministerial blessings are given to children's consumption of energy-dense products in return for the producer's donation of some sports or computer equipment to their schools.
In short, all Departments need to be singing from the same hymn sheet and developing their coherence in individual departmental policy, which is not always there at the moment. We need politically to make the obvious connection between wider global environmental issues and our individual lifestyle choices in terms of car use, for example, which has a bearing on our health and well-being.
There are considerable challenges to be faced in addressing obesity. The biggest is recognising that public health is not just an occasional add-on and should be the central driver of our entire health care system. If the Government fully recognise that following the White Paper, the time we spent on the obesity inquiry will not have been wasted.
3.21 pm
Mr. David Amess (Southend, West) (Con): Since I first became a Member of Parliament, the power, influence and importance of Select Committees has grown tremendously. I note that the second paragraph of the Government's response to the Health Committee's report on obesity says:
"We welcome the Committee's thorough and comprehensive investigation of the issues surrounding the growing problem of obesity. It complemented and directly contributed to the consultation and ongoing debate on Choosing Health? and made an important contribution to the development of proposals for action on obesity set out in the Choosing Health–Making healthy choices easier White Paper that we published on 16 November."
The reality is that if it had not been for the Health Committee's inquiry into obesity, today's national and international discussion of the subject would not have taken place.
I choose this moment to pay tribute to the Chairman of our Health Committee, the hon. Member for Wakefield (Mr. Hinchliffe). I regret very much that he is retiring from Parliament, although I understand his reasons for choosing to do so. He has given the Committee great leadership, and it and Parliament will be the poorer for his retiring. I also echo his remarks on the value of the support that we got from our advisors; Dr. John Benger was a superb Clerk to the Health Committee. I entirely endorse our Chairman's views on the leaking of the report, which was regrettable.
The delay in the Government's response to our report was unacceptable and had much more to do with media management than with their duty to respond. I am sure that it was a nuisance for the Department of Health that the Government felt that they should make all manner of announcements. However, their failure to respond in the way that they should have was a discourtesy to the Committee.
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A number of individuals and organisations have tried to take ownership of the obesity problem, but there is no quick fix to it. It has not been invented only now or in the past few years; it has been a growing problem. When the history of health care comes to be written, the Health Committee's report on obesity will be seen as having made a fundamental and vital contribution to the health of our nation. I do not believe that it would have been produced were it not for Sue Diebelius and Jackie Cox, from the Obesity Awareness and Solutions Trust, to whose work I shall turn in due course.
The hon. Member for Wakefield has already given the facts and figures on the dangers of obesity, but as I said, there is no quick fix to the problem; we are looking at a 10 or 20-year programme. However, in the light of the Government's response to the Select Committee report, we need to embark on action, and to do so now.
A few weeks ago, the Minister had to listen to my good self during a debate on obesity in young people. She will be relieved to know that I shall not discuss all the issues that I raised then in great detail, but I do want to pick out some of them. I am delighted that all sorts of TV programmes are jumping on the bandwagon, but I hope that the Government keep in close contact with them. For instance, if the BBC "Fat Nation—The Big Challenge" programme is to continue for two years, it would be useful to research its findings in Birmingham.
All Members, I think, will have received a letter from the organisation Breakthrough Breast Cancer. We are advised that being overweight after the menopause increases the risk of breast cancer—an issue that we should not take lightly.
An important part of our report is that dealing with education. The Committee felt that educating our young people on the dangers of obesity was all-important. A few weeks ago, the Minister heard me talk about Sally Lawrence of Outloud Productions and her pioneering programme on getting young people interested in the dangers of eating too much. When we took evidence, there was an interesting exchange involving the Secretary of State for Culture, Media and Sport and an education Minister. I am not sure how convinced the Committee was about the existence of joined-up government, and in the light of the Government's response to our report, I am not entirely convinced that they take this matter sufficiently seriously.
It is a sheer coincidence that, today, there has been an announcement about school meals, and I want to know why the Government have failed to take on board our recommendations 38 and 39, on food at schools, which are very important. The real solution to combating obesity is not physical exercise; rather, the emphasis should be on what we eat and drink.
During the Health Committee's inquiry into obesity, we visited America and saw first hand how the vested interests are in complete denial about how serious the problem is. Only this week, there was a disgusting TV programme on very late at night—I could have turned it off but my older children and their friends were watching—about the fad for making people very fat. One lady has reached 54 stone and another 60 stone. That sick fashion for making people fat says it all. Having listened to Coca-Cola and McDonald's in America, I can easily see how that happens.
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It is also obviously sheer coincidence that those minded to take part in this afternoon's debate will have had a letter from Coca-Cola, telling us about all the virtues of Diet Coke. I salute that, but the reality is that if it had not been for the Select Committee report on obesity, the food and drinks industry would not have taken the action that it seems to be taking. The level of salt, sugar and fat in what we eat and drink is all-important in combating obesity.
Last year, I had an exchange with the then Under-Secretary of State with responsibility for schools about the dispensing of snacks and drinks in schools. I hope that the Minister here today will have something to say about progress on that issue. I am sure that curbing the sale of junk foods will encourage youngsters to find healthier alternatives. As I told the Minister a few weeks ago, Southend schools are leading the way in that regard, although I am sure that similar things are happening throughout the country. I fully accept that we should not live under a nanny state, and that it is up to schools' governing bodies to determine their priorities.
In that context, I turn to recommendation 14, which states:
"Parents, teachers and school governors must all be fully engaged in tackling obesity, which should command a high priority on school board agendas."
I must admit that when the Committee was agreeing our report, I thought "school board" a rather old-fashioned term, but never mind—as long as we get action from our school governing bodies, I shall be delighted.
Southend is leading the way in encouraging young people to lead healthier lifestyles. We have had a walking buses initiative since 1999, and an obesity conference is due to take place at Southend United football club. I will be joining forces with the chairman, Mr. Ron Martin, and a range of sporting celebrities will also be present, as will—I hope—representatives of the food and drink industry. The Obesity Awareness and Solutions Trust—and, coincidentally, a couple of my constituents—have come up with the wonderful idea of an obesity telephone helpline. That is an excellent proposal and I hope that the Government will do their best to encourage it.
I hate the expression "traffic light labelling" but we are stuck with it, so I suppose that I shall have to continue using it. I am pleased that the Government have taken the Committee's recommendation seriously and aim to introduce by the middle of 2005 a system that can be used as a standard basis for signposting food, building on the "five-a-day" logo for fruit and vegetables. As the Chairman of our Committee said—he mentioned glasses and food labelling—we need something quickly that people can recognise as a way to a healthier lifestyle.
Given that many Members wish to speak, I shall draw my remarks to a conclusion. It is an absolute disgrace that TOAST's funding has been withdrawn under section 64 of the Health Services and Public Health Act 1968. The usual ministerial response to letters setting out good ideas is to refer people to the primary care trust. The Government's announcement yesterday gave the impression that huge amounts of money are being given to every PCT in the country. However, I speak from experience when I say that there simply is not
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enough money for the PCT in my area to deliver on all the duties that the Government are increasingly imposing on it. TOAST had plans to build a centre of excellence, run a mobile drop-in centre and produce the TOAST Bites journal to help people who, despite dieting and other measures, cannot lost weight and need help badly.
I am proud to have been a member of the Committee, but there is no earthly good in any Select Committee's producing a report, only for the Government of the day to pay it lip service. It is so easy to be swept up in gesture politics—a photo opportunity, a sponsored tea on the Terrace, a public meeting, a letter. What we need from the Government—whoever the Government of the day might be—is serious action on this issue not only this year, but over the next 10 to 20 years. It was not the Government who suddenly discovered that obesity is a problem, but it is they who hold all the cards in terms of power and media manipulation.
I ask the Minister not only to give us a considered response today to the Health Committee's report, but to encourage her colleagues consistently to follow up the Committee's recommendations on obesity.
Mr. Deputy Speaker : Order. Before I call the next speaker, I advise Members that we have a fraction over two hours' debating time to go, and I urge them to allow the Minister adequate time to respond. I am referring not only to Back-Bench contributors, but to Front-Bench ones from the Liberal Democrats and the Conservative Opposition.
3.36 pm
Dr. Ian Gibson (Norwich, North) (Lab): I can be ultra-brief, because I am a cuckoo in the nest; I am not a member of the Health Committee. However, its Chairman, my hon. Friend the Member for Wakefield (Mr. Hinchliffe) and I work together—and with you, Mr. Deputy Speaker—on the Liaison Committee, and I sympathise with what my hon. Friend says about the media pressures put on his Committee. We have had that in the Science and Technology Committee, too, and perhaps the Liaison Committee can try to do something about it, as good work and excellence emanates from all our Committees.
