Health: Anorexia
Lord Giddens Excerpts(11 years, 9 months ago)
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Lord Giddens
To ask Her Majesty’s Government what steps they are taking to reduce the prevalence of anorexia and other eating disorders.
Lord Giddens
My Lords, what a pleasure it is to be able to introduce this debate. I shall start by saying how I got interested in anorexia and other eating disorders some while ago. It happened one Sunday when I got two newspapers—I was feeling flush at the time—and each had a colour supplement. On the front of one colour supplement there was a starving black teenager in Africa, emaciated and on the point of death, suffering from malnutrition. On the front of the other colour supplement there was a starving white teenager in the United States who looked identical in terms of her emaciated frame. It seemed to me that the dynamics of those two things must be completely different. In the first, there was a person dying from traditional starvation: not enough food to go around; in the second, there was someone dying in the middle of probably the first society in world history where there is far too much food to go around.
After that, I started looking fairly intensively at the history of anorexia and other eating disorders, especially bulimia. It is very interesting that there is a history. It goes back some way. We do not know the details, but anorexia seems to have been very uncommon historically and was mainly associated with fasting to death, especially female saints who fasted to death in pursuit of the greater glory of God. Bulimia has some analogues in history, but it was not even named until the 20th century. You can say that anorexia, bulimia and other eating disorders are essentially, in their mass form anyway, illnesses of our time. They started to spread rapidly in the 1960s and from beginnings in the industrial countries they then spread around the world.
As everyone knows, anorexia and bulimia are most frequent among teenage girls, but interestingly there is now a kind of extension through the lifecycle. There are children as young as seven who are already suffering from anorexia symptoms and there are cases of women in their 70s suffering from anorexia and bulimia combined. Male eating disorders have been called the hidden epidemic or silent epidemic. They are not out in the open to the same degree, although there is stigma associated with all forms of eating disorder. The latest stats we have on the UK suggest that one in five children in this country with a serious eating disorder is male, which is a substantial and seemingly growing proportion.
Anorexia may have a physical basis, but this cannot explain the spread of these phenomena. You find an interesting thing in some parts of the world where, in the same society, some people are starving to death from classical starvation in remote regions, and in the affluent cities people are starving from anorexia. It is a global phenomenon. This cannot be explained by physical reasons. Why did it happen?
I think that it is primarily because of the rise of supermarket culture; I do not simply mean the rise supermarkets themselves. Once you have the rise of supermarket culture, you have all forms of food available. You have to choose what to eat, and there is a sense in which everyone has to be on a diet, with a barrage of information about their bodies, their health and so forth. In the case of young women, as we know, they are also bombarded by images of what a desirable body is like. These are powerful images. We now see through the advent of the internet very young children picking up the image of the slim body as the embodiment of attractiveness. These two things come together and, like many other aspects of our culture, they develop an addictive, compulsive character. Anorexia is a compulsive cycle from which there is often no escape without specific medical and other help.
In our society we have a variety of food problems and problems with the relationship between food and the body. Therefore, anorexia and bulimia are the tip of the iceberg in terms of what has become normality. In our society, over 90% of women have been on a diet at some point in their lives. The figure for men is now over 50%. Interestingly, over 60% of women who have no history of weight problems are on a diet, which shows how extensive these characteristics are. We are dealing with a pervasive phenomenon in our society, rooted in a compulsive relationship to food. There is a sense in which, at the other end of the continuum, all of us have to wrestle with what to eat and drink in relation to our health.
Anorexia, as we know, can be treated. Bulimia can be treated but normally demands intensive treatment. About 20% of female anorexics who are diagnosed before the age of 20 die before the age of 40. It is a lethal affliction.
I ask the Minister four sets of questions. First, do the Government have a coherent policy on anorexia and eating disorders? If so, what is it? I found it difficult to locate, having been through the government websites. Do the Government recognise the connections between eating disorders and obesity? One linked factor is binge eating, which is characteristic of bulimia and some forms of obesity; all problems of the body, plainly.
Secondly, what are the Government doing about male eating disorders specifically? These still do not receive the same degree of attention as female eating disorders. One of the main agencies involved in analysing male eating disorders says:
“Nationwide, there is simply a massive deficit in programmes that specialise in men with eating disorders”.
Are the Government taking some steps to address this?
Thirdly, what is the Government’s attitude towards pro-anorexia and pro-bulimia websites? As the Minister doubtless knows, they have proliferated in recent times. They are connected with the social media whereby these ideas become propagated. Essentially, these websites argue that to be extraordinarily slim is a desirable thing, and they do so in a forceful way. The websites themselves can become addictive. There are many precepts and so forth on these websites, but I will mention just one. Supposedly, Kate Moss once said:
“Nothing tastes as good as skinny feels”.
