Conclusions and recommendations
Physical activity—a priority in its own right
1. For
too long, physical activity has been seen merely in the light
of its benefits in tackling obesity. However, there is compelling
evidence that physical activity in its own right has huge health
benefits totally independent of a person's weight—in fact
research recently published suggested that increasing physical
activity levels could have greater impact on reducing mortality
than reducing weight. The Chief Medical Officer's guidelines recommend
levels of activity which will help people derive the greatest
health benefits; but even small increases in activity levels can
have a dramatic positive impact on health. (Paragraph 25)
2. Diet, obesity,
and physical activity all have important impacts on health. However,
it is vital that the importance of physical activity for all the
population—regardless of their weight, age, gender, health,
or other factors—is clearly articulated and understood.
We recommend that the Government, Public Health England and health
professionals, in particular GPs, to take urgent action to communicate
this crucial message to the public. (Paragraph 26)
Individual and population level interventions
3. It
is clear from the evidence we have heard that interventions focused
on encouraging individuals to change their behaviour with regard
to diet and physical activity need to be underpinned by broader,
population-level interventions. Individual interventions include
provision of information about the health benefits of exercise,
workplace incentives, or referral to a lifestyle weight management
scheme. Broader measures include pricing and availability of unhealthy
foods, and redesigning environments to promote physical activity,
which aim to make the healthy choice the default choice. Population-level
interventions have the advantage of impacting on far greater numbers
than could ever benefit from individual interventions, and may
also be more effective at tackling health inequalities than individual
interventions. (Paragraph 32)
NICE guidance on what works
4. NICE
has produced a comprehensive raft of guidance on cost-effective
interventions that can be introduced, either by the NHS or by
local government, to improve diet and physical activity. These
have included interventions on an individual level—changing
individual behaviour, and weight management, and also more 'upstream'
environmental interventions, such as changes to the local environment
that may improve access to healthier foods or encourage active
modes of transport such as walking and cycling. (Paragraph 35)
5. While we welcome
NICE's guidance, it is disappointing that there has to date been
little assessment of how far these guidelines are being implemented.
We have heard that NICE's forthcoming Quality Standards will produce
a clear framework against which progress towards implementing
NICE guidance can be measured. We recommend that the next Government
shows its commitment to improvements in this area by auditing
progress against Quality Standards in the areas of diet and physical
activity across the country to allow benchmarking and drive progress.
(Paragraph 36)
Local authorities—key to improving public health
6.
There is a danger that the current financial pressures on local
authorities will lead them to deprioritise all but the mandated
public health services to the detriment of prevention and health
improvement. We recommend the next Government prioritises prevention,
health promotion and early intervention and provides the resources
to ensure it happens. (Paragraph 43)
7. We also heard that
local authorities need more powers to limit the proliferation
of outlets serving unhealthy foods in some areas; Public Health
England told us that they too had concerns about this. We recommend
that the next Government works closely with the Association of
Directors of Public Health and the Local Government Association
to ensure local authorities have the planning powers they need
for the control of food and drink outlets and for the preservation
of open spaces for physical activity for public health purposes.
(Paragraph 44)
Workplaces
8. One
commentator told us that in her view, it is "at best anomalous
and at worst negligent" that that NHS properties continue
to serve foods high in sugar, fat and salt, with some hospitals
even having fast-food outlets on their premises. The NHS should
lead by example and manage its estate in a way that stops promoting
the over-consumption of energy dense nutritionally poor food.
(Paragraph 53)
9. Beyond the NHS,
workplaces are where working age people spend the majority of
their time and as such can represent a powerful resource for health
promotion. We urge the next Government to work with NICE and Public
Health England to find the best options for achieving this in
a range of workplaces, including the use of financial and other
incentives. (Paragraph 54)
10. While local authorities
now have the lead public health role, there is an ongoing need
for the NHS to provide both prevention and treatment services
but greater focus needs to be given to discussing inactivity or
overweight. The NHS is this country's largest employer and has
a crucial role to play both in terms of promoting the health of
its workforce, and in setting a wider example. More broadly, there
is clearly potential for other workplaces to do more. We recommend
that Primary Care takes the lead, as it has does for smoking cessation,
in promoting physical activity and preventing obesity—these
topics should not be off limits during consultations. (Paragraph
55)
Cross government working
11. While
there now is widespread recognition of the health impacts of diet,
obesity and physical activity, and the scale of the problems we
now face in these areas, these problems are not "owned"
by a single Department or agency. A successful strategy for tackling
these problems needs to mirror the successful strategy on tobacco,
and be multi-level, spanning national and local government down
to every citizen. A successful strategy may to need to incorporate
elements as diverse as public education, regulation, fiscal measures,
legislation, messaging and campaigns, evidence based behaviour
change, changes to the school curriculum, and changes to planning
arrangements. (Paragraph 59)
12. Given the breadth
of these issues, it is essential that the strategy must be cross-governmental
and integrated laterally and vertically, and given the importance
of these issues, led from the very top of government. We call
on the next Government to introduce a co-ordinated government-wide
programme to tackle poor diet and physical inactivity; this programme
should be given the resources and authority necessary to secure
collaboration with all relevant Departments and bodies, and should
report at regular intervals on health improvements to the Prime
Minister, and to Parliament. (Paragraph 60)
Physical activity—a key health priority in
its own right
13. We
have heard the hugely positive message that increasing physical
activity has significant health benefits and does not necessarily
mean playing organised competitive sport three times a week—it
encompasses a diverse range of activities, including everyday
activities such as walking. The point was made that raising heartrate
was the most important thing, but any increase in activity is
beneficial. (Paragraph 69)
14. For some people
it can be easier to fit physical activity in if it is "a
means to an end" rather than an end in itself. The key message
from witnesses was to "just do more", in a way that
fits with your lifestyle. (Paragraph 70)
Promoting physical activity in clinical encounters
15. NICE
has clearly recommended that offering brief advice in a primary
care setting is a cost effective way of getting people to increase
their levels of physical activity. It is clear that clinicians
have a crucial role to play in promoting physical activity. Better
undergraduate and postgraduate education is now required, both
to ensure clinicians' understanding of the medical benefits of
physical activity, and to teach them how to promote physical activity
to their patients in an effective way, particularly when some
patients may be sceptical of such a "low tech" approach.