I will be brief, because I have had the opportunity to ask a couple of questions, and also because I want to give hon. Members who have done much more work on this subject a chance to contribute. I want to talk about diet, which often comes up in discussions, and about the pressures that are put on young people in particular when obesity enters their lives—the social pressures that they are put under by glossy magazines and other sources, and the disgust that they have for their bodies. That kind of pressure is particularly felt by young women, and we must resist it. Doing that involves working with the media, and we have a lot of educating to do there.
I am interested in dietary solutions, because if I had to go on a diet, I would not know which one to pick, and I can understand that neither would many young persons
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and other people. There is the Atkins diet, low glycemic diets, and many issues to do with matters such as low calories. I should declare an interest now; I am a non-executive director of the Institute of Food Research in Norwich, where lots of work is being done on different types of food and its influence on health, people's bodies and recovery from diseases such as cancer. We need some randomised trial research in this area to see whether there is such a thing as a good diet, because my information is that as soon as somebody goes on a diet, they lose weight but it returns because of the conditions imposed on them when they are forced into the avenue of having to undertake a diet. It is not long before they are again having food walloped down on plates for them in grub pubs and elsewhere. I must hold my hand up and admit that I indulge in that occasionally, too.
I particularly want to flag up one issue that I have already raised in a question. Some young people are put under pressure at school and elsewhere because they are called fatties and, under that social pressure, they have to take up certain types of behavioural patterns. That often leads them on a difficult journey down a road of restricting their intake of food, vomiting it up, preventing themselves from following proper diets and so on. The pressure on them is amazing. I do not know about the correlations in this regard; figures are quoted by the Eating Disorders Association, but I say, not in a one-upmanship way, that a Committee such as this one does not have the time to address every issue that is correlated with this. It has done a sterling task.
I want to raise this matter, particularly in this awareness week. People are pushed into trying to shape their bodies into the way that society demands—to get the right size and weight loss, and so forth. That is often associated with psychiatric pressures, which are a real problem. That is important, not just among women, where anorexia and bulimia occur, but among young men, because they are now being pulled in as well. I would not want to look like David Beckham nor would I like to play football like him, but many people see those role models as being of the perfect shape.
The problems faced by young people with eating disorders often lead to other health problems, such as kidney diseases and osteoporosis, and to absences from school and a reduction in academic achievement. As my hon. Friend the Member for Wakefield says, such disorders could be an increasing problem in young people and we have to correlate that with the issues raised. It is difficult for such people to form and sustain friendships with peers, for example. The low esteem that people feel about food and how they ought to look—whether they should be thin, sporty or less plump—is an amazing pressure. If people survive that in our society, they are very lucky.
This week has been important for engaging young people on the issue of eating disorders and for talking to general practitioners, few of whom understand the problems, spot the diagnosis early or do much about it. When we talk about obesity, we should also consider the situation where people think that they have a funny body mass index. I do not understand BIMs. [Hon. Members: "BMIs."] What did I say—BIMs? As long as I did not say BMW—but that is how little I understand them. Such figures are, I think, suspect. Nevertheless, we know that we can be over-plump and want to lose weight.
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We have to be careful about the knowledge we have, the pressures we put on people and the figures that come through from the medical people about where one should try to be. It is an amazing pressure, and I am sure that people here feel it. When one looks round the Chamber of the House of Commons, one does not get the impression that any attention has been paid to that knowledge whatsoever: about 1 per cent. of people must have the right BMI. I say well done to my hon. Friend the Member for Wakefield and his Committee, who have done excellent work. There is a lot to do, and other Committees will take the issue up over the next five or 10 years.
3.42 pm
Dr. Richard Taylor (Wyre Forest) (Ind): May I start by adding my tribute to the hon. Member for Wakefield (Mr. Hinchliffe) and his skill in chairing the Committee with great tact and amazing humour at the same time? It is a unique combination that will be difficult to follow. I knew that he was on the same side as me—I can say this as I am sure that he does not mind a straw what the Whips think of him now—on one of our very early visits to a hospital in the north somewhere. We all introduced ourselves around the table, and I said that I was an Independent MP, and immediately after that he said, "I am a fairly independent Labour MP." That says a lot.
I would also like to pay tribute to our advisers. We have found them especially helpful on occasions when, at their own expense, they have found themselves in, or have come out to, the same foreign country as us. At some of the meetings that we have had on such visits, our advisers have been able to chip in with useful comments and have steered the discussion. At one point in the meeting this morning, which the Minister will remember, a contribution from an adviser might have been helpful. I wonder whether other quarters could take on the idea that, because of the value that the advisers provide, perhaps there could be some method of arranging funding for at least one to come with the Health Committee on visits to parts of England or abroad.
The report and the Government's response made us all very aware of our own body shape and size. I am sure that we all worked out our BMI fairly quickly. I was absolutely horrified to find that although I have always thought of myself as pretty slim, I creep in to the overweight category.
As a junior doctor, I did an extraordinarily difficult house job not more than half a mile from here, where I had an extremely irascible chief. He took it out on his housemen all the time. A friend said to me that when one is really being got at by someone who is irascible and very fat, one should imagine what he looks like in the bath. That immediately cured it. The problem is that I have looked at myself in a full-length mirror from the side after a shower and it is not as good a sight as one would have hoped.
3.45 pm
Sitting suspended for Divisions in the House.
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4.10 pm
Mr. Deputy Speaker : I think that I was right to break for 15 minutes. I was not sure that there would be a second Division, but I was fairly confident that there would be.
Dr. Taylor : I come now to the slightly more serious part of my contribution. The Chairman of the Select Committee gave me the cue to talk a little about the risks to health of obesity. I can do no better than refer to table 3 on page 17 of our report, which lists them with lurid clarity. There is a greatly increased risk of type 2 diabetes, gallbladder disease, lipid abnormalities, breathlessness and sleep apnoea. There is a moderately increased risk of coronary heart disease, hypertension, wear-and-tear arthritis of the knees and, of course, gout.
Many of us learned—I certainly did; I am ashamed to say that I did not know it before—that associated with obesity is a slightly increased risk of certain forms of cancer, particularly breast cancer in post-menopausal women, endometrial cancer, colon cancer and other more obvious conditions such as low back ache and anaesthetic risks. On the same page of the report, reference is drawn to the alarming fact that the relative risk of death for someone with a slightly raised BMI, such as me, is 1.3. Even for a moderately raised BMI—and long before the definition of obesity is reached—the relative risk is 1.6 and, just before reaching the official definition of obesity, the relative risk of death is 2.1. Even being a slight degree overweight is bad.
I intend to pick up on only a few matters from the report and the response. I refer to children and schools because that is important. We sampled the healthy lunch that was given to all children, without choice in one of the Scandinavian countries. It was well taken up and very edible. Some mention has been made already of vending machines. Several of us know that it is possible for vending machines to contain low-fat crisps and low-calorie drinks. There is often talk of nanny states, but someone should dictate to schools and parent-governor committees and say that it is easy to put healthier items in vending machines and make it clear how essential such action is.
Most of us here, certainly those above a certain age, will remember being weighed and measured at school. At paragraph 369, we say:
"We recommend that throughout their time at school, children should have their Body Mass Index measured annually at school, perhaps by the school nurse, a health visitor, or other appropriate health professional."
To avoid the stigmatisation that is one of the objections to such action, we went on to say:
We had evidence that parents of quite severely overweight children did not realise that there was a problem, so the only way in which the problem can be known about is to weigh and measure the children. That is crucial.
Yesterday, the meeting of the associate parliamentary health group on obesity was addressed by Sir Derek Wanless, Dr. Fiona Adshead, a representative from
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Dr. Foster and from the National Obesity Forum. The meeting was well attended. It was said repeatedly that there was lack of data and information about the problem. Weighing and measuring children is, to my mind, a first and easy essential, because there should not be a cost of even tens of pounds; it could be woven into the work of a school nurse, who, it is to be hoped, would be available. Even school teachers could surely weigh and measure, if they were allowed to touch children, which they probably are not. It does not strike me that expense should be a limiting factor.
I want to say a few words about physical activity. One of the recommendations in the White Paper is that it should be made possible—or children should be helped—to walk to school. It is a fact, and there are figures in the White Paper to prove it, that children on average burn up more calories walking to school than during their two hours of physical activity. It is so obvious: if it can be made safe for children to walk or cycle to school, they have to get there so they will burn up calories. I should very much like that to be made possible somehow. I know how difficult it is, but we visited a town in Denmark where virtually everyone cycles, so it is not impossible.
The hon. Member for Southend, West (Mr. Amess) mentioned walking buses. I shall be surprised if he has any in his constituency that have been going for a long time. Usually they depend on a small number of parents who start them. When they leave, no one else keeps them going.
I am of course wearing my pedometer. I am slightly puzzled by our Chairman's score of 13,000 today already, when I know that he was sitting absolutely still from 10 am to 12.30 pm. He must have walked six miles to work, or something like that. However, pedometers are superb for making one aware of what one is doing We heard how, in Colorado, children were fitted with them, and they were used in maths and even geography lessons to work out where the children had travelled. They can be a huge help.