You can see the lethal impact that that might have on a young person who is absorbed into these websites. Is there some way in which the Government can intervene to help control them and the impact they have, especially on young women and, as I have said, increasingly, young men?
Fourthly, what is the Government’s reaction to the case of Laura Willmott which has been extensively debated in newspapers this weekend? She suffered from anorexia and died recently aged 18. She was apparently making good progress under care. When she turned 18 she was treated as an adult and essentially fell through the system. A headline from one of the Sunday papers read:
“At 17 years and 364 days, she is a sick child. At 18 the NHS can watch her die”.
What is the Minister’s reaction to that?
Food: Regulation and Guidance
Lord Giddens Excerpts(14 years, 1 month ago)
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Lord Giddens
My Lords, let me join the queue to congratulate my noble friend Lord Whitty on initiating this debate, the importance of which is much greater than might be indicated by the paucity of noble Lords who are contributing to it.
About 10 years ago, I wrote a book called Runaway World. Its theme was that, in a global industrialised order, we have unleashed forces that we are losing our capacity to control. What is happening to world food production and consumption and their relationship to patterns of health is one example of that. Today the purchase and therefore the consumption of food have become increasingly isolated from food production. It is important to recognise that this is a recent development. It dates back only about 50 years—even later than the noble Lord suggested—in the industrial countries, while it is an ongoing process in developing countries.
The key retail entity in producing this separation, which I argue is structural and underlies many of the dilemmas that noble Lords have talked about, is the supermarket, as with the advent of supermarkets food becomes completely removed from the vagaries of the climate, the seasons and localities. The supermarket also offers the consumer an abundance of products on a scale completely unknown before in history. As this separation between the production and consumption of food becomes radicalised, advertising and marketing become the primary vehicles of information about food—again, a crucial difference from the past.
The modern food industry has been a vehicle of plenty for many; at the same time, it has helped to create an entirely new relationship between food and health. I am not in the business of self-promotion, but I also wrote quite a lot about anorexia and bulimia a few years ago. Why do people starve themselves to death in an era when we have far more food than we can possibly consume? I will not bore noble Lords with the answer, but it is directly bound up with the rise of supermarkets. Once you have that rise, food is no longer determined by what happens locally. There is a certain sense in which we all have to be on a diet in relation to how we want to be. The pressures that exist on young women to follow a certain bodily image become conjoined to that. Anorexia was virtually unknown in history before—it was known only in the activities of a few female saints—but now it and its less radical versions affect large swathes of the female population across the world.
The other side of this, which has already been mentioned, is the rise of obesity. I will concentrate on this, hoping that my remarks will slot in nicely with what was said previously. For thousands of years, obesity was rarely seen. It existed only among a tiny proportion of the very rich. In complete contrast, in 1997 the World Health Organisation formally recognised obesity as a global epidemic running out of control. One billion adults in the world are clinically obese or radically overweight. The most striking increase—already noted, I think—is among children and adolescents. The US and Mexico have the highest overall rates of obesity at roughly 30 per cent and 25 per cent of their populations. The UK is in an unenviable third place at 24 per cent. Some noble Lords might have seen reports in the newspapers of what happened in Australia, where they had to widen the entrances to crematoria because the coffins had got so huge that they could not get them in. This story is apparently not apocryphal.
Contrary to what is often argued, recent studies show quite conclusively that our lives are not more sedentary than was true three or four decades ago. The epidemic of obesity is almost all the result of dietary changes. Of course, we would be foolish just to blame the food and drug industries for this, but their contribution undeniably has been huge. It is a contribution that the food companies are starting to recognise and trying to do something about. Fast-food manufacturers are quick to point out the changes which have been made over the past few years, some voluntary and others prompted by regulation. We have many examples from different countries. In the United States, for example, Pepsi, Kraft, Kellogg and others have promoted what they call a Healthy Weight Commitment Foundation—a sort of voluntary, sign-up organisation. There is not a lot of rigorous regulation in the United States, certainly not at a federal level. Nestlé and similar companies are pursuing parallel lines in the UK and Europe. Yet that is on nowhere near the scale needed.
My opening remarks were due to show that this problem is structural. It is deep, global and unparalleled in previous history. It is perfectly obvious that marginal measures will not serve to control it. The food industry, especially its fast-food sectors, pays back no more than a tiny proportion of the total social costs it creates. In this country, it has been calculated to be £17 billion a year that is needed to treat obesity and obesity-related illnesses. Some medical specialists say that the prevalence of obesity alone in countries such as this one and the United States will overwhelm health services within 10 to 15 years, because of the associated problems of type 2 diabetes, heart disease and many other serious medical consequences that ensue.