We recommend that the next Government works with the royal colleges
and Health Education England to achieve this. (Paragraph 81)
16. In relation to
NHS Health Checks, we heard of a "tick box" approach
to physical activity, with clinicians carrying out Health Checks
lacking the skills to support people in actually changing their
behaviour. We recommend that, given the considerable investment
of public resources in NHS Health Checks, NICE should be tasked
with assessing their clinical and cost effectiveness. (Paragraph
82)
An environment that promotes physical activity
17. We
have heard that the physical environment can have a significant
impact on activity. Open spaces are needed for recreation and
play, and the built environment, including road infrastructure
and speed limits, all impact on how easy or attractive it is to
walk or cycle. We call on the next Government to make a clear
commitment, together with appropriate long term funding, to significantly
increase the levels of cycling and walking. (Paragraph 86)
Engaging different groups in physical activity
18. Physical
activity must be seen in its totality, and a flexible and inclusive
approach is needed to enable individuals to choose a way to increase
physical activity that is right for them. Nowhere is this more
important than in promoting physical activity amongst groups of
people who seldom take part. The most obvious is the disparity
between men and women, but inequalities in physical activity levels
exist between other sectors of society too, and children fare
worse than adults in terms of meeting physical activity recommendations.
(Paragraph 93)
19. Fear of judgement
is a key barrier preventing women from being more active. Some
barriers may be quite simple such as the lack of availability
of sports clothes in larger sizes or mixed changing rooms. The
Government-wide programme on diet and physical activity should
include a specific workstream focused on identifying and tackling
inequalities in relation to physical activity, and it should begin
with work to examine how women, those with disabilities and overweight
people, can be encouraged and supported to be more active. (Paragraph
94)
NHS prevention and treatment services
20. According
to Public Health England, there is an unmet population need for
support for weight loss and sustaining a healthier weight. NICE
have recommended cost-effective interventions in this area and
we recommend that these are funded and implemented as a matter
of urgency. The Committee regards it as inexplicable and unacceptable
that the NHS is now spending more on bariatric surgery for obesity
than on a national roll-out of intensive lifestyle intervention
programmes that were first shown to cut obesity and prevent diabetes
over a decade ago. All tiers of weight management services should
be universally available, and need to be well integrated. (Paragraph
99)
Reforming the food environment
21. We
have heard that the Government's Responsibility Deal has achieved
some successes, but should be seen as a complement to regulation
rather than a substitute for it. We agree with the UK Health Forum,
that we cannot hang all our expectations in terms of all the things
we need to achieve in public health on voluntary pledges. (Paragraph
105)
Labelling
22. Progress
has been made on introducing a traffic light nutrition labelling
system. We recommend that Public Health England backs this up
with a campaign to explain and reinforce this scheme to the public
to assist them in using the new labelling to make healthy food
choices. (Paragraph 107)
23. We recommend
that Public Health England should take the lead by introducing
clear targets for reductions, and the Government should use regulatory
measures to enforce this, if voluntary approaches do not yield
swift progress. The Committee strongly recommends that the first
focus of this work should be on reducing the sugar consumed by
children in sugar sweetened drinks. (Paragraph 111)
Marketing and promotion of foods to children
24. The
evidence we have received has also called for wider restrictions
on promotion of unhealthy foods to children-in both broadcast
and non-broadcast media, particularly social media. We recommend
that the next Government takes steps to stop the marketing of
unhealthy food and sugary drinks to children. (Paragraph 115)
Price promotions
25. The
area on which we have heard the least progress has been made,
but one which has the potential for a significant impact on diet
and health, is retail price promotions on food. Voluntary agreements
have been tried, but now we need to look to harder policy options
to secure progress. We recommend that the next Government commissions
either Public Health England or NICE to review policy options
in this area as a matter of urgency. (Paragraph 122)
Fiscal policies
26. We
have received evidence from organisations supporting the introduction
of a tax on sugar-sweetened drinks. We look forward to the publication
of Public Health England's review of the evidence base for introducing
a sugar tax, which is expected later this year, and we do not
seek to pre-judge its outcome. We welcome the fact that Public
Health England is carrying out this review. Given the scale of
the public health challenge and growing health inequalities we
urge the next government not to shy away from difficult decisions
around proportionate regulation if these are supported by the
emerging evidence. (Paragraph 125)
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