We fear that prevention might not be a priority for primary care trusts and GPs. We were talking to the Minister this morning about local development plans for PCTs. I wonder whether there is any incentive for GPs to put prevention of obesity in their local development plans. That would be good to know.
Treatment requires vast amounts of new money. I am sure that we all welcomed yesterday's announcement of the money going to PCTs. I wonder whether there is enough for the all things that PCTs would ideally like to do. We had an example of the limitations that targets put on services during our inquiry, which was repeated at the meeting of the associate parliamentary health group on Wednesday, at which a GP from Nottingham, who ran an obesity specialist clinic, told us that when the waiting lists had got to 12 weeks, he went into discussions with the managers because they were going to go over target and the only answer was to suspend the clinic. That does not seem to be the right way to use targets.
I want to mention industry briefly. I have been approached since the inquiry by Burger King, PepsiCo, Coca-Cola and McDonald's to emphasise how they
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were trying to be part of the solution. If they have voluntarily become part of the solution, rather than having anything pushed on to them, that will be a good outcome of the inquiry.
I travelled home on the train a few weeks ago with another hon. Member—who I am glad is not here—and I was so hungry that I had the giant-sized Burger King bacon double cheeseburger. I must own up to that, but I had it only as an extreme luxury.
There is a sign that those companies are becoming involved. Coca-Cola tells me that Diet Coke accounts for more than 50 per cent. of its sales in the major supermarkets. That will make a huge difference, as Diet Coke contains about 0.4 kilocalories per 100 ml, compared with about 43 kilocalories in ordinary Coke. I would very much like to hear the Minister's comments on some of the points that I have raised.
4.21 pm
Mr. Colin Challen (Morley and Rothwell) (Lab): I wish to make a brief speech on the Committee's excellent report, which will, I hope, be lean and unsaturated. I begin by declaring an interest: I am a vice-chairman of the all-party weight watchers group, having been elevated to that post last year after losing 3 stone. It seems that the lighter one is, the higher one rises.
Last year—on the day this report was published, coincidentally—it became clear to me that I had to lose weight because I had a combination of high blood pressure, blood sugar, and cholesterol, which were all conspiring to do me permanent damage, which had become evident. I had an increased risk of stroke, diabetes, and possibly all the ailments listed in the helpful guide to diseases linked to obesity on page 126 of the report. The idea that, through my own inaction, I could suffer the fate of having to go on to permanent medication and treatment appalled me. Given that the cost of medical treatment for obesity set out in the report is calculated to exceed £1 billion, I am not inclined to add to that burden.
The report asks whether obesity should be blamed on gluttony, sloth, or both of those deadly sins. I should not like to own up to either of those lifestyle choices this close to a general election, but after my first year of working in this building it became apparent to me that there are many opportunities here for gluttony and sloth, as far as one's waistline is concerned. I got into the habit of always using the lifts, but now I never use them. Like other Members, I occasionally take the opportunity to go to a reception or two, but if I do so now, I have my diet in mind: I discovered that it is no rudeness to one's host if one does not hoover up the entire contents of the nibbles tray.
Exercise and a more structured approach to eating have helped me to attain a weight at which, according to the chart in the back of the report, I am no longer obese—I was just in that dark bracket—but slightly overweight. Many of my constituents sought my advice, and asked how I did it. Many people are concerned about their weight, but sometimes feel that losing weight takes too much effort. I recommend simply that one's approach to escaping obesity must be individualised: it must work for them at their pace and should be free of quick fixes and fads.
There are a few effortless ways in which one can lose weight. People should read food labels, and not be fooled by the fancy, healthy-sounding names that are
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given to many food products nowadays, such as "Simply Good" or "Healthy Living". I discovered that those descriptions are always meaningless and misleading. Instead of using the lift, people should climb the stairs to the next floor at least, and then take the lift, until they can eventually climb to the top floor. That is useful advice when one is using Committee Room 20, which is on the Upper Committee Corridor, and there are lots of Divisions. I now look forward to Divisions, because they are an excuse for a bit of exercise. Generally, I beat Members who have taken the lift back to the Committee Room.
On the subject of pedometers, I too should be interested to know how my hon. Friend the Member for Wakefield (Mr. Hinchliffe) achieved the fantastic feat—
Mr. Hinchliffe : I have to confess that when I looked at it, I was rather surprised to see that I had done 12,000 steps today. I think that I forgot to turn it back last night. I do apologise.
Mr. Challen : Honest to the core. Over the past year or so, I, like many other hon. Members, have been sent pedometers by various companies. I received a very good one from the BBC, although the one from ITV told me that I was walking twice as far as before, even though I was doing the same number of steps. I also received one from a company that manufactures crisps, although I do not intend to wear it to find out how far I am walking. One recommendation that we should take up, therefore, is that there should be a clear standard for pedometers. These things are manufactured very cheaply, which is possibly a good thing, but if they are not made to a standard, how do we know that they are reliable? They could give people the wrong impression about the effort that they are putting in.
Jim Dowd (Lewisham, West) (Lab): I calculated that members of the Committee were each given about six pedometers over the course of the inquiry. I know that the Chairman distributed them liberally to most of his friends and family at Christmas, along with the umbrellas that he got at that hotel in Boston the year before. However, the real point about a pedometer is not whether it is accurate, but that it is a permanent reminder that we should walk when we can. Part of my fitness programme involves parking on the second floor of the underground car park and walking up. So, a pedometer does not need to be technically accurate.
Mr. Challen : I am grateful for that intervention. This is a serious point, and I certainly take my hon. Friend's comments on board, although it is also nice to know when we have walked 50 more steps—or 13,000 more steps—than we did yesterday. However, my hon. Friend raises an important point.
Another recommendation that I would make is that people should go food shopping only after they have had a meal. They will then buy less and reduce their impulse purchases. Having said that, buying more fruit is a good idea and drinking more water is important.
Of the suggestions, or effortless steps, that have been proposed, reading food labels is the most difficult. As the report says, these labels can be confusing or even meaningless to the lay reader. In that respect, I have the
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greatest admiration for the approach adopted by Weight Watchers; it may have been adopted by other groups, too, but Weight Watchers is referred to in the report. The organisation has simplified the essential information—chiefly the calories and the fat content—and put it in an understandable format, and that approach should be used more generally. Combining information in a single figure, which could be printed in a larger typeface and displayed on the packaging where one would usually see the weight of the product, would enable people quickly to understand what the product on the shelf contained.
I was positive about the traffic-light system, but I have one fear about it. The report suggests that manufacturers might be encouraged to change the content of their food slightly to move up to a better bracket. However, the change might be so slight that, although the food gets into a better bracket, the consumer will have no knowledge of it, other than a relative idea of the content of the food. As I said earlier, therefore, it is important that good, sound, absolutely concrete information is printed on the label on the back of products; otherwise, people will have no more than a relative idea of the food's content.
Tim Loughton (East Worthing and Shoreham) (Con): I very much appreciate the hon. Gentleman's point, and I think that there are problems with a simplistic version of the traffic lights, particularly when applied to what is called the avocado conundrum. An avocado can be good for people, but too many can be very fattening. I gather that it is also very good as a facial scrub. None the less, the system can be too simplistic: the question is not only what is an unhealthy food, but what is an unhealthy diet.
Mr. Challen : Indeed it is. I would urge the Government, when they commit themselves to these proposals, to see how the label on the back can be improved so that if someone looks at an avocado, and the label puts it in the middle or the bottom bracket, they will think, "That's a surprise. What does it say on the back?" The traffic lights might encourage more people to read the label, because there will be quite a few surprises. So, people need to be better educated about what they consume.
Many people think that the process of eating should end only when they feel full. In practice, that means that people overeat most of the time. I bet that that is especially true when they consume junk food, which has little nutritional value. The worse the food is, the more people feel that they must eat it in order to feel satisfied.
One of my constituents asked me whether it was necessary to feel hungry every day to lose weight; that is the other end of the scale. Thankfully, from my own experience, I know that it is not. The last two activities on my effortless list, which includes drinking water and eating more fruit, can address that problem.
Finally, I welcome the report's recommendations on active transport, particularly those on walking and cycling. The report suggests that the Department for Transport might be a bit embarrassed because of the ministry of silly walks reputation that it might get if it talks up walking too much. That leaves a bit of a deficit in the Government's approach to obesity. There has
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been strategy after strategy to increase those activities, but targets are never met—not by a long chalk—even though Sustrans has achieved a much improved national cycle network. Perhaps there has been some improvement in recreational cycling.
4.31 pm
Sitting suspended for a Division in the House.