That is a sort of epidemic running out of control. The knock-on costs are completely out of proportion to the existing regulation of the fast-food industry. The Chief Medical Officer in the UK recently spoke of a public health time bomb, which is completely correct. Even having listened to the interesting contributions of other noble Lords, I propose that if we look at this as a deep structural issue with massive social and medical consequences, it is not enough just to tinker at the edges—whatever resistance one might get from the food industry. I shall make three comments on this to which I would like the Minister to respond.
First, we should contemplate far more stringent controls on junk-food advertising to children than exist at the moment. We have to tackle the issues of advertising not just in the orthodox media but, I am afraid, on the internet. Noble Lords will know that there has been a certain advance of control in this country and elsewhere on advertising to children, but many companies have then simply turned to the internet as a vehicle for promoting the same thing. One thing that is well known is that children—and some adults too—find it difficult to discriminate between advertising and other messages in television and other programmes, so they are very vulnerable to those messages. We are not really near to controlling with the rigour that we need. There are some voluntary no-child marketing strategies, which enlightened companies have followed, and I commend them. In this country they include, for example, Mars and Cadbury—although that is pretty recent—but again it is nowhere near enough just to rely on that. In Norway and Sweden, all marketing to children under 12 is banned. Why should we not do the same in this country?
Secondly, the issue of trans fats has quite rightly been raised. I will not go over what the noble Lord said so eloquently and knowledgeably. However, research has shown that trans fats are an independent factor in weight gain. They contribute in other ways, which were noted, because of their use in frying and many other things that produce weight gain, but there is evidence that they independently contribute to it quite apart from how they are used in relation to other aspects of food. I think that the noble Lord, Lord Patel, mentioned that Denmark, Switzerland, New York and California have banned trans fats. Denmark is the most interesting example; it was the pioneer, and because it goes back some way we have more research on Denmark than on the other cases. The research shows amazing health benefits from that ban, with a 20 per cent reduction in some kinds of illnesses directly related to trans fats. Why can we not follow the Danish example in this country and simply ban trans fats?
My third point has not been mentioned by noble Lords, but in my view it is really crucial. Even though it is politically very problematic, we need a tax-based approach to play a part in regulating the food industries, specifically the fast-food industry. That is because, to repeat the point, the fast-food industry is creating social and medical consequences of a massive kind and not contributing to paying for those consequences. We—the rest of us—have to pay for those consequences. That is not morally right and not a situation that one should simply accept, so it is right that extra taxes should be added to food and drink which are high in fat, sugar and salt. The evidence that these foods do as much damage as tobacco and alcohol is strong. Tobacco and alcohol are very highly taxed, and quite rightly so. Researchers at Oxford have developed three models for the potential use of taxation to improve public health, which in the UK they calculate will save upwards of 5,000 lives a year, if they are implemented. Even though there is always fierce resistance from the fast-food industry, the tax-based approach has just as much legitimacy as it does in the case of the tobacco and alcohol industries. The fast-food industry will increasingly face the sort of litigation that has driven such regulation in those industries, so it is not completely against the interests of the fast-food companies to participate in accepting an increased tax-based regime, or at least look at the possibility doing so. That would not only help to limit the intake of noxious foods that produce such tremendous medical problems; it would also make it possible for the food industry to pay back some of the social costs that it creates. At the moment, it pays back virtually none of these costs.
Finally, I ask what the Minister thinks about the FSA, and what will happen to food regulation more generically.
The Earl of Erroll
Well, I keep being told that I am bound to die if I eat too much chocolate and that I am a chocoholic. Is dark chocolate bad or good for you? We could debate that endlessly.
Lord Giddens
You cannot confuse the risk to a single individual with generic risk. That is like people saying, “My granddad smoked 50 cigarettes a day and, look, he lived to be 101”—as if that had anything to do with the risks of smoking, which it does not.
The Earl of Erroll
That almost proves the point. We are all different, and I do not like to live in a world where the Government tell me what to do, because we are all very different people. Those differences are important in society. I am talking about having total central controls; that is why I want to get on to balance. I want to demolish the concept that if you do something silly and you die early, although you may be a cost to the National Health Service in your obesity and the costs of dealing with your diabetes at that point, you have alleviated another budget—the cost of looking after you very expensively in your old age. That is quite expensive, and it is a bigger and bigger problem, as well as all the pension and other costs. I would like to see a true paper done academically on the economic balance between those costs, because I have not seen one. The only one that I ever saw was produced in Holland about the cost of the early deaths of smokers from cancer, and it said that the cost of the cancer care was much lower than the cost of the old-age care, with people living longer. But let us not get side-tracked into that for hours. It is for another day.
