Health: Public Health Responsibility Deal

Earl Howe Excerpts

Thursday 27th June 2013 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, I thank my noble friend for securing this debate and all speakers for their constructive and thoughtful contributions.

The responsibility deal is an ambitious and far-reaching challenge to business to lead the way in creating an environment that helps people to make healthier choices. It is a wide agenda; essentially, it taps into the potential for businesses to improve public health in areas where doing nothing is simply not an option. However, the something to be done is not necessarily best done by Government. Organisations signing up to the deal commit to take voluntary action to improve public health; there is no legally binding element to this. These actions are expressed as a series of pledges covering food, alcohol, physical activity and health at work. The deal has always had strong ministerial support. The Secretary of State chairs a plenary group of senior representatives which oversees the deal. Furthermore, each network is supported by a Minister, and both the Secretary of State and his ministerial team continue to hold meetings with both potential and existing responsibility deal partners.

In the two years since launch, the number of partners has tripled to over 500, with new partners joining every week. People are already benefiting from the deal. For example, the World Health Organization considers us to be a world leader on salt reduction; between 2001 and 2011, average daily salt intakes dropped from 9.6 grammes to 8.1 grammes. Through the responsibility deal all the major UK retailers, together with a number of key manufacturers and caterers, have committed to achieve further reductions. Every one gramme reduction in people’s average daily salt intake will prevent over 4,000 premature deaths and save the NHS £288 million every year.

Responsibility deal partners are also providing consumers with more information about their food through the out-of-home calorie labelling pledge. Over 70% of high street fast food and takeaway meals sold have calories clearly labelled. Partners signed up to this pledge provide one-third of all meals sold on the high street. As regards alcohol, we now have over 90 companies committed to putting labels on drinks by December 2013, with clear alcohol units, lower-risk drinking guidelines and warnings about drinking during pregnancy. This will help people to understand better how much they are drinking, and to drink within the lower-risk guidelines.

Following the success of the London 2012 Olympic and Paralympic Games, there has never been a better time for organisations to promote the benefits of being active. The physical activity pledges cover increasing participation by employees, for example by walking and cycling to work, and working with local communities. Over 300 organisations have signed up to the health at work pledges. These pledges include ensuring that employees with chronic conditions and mental health conditions can remain in work and are managed in the best way possible, and promoting stop-smoking services and staff health checks. Encouraging workplace health schemes which contribute to individual health and reducing absenteeism will also improve productivity.

In recent months we have concentrated on two pledges which, as mentioned by many noble Lords, could have a great impact: calorie and alcohol unit reduction. So far 34 leading food companies have signed up to a pledge to help the population reduce its calorie intake. They have committed to actions including product reformulation, reducing portion sizes, providing information and shifting their marketing mix towards lower calorie options.

The alcohol unit reduction pledge brings together over 30 producers and retailers. By December 2015 they will reduce the number of alcohol units in the annual UK market by one billion, a drop of around 2%. It is estimated that in a decade this will result in many hundreds fewer alcohol-related deaths and many thousands fewer hospital admissions.

We will continue to increase the reach and impact of the deal by signing up new partners, making sure that there are appropriate pledges for all sectors and, where needed, developing new pledges. For example, a new front-of-pack nutrition labelling scheme was published last week, as noble Lords have mentioned. We welcome the support of the retailers and manufacturers that are pledged to adopt the scheme, which will help consumers to choose healthier, more balanced diets. The noble Lord, Lord Brooke, and the noble Baroness, Lady Hayter, were right to say that there is still a way to go before we sign up anything like enough, but we are confident that more organisations will agree to support the scheme over the coming months. Those who have signed up will want to make sure that they provide information which is helpful to their customers.

We also announced a pledge on domestic violence. This includes guidance to help organisations support colleagues experiencing harassment, stalking, violence or abuse. The Government are committed to evidence-based policy. In addition to the updates that partners submit each year, the Department of Health has commissioned an independent evaluation of the responsibility deal. The deal is a complex public health initiative and an assessment of its impact is challenging. Our strategy is therefore to evaluate the specific aims and objectives of the deal as a whole and a small number of pledges. The evaluation will be undertaken by researchers from the Policy Innovation Research Unit at the London School of Hygiene and Tropical Medicine.