4.49 pm
Mr. Challen : I was finishing on the subject of the Committee's recommendations on active transport. As part of my diet and fitness regime, I have started cycling again. I have picked it up again after about 20 or 30 years, and the roads are just as inhospitable now as they were then. Very little seems to have been done to encourage cycling. A few white lines painted down the road does not protect us from cars, so we must consider innovative ways of tackling that problem. We must also ensure that train operating companies are obliged to take people's bikes, without cyclists having to jump through a range of hoops or encounter difficulties. Some companies are preventing commuters from taking their bikes on trains, and there is something seriously wrong with a system that allows that to happen.
It comes as no surprise that the Dutch have lower obesity levels than ours, because they have a dedicated urban and rural cycle network, and have had for decades. I have had the pleasure of using it, and one can cycle all day long in towns, cities, villages and open countryside and never come across a car. We should bear it in mind that our country is hillier than Holland, which is conveniently flat for cyclists, but even in places such as Leeds we must consider new ideas so that people are not worried about cycling up and down hills all the time. My constituency has quite a few hills in it.
Only yesterday in the Yorkshire Evening Post, there was an article about an idea for a new, elevated cycle expressway from a Leeds engineering consortium. That is the sort of imaginative idea we must consider, because only when we have imaginary ideas will people be tempted out of their cars and other sedentary transport options.
The report is imaginative; it should be required reading for all Departments. If the Committee will forgive the pun, it would be ideal if a slimmed-down version were available for wider public use. It contains a lot of information, presented with clarity and strength by Members, and if it were available in surgeries and other places, it would be an excellent contribution to the wider debate that will have to continue.
4.51 pm
Jim Dowd (Lewisham, West) (Lab): This afternoon has been so disrupted by events in the Chamber that I think we are running about 40 minutes behind schedule. I shall therefore keep my remarks brief and to the point.
I add my thanks and congratulations to the Chair of the Committee, my hon. Friend the Member for Wakefield (Mr. Hinchliffe). Others have already given
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theirs. He is always a genial and firm guide to our proceedings in the Select Committee. None of us knows what may happen in the next few weeks and months ahead, but it occurs to me that this could easily be the last time he introduces a report from the Committee to the House, so I place on record my thanks to him for all his work over the years and for his unswerving friendship. It has been a pleasure to serve on the Committee with him.
There is a difficulty with the report. The hon. Member for Southend, West (Mr. Amess), who unfortunately is not in his seat, said that the delay in the Government's response to the report was intolerable. I suspect that—in his own Southend, Basildon kind of way—he over-egged the pudding, but the delay makes life more difficult. We undertook our first evidence session well over 18 months ago, and that makes recalling the detail much more difficult. None the less, the inquiry was a fascinating and revelatory experience. I certainly learned a great deal from a variety of sources from a range of backgrounds.
Like the Chair of the Committee, I must mention the gross distortion that afflicted the report when it came out in May. The vilification of the Chair—that is what it was; it was very personal—was wholly and utterly inaccurate. One could understand it if some tabloids behaved that way, but it is a complete and utter travesty when a newspaper as self-regarding and allegedly serious as The Independent headlines a story, "How obesity report was undermined by the quest to grab public's attention".
The Chair has already outlined in detail the issue contained in the second paragraph of the introduction to the report. It occupied little more than a couple of hundred words and was not alluded to anywhere else in the report. The report, including appendices, comes to more than 500 paragraphs, so the idea that what was contained in that one paragraph skewed the whole publication is completely and utterly absurd. That is what happens when one is as self-important as The Independent, which also ran a leader article on 11 June saying that the Committee had acted recklessly in including that information "without checking its veracity". It continued:
"More than that, the committee has gravely damaged efforts to make Britain wake up to its obesity crisis."
That is plain and utter nonsense.
All the reports that have been produced over the years by the Health Committee and our sister Committees are excellent pieces of work, but this one will stand the test of time because of its focus on several different issues and elements of the obesity crisis, as it is called.
The Committee also learned when taking evidence that the so-called obesity crisis is, like climate change, not universally accepted, even in the scientific community. One witness said that obesity was "a big fat lie" and suggested that we completely misunderstand the nature of the problem, but rather like the argument on climate change and global warming, I believe that that is very much a minority view, if not an idiosyncratic approach to the problem, because we got a similar message right across the piece, whether from people who were individually affected by it—there was a debate on whether one should call obese people sufferers—or from food manufacturers, retailers and advertising agencies.
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There are other examples of how the press trivialise things. The problem with the other paragraph was that it was the second in the report. Of course, most journalists will read only to paragraph 3 or 4 at the most and assume that they have read the lot. If the press had read further into the report, I am sure that what happened would not have happened.
When we were in New York, a commissioner told us that, for the first time in history, the generation of children and young people in the city would have a lower life expectancy than their parents. Evidence from this country and Australia also suggests that, and we make the point in the summary, because it looks likely to be the case in the United Kingdom if the trend is allowed to go unchecked.
The tabloids got hold of that, and I remember reading one article—I have not got it with me—that said that the crisis was so serious that children would die before their parents. That is patently untrue. If that were the case, the human race would be extinct in little more than a generation. Children are not going to die before their parents; they simply will not live as long as their parents can reasonably be expected to live. As the report makes clear, obesity is the most serious threat to public health not only in this country, but in other countries in the developed world, such as Australia and the United States.
Astonishingly, the Committee even took evidence that suggested that signs of obesity are emerging in Africa, and certainly in South Africa, which is the most advanced part of that continent. That is happening for various reasons, including the fact that as people move towards cities and away from essentially agrarian economies, they not only tend to have sedentary jobs rather than do manual work, but have access to buses, trains and other public transport systems. In more rural areas, they would walk quite a lot, whereas in cities they ride around in cars and on public transport. Even people who are not particularly wealthy have access to those facilities, and South Africa has started to experience the same trends that we have experienced in the more advanced economies for many years.
There is no simple way through the problem—indeed, the report makes 60-odd recommendations across the piece. The evidence that people eat too much of the wrong things and do not take enough exercise in return is at the heart of the calories-in, calories-out argument.
To some degree, obesity is a problem of affluence. Paradoxically, however, the richer someone is, the less likely they are to suffer from obesity, which peaks on a kind of curve. Richer people tend to be the ones who drink mineral water, join gyms, have pedometers and so on. Past a certain point of prosperity, the curve starts to fall, although the vast majority of people are on the rising part of that curve, which is the challenge before us.
I will mention a couple of other things. The human body, like those of most species, has defensive mechanisms and tends not to indulge in risky behaviour that jeopardises the individual. I asked one of our witnesses why that is not true of how we eat. We like things that are bad for us. We do not like the things that are good for us and find it a trial to eat properly. She explained the issue in a graphic way, saying, "In stone age times, the whole tribe would gorge themselves when
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the tribe killed a mammoth, because life was so precarious that people did not know where the next meal was coming from."
We are many centuries away from that and hardly anyone in this country does not know where their next meal is coming from, although there may be a few at the margins who do not. However, we still behave in that stone age way and have a stone age psychology and physiology. In part, that makes dealing with the issue difficult, because it requires most people to behave counter-intuitively. Society has progressed much more rapidly than our approach to food and healthy eating.
I am delighted that the hon. Member for Southend, West mentioned the other thing that I want to talk about—the traffic light labelling model. I was not going to call it that, but when I discovered that he dislikes the term so much, I could hardly resist. I accept what others have said about how that model can be simplified and welcome what the Government are doing to try to reach agreement on it.
We have said that we will give the Government and the industry a chance to reach agreement, but that other steps should be taken if they do not, because food labelling as it is now is fact without information. It is just numbers on the side of a tin saying how many calories and kilojoules and how much sodium and so on the contents of the tin contain. While those numbers are factually accurate, they do not convey information to people in a useable form. If we were to move to a traffic light model or some variant of it, much would be generalised.
I accept what was said about the so-called avocado problem. Obviously a bag of sugar would have a red label on it under any circumstances because it has a lot of sugar in it, but as it is a bag of sugar that is hardly surprising. The same would be true of dairy products, which have large amounts of fat in them. However, I agree with the hon. Member for Southend, West strongly on the argument about healthy and unhealthy food, which emerged when we were putting the report together. Although we slipped into using such language occasionally in the report, my impression is that there is no unhealthy food. If we were trying to tell people living on 50 cents a day in sub-Saharan Africa that there were unhealthy foods, they would look at us askance. There are no unhealthy foods; there are unhealthy diets. We need to put in place a balance.
Of course, everyone likes a treat such as chocolate from time to time, but they should not have it all the time. People like McDonald's. The hon. Member for Wyre Forest (Dr. Taylor) admitted to that predilection. Once in a while such things are okay, but they must be part of a balanced diet and a more active lifestyle. That is patently obvious.