I wanted to look at the whole thing from end to end. You have to look at food distribution, diet, disease, and the effects of this on the system and people and everything like that. To take the nutrition bit first, I used to run around mountains and leap around the place energetically and one thing that I was always told was that we need balance. People always believe that advice, because they are told, “You are what you eat”; that is the problem—everyone believes that now. But actually we are individuals, and it depends what you do as to what you can do and cannot do. Sportsmen sweat salt. If you run around hills and take a lot of exercise, you have to take extra salt. I have heard of a chap who is the son of a friend of my wife’s, who nearly died on the Welsh mountains because she had him on a salt-free diet, and he thought that it was poisonous to take extra salt. We have to be careful with these messages, because they are not universal messages. I remember talking some years ago to a nutritionist, who was quite concerned about how we were extrapolating the research on middle-aged men’s diets to children, who have very different dietary needs. They need different minerals in different quantities, because their bodies are growing. I realise that these things change throughout life and that there is no one universal message. I do not really get that from the press. We have to be quite careful about how that is put across. It is quite subtle and noble Lords may be experts, but I am not sure that all the public are, and that concerns me quite considerably.
I am very reassured by the noble Lord, Lord Patel, that I was right to stick to butter throughout my life. I believe that it builds up calcium in my bones, and I should be worried about osteoporosis because men are living longer. I do not really know, because I am not a nutritionist, which is right and which is wrong; all I do know is that whenever I am told that I should not eat something, later on someone says that I should and then they say I should not eat it again. Messages throughout history are confused, and I do not think that there is probably one right or wrong. I had heard about the artificial sweetener thing, and I am hugely reassured, because I have stuck to sugar. I dislike artificial sweeteners and have always felt that they are inherently wrong. I wonder sometimes—although this is straight off the top of my head and I know nothing about it—whether if we reduce the salt content in all foods, that does something about our body’s perception of what we are eating and we eat more bulk as a result. These are such complex things that we do not know. I know that noble Lords think that it is simple—they are shaking their heads—but I am not sure that I am convinced that it is so. I shall have to read up on it.
But I am like an ordinary general member of the public. When I was running around hills, the food I ate was very simple. You had protein to build up the body, some carbohydrates for long-term energy and you finished with some sugars to give you an immediate energy boost to keep you going while the body was digesting, or you hit a sugar low otherwise. Equally so, if you are going to take all the sugar out at the end of meals in schools, I bet you that pupils will fall asleep with inattention in the afternoons. That was the concept of the pudding. If you overdo it and do not get the balance right, they are going to get fat—I agree. But you do not just kill and ban something just because of that. The real problem is that we are now so frightened of children running around the place and doing dangerous things that they are kept sitting down the whole time. When I sit in an office, I drink more cups of tea and eat things on the side, whereas if I am moving around and doing things I am not only burning up more energy—I do not have the time to eat as much. The exercise point is the unintended consequence of us getting parents terrified that there is a paedophile standing on every corner, which is probably also driving obesity. You may think that I am mad about this, but a lot of people would agree. We have stopped children walking to school so much. All right, we are now starting with walking buses, and things like that, and that is good. But we must attack this problem not only from the diet point of view.
I shall give your Lordships one other story about this that is quite interesting. Years ago I was travelling in the south of France. Because I did not know how to cook, I lived on Spanish vegetable omelettes for a month, with no meat. When I hit Italy just after that, I had deep intense cravings for ham and I used to go down the street buying it from every shop: “Etto prosciutto, per favore”. I have never lost my craving for ham; it did something to my body. The unbalanced diet does not work, and we have to be very careful of that.
Leaving that aside, the other thing that I wanted to look at was disease—the excessive cleanliness that can come out of regulation. We are born with an immune system that you need to train early. When my children were young, they used to try to drop things that they did not like on the floor for the dogs to eat, but we would make them eat them. They said, “Oh daddy, we’ll get diseases”. “I said, “Don’t worry, it builds up your natural immunities”. Years later, when my daughter went to Tanzania to help build some loos for a school there, she was the only one who did not go down with severe dysentery. She said, “Daddy, you were right”. One of the problems is that we sometimes transfer the risks of some of these things. If we had slightly less food safety and cleanliness, would we increase people’s capacity later on in life to survive? Are we merely making it safer at one end to make it more dangerous at the other? Those are the sorts of things that I worry about quite a lot.