A scoping study has been completed and included an international review of voluntary agreements between Governments and business, published in the journal Health Policy. The key message is that voluntary agreements, if properly implemented and monitored, can offer an effective policy approach. The main evaluation started this year and will run over three years. It is made up of a number of strands including examining the overall operation of the deal by engaging with its partners and key stakeholders; an in-depth analysis of a number of case studies; and measuring the public health impact of selected pledges. We will receive interim feedback wherever that is possible.

I have been asked a number of questions and I will cover as many as I can. I undertake to write to those noble Lords whose questions I have not covered. My noble friend Lord Clement-Jones spoke about the evaluation. I want to emphasise that the responsibility deal is only one stream of our policy activity. The evaluation of the deal looks at the mechanism as a whole plus a selection of case studies across the networks. The excellent schemes that my noble friend referred to have been operating for a number of years and are organised by other bodies, so they will not be evaluated as part of the responsibility deal evaluation.

A number of noble Lords, including my noble friend and the noble Baroness, Lady Hayter, have expressed scepticism on the concept of nudging. There is a difference between nudging and what we are trying to do with the responsibility deal, which is to bind companies into voluntary agreements. Nudges, such as providing information or advertising healthy products, form an effective part of a range of different public health interventions set out in the Nuffield ladder of intervention. Actions further up the ladder include enabling choice, guiding choice and restricting or even eliminating choice.

We adopt a range of approaches across our public health policy, depending on the level of harm caused and the target population. For example, we take actions higher up the ladder of intervention where children are at risk. The responsibility deal is, I emphasise, just part of this. Moreover, not all the actions taken within the deal are nudges. For example, the removal of trans fats from a wide range of companies’ products restricts choice and is not a nudge.

In answer to the noble Lord, Lord Rea, pledges are not proposed by the department but are proposed and developed by members of the respective networks. That is appropriate because we want meaningful pledges to which companies can put their names and undertake to abide by. The scoping review’s recommendation on voluntary agreements and robust targets was another issue raised by the noble Lord, who also asked whether targets were the same as pledges. The answer is no: some of the deal’s pledges, such as out-of-home calorie labelling, alcohol labelling, alcohol unit reduction and salt reduction, include milestones or targets in their wording. For other pledges, mainly those relating to health at work and physical activity, it would not be suitable to include a target. I will send the noble Lord a complete list of the organisations who have signed up.

The noble Lord, Lord Brooke, spoke about public health industry support for the deal and whether the deal was valid without it. A number of key public health organisations, including the Faculty of Public Health and the Association of Directors of Public Health, support the deal and are signed up as partners to it.

I agree with the noble Baroness, Lady Masham, that there is a need to educate young people on the risks of alcohol consumption. We are introducing an education and prevention pledge for schools which will secure investment to co-ordinate and initiate well evidenced alcohol prevention and education programmes for children and young people. We expect to launch that later this year. The noble Lord, Lord Brooke, asked what was being done on minimum unit pricing. The answer is that no decision has yet been made. We have received extensive submissions in response to the recent consultation and are considering all the views and all the evidence before making a decision in due course. Alcohol calorie labelling is a complex issue, which I know the noble Lord is aware of, but it is something that the Alcohol Network is looking into, and I will pass the noble Lord’s comments to the chairs of that network.

I apologise to other noble Lords that I have run out of time, but to tackle these challenges—obesity, harmful alcohol consumption, physical inactivity and reducing the prevalence of non-communicable diseases —we should not be scared to engage in and use the reach of business to achieve mutually beneficial aims. I thank the noble Baroness, Lady Coussins, for what she said in that context. Improving public health will always be the cumulative effect of sustained collective activity over time. There is no silver bullet. Public health is everyone’s responsibility and I hope that I have reassured my noble friend, in particular, that the responsibility deal is a fundamental part of an ongoing process to improve the health of the nation over the lifetime of this Parliament and beyond.