The other point that I want to mention is the one that the hon. Gentleman raised on recommendation 58: measuring the body mass index—BMI—of school children. I was pleased by the Secretary of State's announcement yesterday on funding. I was also pleased that every area will essentially have to restore the school nurse. I noticed last week that that is exactly what is to be done in the United States, although I cannot remember whether it will be in one state or by the federal authority. All schoolchildren will be weighed and
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measured, and a confidential report sent home to their parents. I am delighted to hear about that and hope we can do the same here.
In conclusion, it was a pleasure to work on the report. There are a lot of things in it, some of which will be easier to do than others, but if it helps to focus on a major threat to public health, the Committee and the House will have done a public service. I broadly welcome the Government's response, but hope that they can be slightly more positive and reduce some time scales accordingly.
Mr. Deputy Speaker : Order. Before I call the next speaker, I must tell the House that this sitting has to conclude at 6.23 pm and—I do not think I am saying something that hon. Members do not know already—that there will be a Division at 6 o'clock. We either continue after or conclude before then.
5.6 pm
Mr. Keith Bradley (Manchester, Withington) (Lab): Thank you, Mr. Deputy Speaker; I shall work towards the latter stricture.
I start by congratulating my hon. Friend the Member for Wakefield (Mr. Hinchliffe) on chairing the Health Committee and on doing such tremendous work on its behalf over many years. He and I were elected at the same time, 18 years ago. I will not say that we have grown fat together over those years or what the reasons for perhaps doing so were, but I am grateful for his friendship and he will be sorely missed by the Committee.
I reiterate one of the main points made by my hon. Friend in his opening remarks, which is the role of public health in the development of health policy. It is crucial that we return public health to the heart of our plans. I am concerned that primary care trusts, which now lead on public health at local level, still do not fully recognise the importance of the public health role; nor do they put the role of the director of public health as high up their development agenda as they should. Will the Minister ensure that all PCTs recognise the importance of that role, and that their public health plans are at the heart of all developments in the localities?
I want to concentrate on the "calories out" side of the argument. Given what I know of my local schools, I remain extremely concerned about the amount of physical activity that takes place in schools and in the community generally. We must put even greater emphasis on the role of such activity in schools and ensure that we move rapidly towards the Committee's recommendation of three hours' physical activity a day. Such activity need not be formal sport. Some children find it difficult to engage in sporting activities, and the report highlights a range of other activities in which they can engage, such as dance, aerobics and other useful activities that contribute towards "calories out". We should aspire to the Committee's recommendation of three hours' physical activity a day, which is based on the European Heart Network recommendation.
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I welcome the fact that the Government now intend that by 2008, at least 85 per cent. of children will exercise for two hours a day. However, that is still too little, and progress towards ensuring that such activity takes place in every school, to the benefit of all children, is still too slow.
We have to look carefully at the curriculum. The curriculum authority needs to be charged with the responsibility of developing a physical activity plan and Ofsted needs to monitor it. We must ensure as soon as possible that children get back into a range of physical activities, because as we have heard, they certainly do not engage in them at home. They sit in front of the telly or play their computer games, and I know from my own family experience exactly how that happens. We have to work with local sports clubs as well as schools, because it is not only schools that need to develop physical activity. Even if we do manage to get more sport back into schools, the links between schools and local community clubs have to be reinforced, so that young people can be involved in sport for many years to come and not lose impetus when they leave school at 16, and become inactive again.
I welcome the fact that in our capital programme, "Building schools for the future", the importance of sports facilities is recognised. Many schools do not have decent changing rooms or sports facilities, which is an impediment to children getting involved in sport. For children who are already overweight or obese, there is also a fear of bullying in school. If there are no decent facilities—if that problem is not tackled—we will not achieve the level of participation in sport that we so desperately need. The Government have recognised the importance of this issue by investing £1 billion in sporting activities, but I urge them to take the extra steps as soon as possible to engage all children in such activities.
I should like briefly to comment on a related issue, which is how children get to school and existing initiatives to provide safer routes for those who walk or cycle to school. We have already heard about our visit to Odense in Denmark, where we saw the excellent safe routes being developed throughout the town to enable children and parents to cycle and walk safely. Far more needs to be done in this country on safer routes. I know from my own experience that car upon car arrives at the school gate, dropping off and picking up children. This is mainly a safety issue. Parents are worried about their children walking or cycling to school, and we must do much more to plan safe routes for them.
In Denmark, we saw a good example of a computer programme that enabled children to identify for themselves particular points on the route that were dangerous. A plan could thereby be worked out, so that parents were comfortable with their children taking such routes to school. There is much to do on that issue in this country, and it is important that the Department for Transport, in conjunction with other Departments, gets involved in such programmes to ensure that walking and cycling again become the normal way to travel to school, as they were when I was at school.
I used to cycle or walk to school and did not even consider being dropped off by my parents in a car, because cycling or walking was the norm. We had huge cycle sheds at school, but they no longer exist because children are not encouraged—or even able—to get to
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school in that way. A private Member's Bill was introduced last year, by my hon. Friend the Member for Carlisle (Mr. Martlew), on the use of helmets by children cycling to school. There were many arguments for and against that Bill, but if it would ensure that children can safely cycle to school, the Government should consider it again.
We noted in the report that it was, to say the least, "scandalous" that the Department for Transport had taken 10 years to develop a national walking strategy. I do not know how many years it will be before there is clear implementation of such a strategy. However, I hope that the Minister will, through the Department, encourage the healthy aspects of walking as a key part of the future strategy on public health.
Quite a few references have been made to pedometers today, and I was pleased to launch, in this House, the Granada Television "on the move" initiative. The fact that a wider range of organisations are now prepared to get involved in this debate is a testament to the Committee's work on the report. Granada Television continues to launch such initiatives regionally, in the north-west and nationally. It spoke to me only this week about the next phase in its programme. We have been able to engage key organisations—in industry, in the media or in government—to ensure that such initiatives are not one-off publicity exercises. There is a long-term commitment and a recognition of the problem. Such organisations want to engage continually to find new ways in which children and adults can become much more active, and be part of the solution to the "calories out" problem.
As a relatively new member of the Committee, I was amazed at the way in which we were able to be part of a massively growing debate on obesity. We helped to trigger that debate, and in that regard we can take some credit. I want to underline the point that the way in which the Chairman was vilified concerning the report's presentation was completely inappropriate; it did the media in question no credit, and it completely undermined the response that we received. However, we can now examine this important problem, which has massive health implications, put it seriously on the agenda and ensure that all participants work together to resolve it.
Mr. Deputy Speaker : Two further Back Benchers have indicated that they want to speak in this debate and then there will contributions from the two Opposition spokesmen and the Minister. I fear that we will not be able to complete everything by 6 o'clock. I call Dr. Doug Naysmith.
Dr. Doug Naysmith (Bristol, North-West) (Lab/Co-op): I have no wish to speak, Mr. Deputy Speaker.
Mr. Deputy Speaker : I call Jane Griffiths.
Jane Griffiths (Reading, East) (Lab): I, too, do not wish to speak, Mr. Deputy Speaker.
Mr. Deputy Speaker : Perhaps my comments about 6 o'clock had some extraordinarily magical effect.
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5.18 pm
Mr. Paul Burstow (Sutton and Cheam) (LD): I thank the Chairman of the Select Committee for introducing the debate on this report and for the opportunity to take part in it. I had the chance to serve on the Committee for about a year during this inquiry and I found it one of the most rewarding parts of my parliamentary life so far. I will keep the experience of serving alongside the hon. Member for Wakefield (Mr. Hinchliffe) throughout my time here. He is an exemplary Select Committee Chairman and is a hard act to follow. I wish him well in what he does when he leaves this place—by his own choice—at the forthcoming general election. I thank him for everything that he has done in that capacity.
The hon. Member for Wakefield was right to be robust about dealing with the way in which the misreporting, distortion and dishonest tactics of certain individuals has, in some ways, obscured the incredible worth and merit, not only of the report, but of the massive number of contributions from people who came to give evidence to the Committee. They should be properly recorded. He was right to put what he did on the record.
I was reflecting on one or two of the comments that have been made during the debate so far. Perhaps there has been almost too much disclosure about personal body images. I am not going to add to that. I was also struck by the admission by the hon. Member for Wyre Forest (Dr. Taylor) about his beefburger experience. I hope that his admission of eating a super-size burger does not become a decisive factor in his constituency in the forthcoming general election.
Obesity poses a major public policy challenge. It is a challenge because, although it seems easy to deal with, it is one of those classic wicked problems. Some say, "Just eat less," and others say, "Just exercise more." Although both are right, both are in a sense being simplistic and superficial because both assume that obesity can be solved if we just get a grip on our lives. Of course, we all have a personal responsibility for our health and diet, for taking exercise and for our lifestyles, but, as the hon. Member for Lewisham, West (Jim Dowd) suggested, our 21st century lifestyles do not fit terribly well with our caveman instinct to binge in times of plenty and conserve that precious energy in the form of fat. The hon. Gentleman made an important point. We have designed out activity and designed in comfort eating, and our fast-paced lives have fuelled a fast-food culture.