The other thing that I worry about is the general build-up of regulations. Often, all these individual regulations are very reasonable but in aggregate they just become excessive—they bog the entire system down. To horrify the noble Lord, Lord Giddens, I have a Kit-Kat here. Have I read any of this stuff on it? No, I haven’t got time, but I am sure it is all good, well meaning labelling. I have not got powerful enough glasses for that any longer, anyway. In order to make the text bigger they would have to make the packaging bigger, in which case they would increase the waste, in which case we would have more landfill and other undesirable effects.
That brings us to the problem that some of these regulations are very good for one thing but bad for another. I declare an interest here that I am married to a farmer. We are at the start of the food production chain. People are working further and further back with the regulations. Great. I do not have a problem with that in principle. I do not have a problem with the fact that all the glass light bulbs anywhere near a barn should be covered; we do not want glass falling into raw wheat before it is ground up. It would end up with ground glass in it. So that is very sensible. But when you start looking at all the other bits and pieces, you realise that you need an A-level at a minimum to be a farmer. Farmers were not that sort of person; they were people who loved the soil, the land and producing things. They loved the animals. They did not have to tick boxes the entire time and recognise all sorts of obscure things.
You might decide to take the pressure off and sign up to a thing called the Whole Farm Approach. It is a wonderful thing. You go online and tick the boxes, and it checks whether you have ticked them right. But there can be problems. My wife has a few cows that graze some grass, because it is environmentally correct to do so and it is all done under environmental schemes. They are rare-breed South Devons, a native species, and they are hardy animals that live out all year. They are very happy and they have plenty of shelter out there. When we come to the question, “Have you got cattle housing?”, the answer is no. To the question “Does your cattle housing have proper ventilation?” you can answer only yes or no. So do I say, “Yes, my non-existent cattle housing has adequate ventilation”, or do I say truthfully that there is no ventilation because is there is no cattle housing? The answer is that if you tick “no”, you fail. It tells you so, and it tells you to go and sort out your cattle housing ventilation in your non-existent cattle house.
You get other asininities. Because these cows are not housed, there is no manure to spread. Do not worry, in case any NVZ people are listening in, we are very careful about manure loading on the ground—we do all that stuff with compliance, stocking rates and so on. So no, we do not produce any manure. Do we obey RB209 on the correct calculation for manure loading? We do not, because we do not have to do the calculation, so we have failed. Instead, we have to say that we calculate our non-existent manure loading properly. If people are running these sorts of schemes, could they at least employ someone who has bought a pair of decent practical wellies at some point and spent some time on a farm, not just someone who has done an environmental studies course at university and then gone straight into an office?
Some of these things worry me—there is a lack of common sense throughout. The certification you need for everything means that nowadays everything has to be trained for. Now you have to have a certificate on how to move a cow into the back of a horsebox and move it over a couple of miles or whatever. It is just getting out of control. This worries me because it induces a lack of respect for the system and the sensible regulations, and everyone starts working their way around them. If we are going to have regulations, let them be sensible. At the common sense end, people say, “Yes, that makes sense”. It is not just seen as a load of nonsense everywhere.
We overuse the precautionary principle all the way down the chain. I hear all the messages from the noble Lord, Lord Giddens, and others, and I know that to a large degree they are right, but at an individual level I want to make a decision about whether I am going to eat something because it has the right mouth-feel or the right taste, or to buy a bag of crisps because I know that that will keep me awake better when I am tired. I know I should not be driving tired, but sometimes it just happens; you are between stops, there is not another motorway services for 40 miles and you need to keep going. I happen to know that, for me, crisps are better than chocolate for doing that, even though I am doing the wrong thing.
The other thing that worries me, thinking back to what the noble Lord, Lord Whitty, said at the end, is the control of agencies, of which, unfortunately, he has bitter experience. One of the unfortunate things that happened at the end of the previous Conservative Administration was the growth of agencies that were outside ministerial control. That lack of control right up the chain of command—so that there is, in effect, a separation—has always worried me. I am rather pleased that these matters are being taken back in-house so that Parliament can look at them properly and the poor Minister does not have to stand up and say, “Until they have fallen outside their remit, I am not allowed to go in and sort it out. I have to pretend that there is nothing wrong because that is what they are telling me, even if the rest of the world is telling me that they are underachieving”. What happened with the RPA is very unfortunate. I am looking forward to seeing that finally sorted out properly.
Can we please stop the EU redefining field boundaries? I have just redone a digital mapping for the third time.
I suppose my message is very simple. Let us have some common sense. I know it is not common and I do not know whether I have it. Let us watch out for having such strict rules that, on the one hand, we say that we do not want waste but, on the other, we have to package so tightly that waste is created by having rules. I do not mind if my bread is wrapped up or handled. I have enough natural immunity, as others should. That is my message. Human beings survive quite well. If you do not, that is bad luck. It may happen to me. However, we were born with responsive systems, which can manufacture antibodies to protect us from viruses, bacteria and so on. Let us train those up early. Let us have a little less regulation and a little more danger in the system, and not go overboard in trying to control everything.
Lord Giddens
Was the noble Earl suggesting earlier that the more people who die young, the more costs are saved by the health service?
The Earl of Erroll
I do not suggest that for society—not at all. I am saying that we should not go overboard in saying that the sole goal in life is its length, rather than its quality or doing the things that you want to do. We control people out of being able to take risks and do dangerous things themselves. I am not saying that we are trying to kill people off early. If people want to do things their way, they should be allowed to do so.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I thank the noble Lord, Lord Whitty, for calling this debate on food standards and the role of regulation and guidance in the food chain. As your Lordships may know, this is an area for which the noble Lord and I have, at one time or another, both been responsible in our previous roles as agriculture ministers, his experience being much more recent than my own. Along with other noble Lords I pay tribute to the noble Lord’s work as the chair of Consumer Focus.
The food that we eat is fundamental to who we are. It is, of course, a source of essential sustenance necessary for basic survival. But food can also be much more. A meal made with the finest ingredients, prepared with skill and care and shared with loved ones can be one of life’s great pleasures. Yet no matter what our culinary preference, we all expect our food to be safe. It is no longer enough that we do not expect to be taken ill with a mild dose of salmonella or to have our lives put at serious risk by botulism; we also need to pay attention to the less acute causes of harm which noble Lords have rightly highlighted—the high levels of salt, sugar and fat that can do so much harm over the course of our lives.
While I do not believe that the role of the Secretary of State is to tell people what they can and cannot eat, there is a role in making sure that the food we eat is safe; that we make people fully aware of any long-term risks from our diets; and that those risks are minimised as far as possible. The sensible use of appropriate regulation and guidance is essential to this. The warnings sounded by the noble Lord, Lord Patel, are well founded. Far too many people in this country eat far too much salt, saturated fat and sugar, and nowhere near enough fruit, vegetables and oily fish. The personal costs to our health and the high financial costs to business and, through the National Health Service, to the taxpayer are huge. If everyone ate a diet that matched national nutritional guidelines we could prevent around 70,000 deaths every year. The current cost to the NHS of those deaths is thought to be around £8 billion a year. This does not include the further costs to the wider economy in lost productivity.
As the noble Lord, Lord Giddens, for one, pointed out, obesity in particular is a serious and growing problem. Nearly three-quarters of a million people in the UK are classified as morbidly obese—overweight enough to cause real long-term damage to their health. As such, they increase their risk of being diagnosed with diabetes, some cancers and cardiovascular disease, as well as a wide range of conditions that have a significant negative impact on a person’s quality of life.
The Government are committed to improving the health of the nation. We consider public health to be a high priority and to be everyone’s business. Much has already been achieved—and here I pay tribute to a great deal of the work done by the previous Government: there is clearer and easier to understand information on the front of food packaging than ever before, helping people to make healthy choices at a glance; there are national guidelines to protect the most vulnerable and ensure high-quality food in places such as schools, hospitals, care homes and prisons; voluntary initiatives with the food industry have seen significant reductions in the amount of salt in our foods; we have put in place a new Change4Life strategy; we are working with industry on appropriate safeguards for marketing food and drink to children—I shall say more about that in a minute; and we will continue the national child measurement programme.
Something that many of these achievements have in common is that they stretch beyond the limitations of purely government actions. We recognise that public health is not a social good that can somehow be mandated from the centre. The way to make real progress is through a coalition of partners—government departments, private companies, charities and individuals all taking responsibility for their own actions. We want business to do more to help meet public health challenges. We want all partners to be joint owners of a long-term public health strategy and for each to play its part in improving people’s health. This is the thinking behind the Responsibility Deal, our response to the challenges that cannot be resolved through legislation or regulation alone. The Responsibility Deal is a partnership between government and business that balances proportionate regulation with corporate responsibility to tackle the health problems associated with poor diet, alcohol abuse and a lack of exercise.
The noble Lord, Lord Whitty, raised the specific issue of nutrition. Providing clear, easy-to-understand nutritional information for consumers is essential if people are to make informed choices. This is also true when eating out. We have challenged the food industry to give its customers this information. From a traditional bag of fish and chips to a special treat for the whole family, eating out has become an important part of our culture and must be included in any serious attempt to influence it.