As the Committee report makes clear, and as the hon. Members for Southend, West (Mr. Amess) and for Morley and Rothwell (Mr. Challen) rightly said, there is no single, quick-fix solution that will shed the pounds and save lives. As the report, with its many recommendations, clearly demonstrates, a whole host of actions is necessary if we are first to halt the rise and then to reverse the trends in obesity.
If the rapid acceleration in childhood obesity over the past 10 years, which we have heard about in the debate, continues unchecked, by 2020 more than half the nation's children will be obese. So, we have a vicious circle that works its way down the generations. Most overweight and obese children grow up to become overweight and obese adults, and overweight and obese adults are more likely to bring up overweight and obese children.
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As a result of that, many children born today—I was listening to what the hon. Member for Lewisham, West said about this—could be among the first generation to die before their parents. He said that that could not be quite how it should be formulated, but that was certainly the lesson that I drew from some of the things that were said in the hearings of the Committee. Because today's children could, as a result of type 2 diabetes and other things, wind up dying in their 40s, it is quite conceivable that their parents could outlive them. In effect, we are seeing a century's worth of public health improvement wiped out by childhood obesity. No wonder the chief medical officer has described obesity as a health time bomb—and the ticking is getting louder.
The hon. Member for Wyre Forest mentioned the increased risks that are associated with even a moderate level of being overweight. Being overweight, and being obese in particular, can take nine years off a person's life expectancy. Every day, 80 people die of diseases triggered by obesity. The time bomb may well have gone off, but its consequences will be with us for a good deal of time into the future. In this country, in this century, children are being diagnosed with type 2 diabetes for the first time. During the inquiry, we heard that children as young as eight are being diagnosed. The outlook for those children is bleak. Before the age of 40, many will die of heart attacks. The rest face the prospect of a life stunted by chronic kidney disease, tied to a dialysis machine, waiting for a transplant.
Already locked into future health care costs in this country is the growing number of children with type 2 diabetes, diagnosed and undiagnosed. The costs of that and all the other associated costs have been well rehearsed by the Chairman already and I will not repeat them, save to say that the National Audit Office said that by 2010 the total combined cost would be £3.6 billion, but the Select Committee's conclusion was that the upper limit now was £3.7 billion. Six years ahead of schedule, we are already realising the costs to society that were feared and forecast by the NAO in its report in 2002.
What is driving all that? As has been said, in simple terms the energy equation has got out of balance; we gain weight when we consume more energy than we expend in our everyday lives. It is glib and unhelpful simply to say, "Eat less and exercise more"; it is essential that we tackle the forces behind poor diet and sedentary behaviour.
The data on the calories in and the calories burned are very poor. For example, the last national diet survey found that adults report that they eat 82 g of sweets a week. However, the industry sales data that we were given during the Committee's inquiry suggests that 250 g are sold per person per week. That represents an awful lot of chocolate bars being stashed in cupboards around the country, and one wonders what is happening to them. That is why the Committee's recommendation that there should be a review of how the food survey is conducted is important. I hope that we can hear more about that at some point—if not today, then from further Government announcements.
What children, particularly young children, consume is particularly determined by parental choices and what we do as parents. Those choices are not made in a
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vacuum, but are shaped by commercial and societal pressures that push people towards unhealthy choices. During the inquiry, we heard a lot about the tactics of the food industry: commercials, product placements, celebrity promotions and toy collectables are just a few of the tools of the trade. Most of that advertising promotes sugared breakfast cereals, sweets, salty snacks, sugary drinks and fast-food outlets.
We were given one example that is in the report, but bears repetition. The "Microstars" campaign by McDonald's ran for five weeks and there were 20 toys to collect. To collect them for free, a child would need to eat an average of four "happy meals" a week, which would total 12,260 calories over the five-week promotion. The creative and client brief for the campaign described the aim as getting
The brief went on to state that that gave
Just how heavy does a six-year-old get from eating 12,260 calories in five weeks? When one considers such a promotion, it brings a whole new meaning to super-sizing. If the Committee's report does nothing else, it should shame the industry into never using such tactics again.
It would be a mistake simply to see diet as the beginning and end of the obesity epidemic. We have to consider the other side of the energy equation: energy out. Hon. Members who have spoken have outlined the deeply depressing documentary evidence about the levels of activity in our schools and our society more generally. I shall not go through all those now. However, the inactivity among children today and the negative attitudes towards sport and physical activity generally, are likely increasingly to turn them into the couch potatoes of tomorrow.
In a debate about childhood obesity in this Chamber a couple of weeks ago, I asked the Minister about the public service agreement targets. She set out the 2004 PSA target on childhood obesity, to which the hon. Member for Wakefield referred. It is to
"Halt the year-on-year rise in obesity among children under 11 by 2010 in the context of a broader strategy to tackle obesity in the population as a whole."
The hon. Gentleman posed an important question, to which I hope the Minister will be able to respond. Is that target really challenging? Does it really act as an adequate stretch for dealing with these issues? It calls for a plateau at 2010. As childhood obesity is already at 15 per cent., that would mean, at current rates of increase, that 19 per cent. of children could be obese and that the target would still be met. Is that target good enough to address the problems? Is the Minister telling us that the measure is adequate? Surely, we need something more ambitious. She should be able to tell us now to what extent the public policy measures already in place will cumulatively have the effect of reversing the trend. When do the Government expect the trend to reverse?
The Government ought to be prepared to use law and regulation to help people push against the commercial and societal pressures that drive obesity. It is not about being a nanny state; it is about the state being on the
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citizen's side and ensuring that corporate interests do not harm the common good. A number of measures could help families in that regard.
The hon. Members for Lewisham, West and for Southend, West referred to the labelling scheme proposed by the Committee. That scheme could play an important part, particularly for packaged and processed foods. I hope that the Minister will be able to give us the assurances that were sought by the hon. Member for Wakefield on that subject, because it is a key part of moving the agenda forward.
Something that the Committee did not discuss, which is worth raising today, is the contribution that midwives and health visitors can make. Given that research points to the powerful role that parents play in shaping children's lifelong eating habits, those professionals have a key part to play.
This is a good time to ask the Minister to tell us precisely what is meant by a "cluster of schools" in respect of school nurses. It was said in yesterday's statement that there will be one school nurse for each cluster. It would help to know how many schools are in each cluster.
I have one or two more questions. On nutrition and school meals, the report recommended moving to a nutrition-based standard for school meals. Today, the Government made an interesting and eye-catching announcement about having tougher standards for school meals by 2006. Will the Minister elaborate on the Department's press release on school meal standards, and particularly what it means by saying that
How can one "strongly consider" something, and how long does one need to strongly consider it for? I hope that the Minister will be able to answer that question.
We are at a point in our evolutionary history where our instincts are putting our lives at risk. Our instinct is to eat, often too much, and that is putting lives at risk because of the plentiful supply of food. Obesity may not be the cause of our extinction, but it confronts us with some key policy challenges. Those challenges require the Government to take on the vested interests of the kind that sought to rubbish the report; they should ensure that the public interest is served, not the commercial interest.
5.33 pm
Tim Loughton (East Worthing and Shoreham) (Con): To be on the safe side, I should declare an interest. On page 105 of the report, there is mention of some information from J.P. Morgan, and I have a registrable shareholding in J.P. Morgan Chase.
I welcome the debate. It has been good. I pay tribute to the chunky Chairman of the Select Committee, and to his stout chairmanship of the Committee over many years. The report raises some good points. I shall not repeat all the information that we have heard today, but I agree that obesity poses the biggest public health threat of this century. It is the single biggest health challenge, particularly with regard to young people, that any Government could face. It would be a false economy to do nothing about it, not only because of the financial figures that we heard about but because of its effect on people's lives and the fact that they will be shortened.
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The report makes many interesting points with which I agree—the need for food surveys; the problems of pester power; the need to push the issue up the political agenda, perhaps through a Cabinet-level public health committee; the problems of simplistically seeking to introduce a fat tax or ban advertising; and the problem of moving the issue up the agenda for PCTs and giving them the resources to do something about it in a "largely sceptical NHS", a phrase that was used in the report. I certainly concur with the hon. Member for Wakefield (Mr. Hinchliffe) that we need to restore public health to the engine room of health policy, and that we need a joined-up policy.
A number of hon. Members made important points, not least about the influence of the report—something that my hon. Friend the Member for Southend, West (Mr. Amess) pointed out. It certainly had an enormous influence on the hon. Member for Morley and Rothwell (Mr. Challen)—so much so that, when it was published, he lost 3 stone.
Hon. Members mentioned Denmark. I remember going to Denmark with another Select Committee and meeting the Deputy Prime Minister, who was a larger than life character in many more ways than one. He had to leave our meeting early, whereupon he was not whisked away in a ministerial Jaguar, but got on his ministerial bicycle followed by a fleet of aides who were also riding bicycles and trying to keep up with him. That was a wonderful example to set, but I somehow fear that it might not catch on with our Deputy Prime Minister and his Department.