In this and in all areas of regulation, guidance and food standards, there is a balance to be found between the impact on health outcomes and the impact on business. We need always to take a proportionate approach and to try to get the balance right. Food is the UK’s largest manufacturing sector. It is a real success story, bringing billions of pounds into the Exchequer and employing tens of thousands of people. We must be careful not to strangle this particular golden goose with excessive regulation. We want a light touch wherever possible. Where we can achieve our objectives through voluntary agreements, we should do so. We also need to be realistic about what is within our gift to do. Much food regulation is EU-wide, so we need to negotiate and agree certain changes at an EU level. I need hardly say that we should also avoid gold-plating any legislation when implementing it.
One other key plank of public health policy is informed consumer choice. The noble Lord, Lord Whitty, is a particularly strong advocate for consumers and their rights in his role as chair of Consumer Focus. Often, people’s health and well-being are rooted in their daily lifestyle choices. To improve public health, we need to support people in changing their behaviour, making the healthy choice the easy choice. Public health must not be about nannying consumers or demonising particular foods. We need to find new approaches, founded in behavioural science, which nudge people in the right direction.
While we have made some progress, we have only really started to scratch the surface. Our average salt intake is down almost 10 per cent over the past decade, which will save the lives of 6,000 people each year as well as saving the economy around £1.5 billion. But we still have a long way to go before we reach the recommended level.
Early indications suggest that people are starting to reduce their intake of saturated fat, but we are still a very long way from the ideal level. Although levels have fallen substantially in young children, we are still eating far too much added sugar. Sadly, the consumption of fruit and vegetables remains poor, with only a third of people eating the recommended five a day. For all these reasons, we will publish later this year a public health White Paper. It will set out in detail our plans to transform public health: a good, balanced diet, more exercise, drinking responsibly and stopping smoking.
The noble Lord, Lord Whitty, and other noble Lords dwelt to a considerable extent on the decision by the Government to move nutrition policy to the Department of Health from the Food Standards Agency, a transfer which took effect from 1 October. The main reason for doing that is not only to ensure that nutrition policy is delivered coherently and consistently in relation to nutrition—although nutrition is certainly part of it—but also to recognise the direct interrelationship between nutrition policy and public health policy in areas such as obesity, diabetes and coronary heart disease. It is an early step towards realising the Government’s vision of drawing together the diverse arrangements for delivering public health into an inclusive public health service. The transfer will mean that the Government can give the general public more consistent information. It will also mean, as I have indicated, a more co-ordinated and coherent policy-making process and a more effective partnership between Government and external stakeholders.
I agree with the noble Lord, Lord Whitty, that the creation of the Food Standards Agency was sensible and necessary in the context of public confidence at the time in the Government’s advice on food safety. I am not so sure that I agree with him that there was any lack of consumer confidence in the Government’s advice on nutrition. The main problem, I think, lay in issues around food safety.
I assure the noble Lord, Lord Rea, that the Food Standards Agency will continue to ensure the public’s safety by maintaining its essential and robust regulatory role on food safety, covering all aspects of development, implementation and delivery. In the context of consumer confidence, what matters is surely transparency. The Government are committed to provide evidence-based advice to consumers in order for them to make healthier lifestyle choices. We understand the need for transparency in our policy-making and the need for independent advice and scientific accuracy. The Government will continue to be advised by independent experts to ensure high-quality, trustworthy advice to consumers.
The noble Lord, Lord Rea, mentioned the press report that appeared on 24 September that suggested that various public bodies would be axed, including the Government’s independent Scientific Advisory Committee on Nutrition. In fact, discussions are still on-going and we will be in a position to make an announcement on the matter in due course. In the mean time, SACN will continue to provide expert advice on nutrition to the Government. Again let me reassure the noble Lord that our expert scientific committees, of which we have several, will continue to operate in line with government principles of scientific advice and codes of practice for scientific advisory committees. Those will ensure transparency in their work, and the minutes of those committees will be published.
The noble Baroness, Lady Thornton, questioned the evidence that food labelling belongs in Defra. She will recognise, I believe, that there was a division of responsibility for food labelling. We will now have a more consistent delivery of food labelling policy that will bring together general labelling and issues such as country-of-origin labelling.
The noble Lord, Lord Giddens, asked me to give the Government’s view of the FSA in general. I hope that I have indicated that we think very highly of the FSA. We recognise the good work that it has achieved as well as the principles that it has established of openness, transparency and evidence-based policy. At the same time, it is important in delivering the Government’s objectives on public health to draw together nutrition policy so that it can be delivered more coherently.