This subject has rightly had a much higher profile in the press of late; there are numerous groups to do with obesity and lots of sources of information on it. The problem is not a lack of information; it is clarity of the information and knowing which information to follow. Anybody will be blinded by a plethora of advice—what is in, what is out, what is good, what is not good—that changes from one week to another.
Lots of solutions for obesity have been put forward. I remember that Lord Digby wrote in a letter to The Times last year that the problem of obesity could be easily solved by designing teenage computers powered by pedal-driven generators but that in the modern nanny state the idea would undoubtedly be struck down by the European Court of Human Rights on the grounds of misuse of child labour. A study by the university of Maryland put obesity down to toddlers being strapped into pushchairs for too long after they were born. Professor Julian Peto suggests that there should be annual weigh-ins in schools and that fat reports should be sent home to parents. That has been mentioned today; it has some scientific basis.
One of the most worrying pieces of research was by Alison Jeffrey from the Peninsula medical school study. It revealed that only 25 per cent. of parents with overweight children recognised that they had a problem. No fathers recognised their sons as overweight, and 33 per cent. of mothers and 57 per cent. of fathers described their obese children as normal. There is a real problem if the families themselves do not recognise such problems.
There are all sorts of other theories for why we have this problem. One theory is that the decline in physical activity is to blame. Children today expend 600 kilocalories per day less than they did 50 years ago.
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There are the problems of the lack of school sport and places for recreation, and two hours a week for 75 per cent. of our children is a woefully inadequate and unambitious target. In Sweden the target is 10 hours a week; we must raise our game in that regard. There are other problems to do with Chelsea tractors and the drive to school. We must do better in terms of designing safer routes to school. However, those safety issues are not only to do with traffic; parents also have other fears, such as child abduction. Our children lead very sedentary lifestyles. Up to the age of seven, a child will watch on average 10 hours of television a week, but a 13 to 15-year-old will watch an average of 17 hours of television a week, during which time they are doing no exercise.
There is also the fashion for new processed foods. People often have poor diets at home because they are subjected to increasing amounts of processed foods, largely because of the lifestyles of their parents—more parents going out to work and so forth. For every 25g of green vegetables a child now eats, they consume 100g of sweets and chocolates. That highlights the problem of school vending machines, and steps are being taken to deal with that. The Green Machine is a company that promotes healthy options in those machines. This is not just a problem in the UK or the US. It is also a problem in Europe. France is even catching up with us; it has 2 million members of Weight Watchers, and obesity has risen by 5 per cent. since 1997—and the 1,000th branch of McDonald's in that country has just been opened, I believe.
We have had a lot of reports and information, culminating in the recent public health White Paper. We must not tell people what not to do. We need to find a solution that people can easily identify with and go along with. Simply telling people that they must not go to Burger King or eat burgers and other junk food will not work. We are never going to persuade children not to eat and enjoy burgers, but we can hope to persuade them to eat fewer burgers as part of a better-balanced diet, and to persuade manufacturers to produce less unhealthy burgers and other similar fast-food options.
We need an integrated approach based on information, education and incentivisation. At the last count, a search using Google for healthy eating websites produced 1.76 million websites. We can get all the information we want on every single type of burger that is available across the entire North American continent, including its various ingredients and fat content. There is no lack of information. However, when someone goes into a supermarket, there is a four-second lag between taking an item off the shelf and putting it into a shopping trolley; in those circumstances, even the most committed mother or father who wants to choose healthy options for their children is completely bedazzled by the range of different labels and claims.
I tried an experiment with my children last year. I gave them each £10 when we were going round Tesco, and asked them to buy lots of stuff for the following day's meals. They came back with all the regular suspects: Frosties, which are 49 per cent. sugar, lots of chocolate and crisps. They did a fantastic job at getting two-for-one bargains—their money went a long way—but in terms of the healthiness of what attracted them
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and appealed to them in terms of presentation, it was a complete and utter disaster. They are not untypical, I am sure.
We need a better benchmark that is easily understandable for people who want to see better information that they can understand. We need to work with industry. Many people have said that the industry wants to and must be part of the solution. A joined-up solution must involve industry as well. For example, the salt action plan includes the Food and Drink Federation and is beginning to work. We need many more schemes like that.
Price is also a factor. Everyone has said that Coca-Cola now sells more Diet Coke than red, regular Coca-Cola. However, the price is the same. When unleaded fuel was brought in by a previous Government, it had a price advantage. If some of the big multinationals were serious, a price differential would promote the healthier options. That has not been tried. Those companies have the power to affect lifestyles, particularly of children.
The second aspect is education and promotion. We need to get people when they are young, with better education in schools. We have had the example of the five-a-day free fruit, which has had only a marginal impact. We need more nutritionists working in the health service and in schools. We need more school nurses—that has been cited as part of the solution several times. We need better advice from GPs, rather than a clutter of leaflets and, at the last count, only seven specialist obesity clinics in the United Kingdom. We need to teach better cooking and nutrition skills in schools. We need better GP training; a GP will typically receive only five hours of training on nutrition in a five-year course. PCTs receive poor funding to provide obesity conscious campaigns that will get them where they need to go.
We talked about school meal nutrition. That is important but many children—in my county, all children—have packed lunches. We have to get to the source of the problem. It is not just a question of what food we are providing them with in schools—I have mentioned vending machines and physical activity. Runnymede St. Edward's school in Liverpool, which I am sure is not untypical, banned fizzy drinks and instead installed water coolers in each classroom. In a short space of time, its test results improved. There are a lot of theories about hydration of the brain, which improves concentration and takes out the E-factors that we get in fast soft drinks.
We need to use advertising in a powerful way, as we did with HIV/AIDs in the 1980s. It should not just be a snapshot campaign; it needs to be an ongoing campaign that stays in people's minds, perhaps using shock tactics. The product—the fat—needs to be made into the enemy; not the consumer. That was the success of the anti-smoking campaigns in California and other parts of the United States. With fast food, it is no good merely to point the finger of blame at the fast food merchants—Burger King and McDonald's are always mentioned. McDonald's is now the largest retailer of fresh food in meals in the country. It has brought in salads, and as long as one does not completely drown them in the large sachet of dressing that comes with them, they are a healthy option. They are part of the solution.
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The third aspect is incentivisation. We need to make healthy eating fun, cool, easy and mainstream. We need to have rewards for children who take healthier options so that they will use pester power when shopping. We need to use celebrities and cartoon characters to promote healthier foods. For example, the Lawn Tennis Association, in association with Ariel, ran a promotion where people collected tokens and got a free tennis lesson. That was enormously successful. A primary school in West Sussex awards points for each healthy option that a child brings into school in their lunchbox, which are then redeemable in local shops. Many imaginative measures can be adopted, but we need a multi-agency approach that must be realistic and able to change children's lifestyles. We cannot do that overnight.
The Government do not necessarily need to establish the benchmark. In the past, experience has shown that we need independent, credible benchmarks and endorsements that people can actually trust. The Government have a role as a co-ordinator and an enabler in such matters. With people in the industry, in the Government, in the health service and in education working together over the long term, hopefully we shall at last begin to deal with the serious time bomb that has already gone off.
Mr. Deputy Speaker : I thank the hon. Member for his co-operation.
5.45 pm
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson) : The growth in obesity is a subject that has taken on an increasingly high profile over recent years and it now occupies a prominent place on our public health agenda. I therefore congratulate my hon. Friend the Member for Wakefield (Mr. Hinchliffe) and members of the Health Committee on their timely and comprehensive investigation into such a serious problem. We welcome the opportunity provided by the inquiry to set out our policy on the prevention and management of obesity. The Department submitted substantial written evidence to the Committee and I am grateful to my hon. Friend for saying that it was the best that the Committee had received and that it had proved helpful.
We obviously delayed our response to the White Paper, and I am grateful to members of the Committee for their tolerance in waiting for it. I wish to pick up quickly the point made about the delay; it was due simply to clearance by our domestic affairs committee of the response to the Select Committee's specific document, not to anything else. The speculation about the Government's intention in respect of the media has nothing to do with the matter. I assure the hon. Member for Southend, West (Mr. Amess) that he is barking up the wrong tree.
Before I move on to the report, I must say that my hon. Friend the Member for Wakefield will be much missed in the House. Ministers have greatly appreciated the contribution made by him and his Committee to the progress that we are making on health matters. The Committee's report was a valuable contribution to the debate on the topic and contributed to the development of our proposals, which we set out in the White Paper entitled "Choosing Health".
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I wish to run through quickly some broader items. There is much more investment. There are key issues to be dealt with, such as prevention and health and equality issues. We want the service to be a health service, not only a sickness service. Indeed, public health must be at the centre of all that we are doing, and I agree with hon. Members who have been strongly arguing that point. It is also an area in which choices are important, as are information and support. We cannot make anyone do anything.
I might be disposing finally of the argument of the hon. Member for Southend, West. He seemed to be living on another planet when he said that all the cards were held by the Government. Very few cards on obesity are held directly by the Government. Indeed, many individuals have rights and responsibilities in such matters and many difficult issues have to be dealt with. I do not wish to simplify the problem. Perhaps the hon. Gentleman has found an intergalactic mammoth; the one that I am dealing with is definitely earthbound.
The Committee recognised that obesity is a complex, multi-factoral condition with a wide range of causes. I shall not spend time going into them, but the increase in weight and obesity and the increased energy intakes that are relative to needs is the key cause of obesity. Today, few children eat the recommended five-a-day portions of fruit and vegetables and three in 10 boys and four in 10 girls do not take the recommended hour of physical activity.
We need sound data to support delivery of the target. Several hon. Members have said that the target was not ambitious enough. I hope that it will not prove to be too ambitious. It is more difficult to halt the trend than hon. Members assume, not least because it is not only down to the Government to do something about it. We can do all that we can, but if people still choose to rush headlong towards the mammoth and put all of it in their mouths and not take much physical activity, we will not win quickly.
For the first time, the Department of Health has published requirements on strategic health authorities and PCTs to return local delivery plans and local monitoring data on the obesity status of adults registered with general practitioners from 2005 and the prevalence of obesity among children from 2006 or 2007. The new LDP lines will also back up the future action on obesity proposed in "Choosing Health". To support that, we are working closely with the Department for Education and Skills on appropriate systems for recording weight and height measurements among school children and the vexed question of body mass index. That is an important way forward.
There must be clear information that people trust for them to make healthy choices. Several hon. Members have sketched that out powerfully. We will press for simpler and mandatory EU labelling in 2005. There will also be nutrient criteria by mid-2005, followed by a signposting system that gives clear and consistent information about the nutritional content of food and the foods that should be eaten sparingly. Of course, all that work must go on with the industry, but we believe that healthier food should be the norm rather than the exception.
In the important area of promotion of food to children, Ofcom will consult on tighter rules for broadcast advertising, sponsorship and promotion. We
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will also be working with industry to strengthen codes for non-broadcast advertising and promotion. To take that forward, the Department of Health is leading on the establishment of a new food and drink advertising and promotion forum to review, supplement, strengthen and bring together existing provisions. The first forum meeting is due to take place this spring. We will also consider new legislation if there is no suitable improvement in the nature and balance of food promotion by early 2007, although I expect we will make some progress in the meantime. We also intend to discuss with the food industry how it might contribute funding to national campaigns and other initiatives to promote positive health information and education, because it, too, has a role.
We welcome the recent comments from the new EU Commissioner Markos Kyprianou, about the promotion of food to children. Indeed, today he met the Secretary of State for Health in London. We intend to use the UK's presidency of the EU later this year to press ahead on the matters that we have discussed. Clear, simple labelling that people can read, in particular from the front of a packet, is important, although I take on board the remarks made by my hon. Friend the Member for Morley and Rothwell (Mr. Challen)—clear, simple labelling on the back of a packet that people can understand is a key issue. However, I fear that most of us are in too much of a hurry to read it. We leave our glasses behind or we have small children in tow in a supermarket, and in modern life it is just too difficult to go through all that detail, so front-of-packet labelling is important.
I turn in more detail to the question of physical activity. Physical education in school is part of the Ofsted regime. It is the overall evaluator of the PE school sport and club links programme. As part of the new inspection framework to be introduced in September, Ofsted will pick up physical development as part of its assessment of the school's contribution to children's well-being. That will include details of the extra-curricular activities and sport available. The physical activity and diet components of the national healthy schools programme will be part of the framework as well.
A physical activity plan will be published shortly as part of our delivery of the White Paper's proposals. In investing in opportunities to make lives more active, all schools in England will have active travel plans by 2010. Many schools, including several in my constituency, already have active travel plans, and I hope that many more will be developed. I entirely accept the point made by my right hon. Friend the Member for Manchester, Withington (Mr. Bradley) and others that we need more children walking and cycling to school. One main problem is people's concerns about safety, but that creates a vicious circle. With more traffic on the roads, one becomes more concerned.
We must bite the bullet and make those activities possible, because they link up with the points made by my hon. Friend the Member for Wakefield about how we must embed such behaviour in everyday life. It is not possible for sporting activity to form the main physical activity during the day; people need to be physically
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active as part of their everyday lives. Walking or cycling to and from school is a key activity for children; and to and from work it is a similarly key activity for adults.
We are making a massive investment in sport. Some £1.5 billion is going into PE and sport in the period from 2003 to 2008. Sport England announced allocations of £315 million of funding for sport only recently. We have discussed pedometers, and they have a huge motivational value. I have seen that myself, from wearing one and from the accounts of everybody I know who has one.
Schools are a key setting in which we can improve children's health. Our vision is that by 2009, all schools will be healthy schools that provide supportive environments, have policies on healthy and nutritious food, and have the time and facilities for physical activity and sport both in and beyond the curriculum.
We are committed to improving school food and drink not just at lunchtime but throughout the day. We are revising the school meal standards to reduce the consumption of fat, salt and sugar and to increase the consumption of fruit and vegetables. Indeed, we shall strongly consider introducing nutrient-based standards, as the Committee suggested. We are doing everything that we can to make that possible. A number of practical issues seemed to need resolution. I am confident that we will be able to cut through many of those issues and resolve them, but it is too early to give a cast-iron guarantee about that. It is certainly our intention to get as near to it as we can.
We will also extend the new standards so that they effectively address food throughout the school day, including vending machines and tuck shops. I was delighted that the hon. Member for East Worthing and Shoreham (Tim Loughton) advocated many of the things that we piloted, supported and encouraged in schools, such as green vending machines and the water initiatives. I disagree with him about the free school fruit and vegetable scheme, which is having a huge impact. I have been to schools where the scheme has transformed what goes on and has led to a much healthier consumption of food stuffs throughout the school day, with children acting as monitors for programmes. When they are not included in the scheme, the juniors are continuing to eat the fruit and vegetables that are supplied. It is built into the school day and the break-time. We want a lot more schools to do that, but schools can do a lot now.
We will give more support, to heads, governors and caterers to get the best meal service through, for example, training the caterers and giving them guidance on food procurement. We will also launch a toolkit that will guide, inspire and help schools to take the whole school approach to healthy eating. As I said, 2 million children benefit from the school fruit and vegetable scheme. Today, my right hon. Friend the Secretary of State for Education and Skills announced a package of measures that will make sure that considerable work is under way. We want parents to be empowered to make the change along with schools, and want them to be supported by an organisation that gives independent support and advice. We also want to introduce tougher standards on fat, salt and sugar.
I will briefly touch on two largely unrelated items that cropped up, which are both important. We are concerned about eating disorders, especially among
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young people. We take them seriously. Anorexia, in particular, can have serious consequences for general health and has high rates of mortality. That is why we asked the National Institute for Clinical Excellence to publish guidelines on core interventions for those disorders as part of its second programme of work that was published last year. The national service framework for mental health also makes specific reference to people with eating disorders. I am sure that change will not happen overnight, but we hope that, through the record investment in mental health, we will make a real difference for people who suffer from eating disorders.
The subject of bullying and body image in schools also arose. We are concerned about it. Anti-bullying strategies are being used to make sure that we have an effective response. Guidance has gone out from the Department for Education and Skills that says that bullying must not be suffered in silence. That guidance is available to all schools. Those in schools need to make sure that all that guidance and support is in place and that children are appropriately supported, whether the bullying is because of obesity or another reason.
I would like to have addressed many matters at greater length, but the debate has been lengthy. The Government cannot do everything alone. Joined-up action is important across government, but delivery will also require concerted effort from industry, the
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voluntary sector, local government and so on. There is a huge need to join this up. A huge delivery agenda is ahead. The NHS needs to be transformed from the sickness service to the health service, so that prevention is given the high priority that we all agree it deserves. That is a key message that we set out in the NHS improvement plan.
All that is only a start. We need to learn much more about what further action to take. We will soon publish a delivery plan for the White Paper with discrete plans on nutrition and physical activity, showing how we will take the work forward. That will be important. The White Paper commitments are backed up by funding of £1 billion during the next three years. Halting the rise in obesity is a challenging goal, but one that we are fully committed to achieving. We shall lead, but we need others to play their part. We will build on the partnerships and example that the report gives us.
Mr. Deputy Speaker : I feel exhausted by the galloping pace at which the Minister attended to the winding-up speech. As a past Chairman of the Health Committee, I congratulate the hon. Member for Wakefield (Mr. Hinchliffe) on the leadership that he has provided to the Health Committee since he has been Chairman.
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