Much has been said this afternoon—not least by the noble Lord, Lord Patel—about saturated fat and salt and their connection with ill health. Two key dietary influences in the development of cardiovascular disease are the levels of saturated fat and salt in the diet. High intakes of saturated fat can cause increased cholesterol levels, which are a major risk factor for CVD. Similarly, high salt intake contributes to high blood pressure, which is also a risk factor. I say to the noble Earl, Lord Erroll, that there is strong international agreement with UK expert opinion on what constitutes a healthy balanced diet that is low in salt and saturated fat. The substantial body of scientific evidence supporting that view includes long-term epidemiological studies, which conclude that a healthy balanced diet has a positive effect on the prevention of diet-related chronic disease.
The noble Lords, Lord Patel and Lord Rea, suggested that there should be a stronger regulatory approach to such matters rather than simply a continuation of the voluntary approach. The UK is moving further and faster on salt, saturated fat and sugar reduction than most other countries, even those that have taken a regulatory approach. The responsibility deal aims to build on that and to challenge industry to play its part in improving people’s health. Legislation would undoubtedly produce an additional burden, which could stifle industry innovation. Industry ought to have the flexibility to decide how it delivers public health benefits. Consumers also need to take responsibility. We need to find ways in which to support people in changing their behaviour and improving their diets. The Food Standards Agency is fully on board with this voluntary approach. It has worked with the food industry to deliver voluntary reductions and to secure public commitments to the reformulation of food.
The noble Lord, Lord Patel, spoke eloquently about trans fats. Action by the food industry in the UK has reduced average trans fatty acid intakes to less than half the maximum level set for public health. We understand the public concern over artificial trans fats and will continue to encourage the food industry to eliminate their use. The Government’s public health White Paper and the responsibility deal will set out more of the strategy, but my right honourable friend Andrew Lansley has stated that the Government will continue to encourage the food industry to eliminate the use of artificial trans fats.
Lord Giddens
In the light of what the noble Earl has said, will the Government consider completely banning trans fats?
Earl Howe
My Lords, the whole matter of trans fats is under review. I expect that we will be in a position to say something in the public health White Paper. In the context of the noble Lord’s question, it is instructive to look at the experience of other countries. The United States took legislative action on trans fats only after voluntary measures had failed and because intakes by New York citizens in particular were much higher than those recommended and much, much higher than those in the UK. Denmark acted to ensure that individual food products did not contain high levels. We believe that much of this can be achieved by voluntary measures, which will be considered as part of the responsibility deal.
The noble Lord, Lord Giddens, suggested in his speech that the ban of trans fats in Denmark has directly reduced the incidence of chronic diseases. I would be interested to see the evidence that he has for that. We are not aware of published scientific evidence of a direct linkage between reducing trans fat intakes and changes in disease rates in the population in Denmark, so I should be glad to communicate with him on that topic.
The noble Lord, Lord Patel, questioned whether the voluntary approach would be enough. Voluntary action by industry so far has shown that it can be successful. As I indicated, we want to make industry joint owners of the long-term public health strategy. That includes our drive to reduce salt levels in food, about which the noble Baroness, Lady Thornton, asked.
The noble Baroness, Lady Hayter, asked for reassurance that protection of the consumer will be a watchword for the Government. I can tell her that the responsibility deal most certainly includes representation from consumer-focused organisations, to make sure that consumers’ interests are protected. She also spoke about the impact of poverty on diet. We recognise the action that retailers have taken to ensure that the nutritional qualities of value food lines and premium food lines are comparable. The Government’s responsibility deal can take into account these types of issue to help to promote good nutritional standards.
I say to the noble Lord, Lord Patel, that the Government are committed to working with the industry, as I indicated. We have seen a great deal of progress with children’s diets, as he will know in relation to foods that are high in fat, salt and sugar.
The noble Baroness, Lady Finlay, asked what action the Government will take to help educate consumers, particularly about food labelling. The Government fully support consumer education to help achieve a balanced diet. That will continue with the “Change for Life” brand, which can evolve in response to evidence and the economic climate. We recognise the role of simple nutritional labelling on pre-packed foods and are supportive of measures that support its usefulness. We would like to see front-of-pack labels that include percentage guideline daily amounts for the five nutrients which are of particular dietary importance.
I shall write to noble Lords with answers to other points. Perhaps I may conclude by briefly emphasising that more than any other area of health, public health has the potential to change people’s lives for the better. It cannot be seen as an add-on, or as somehow secondary to the important business of saving lives. It is saving lives and, at a time of tightening budgets, by preventing people from becoming ill in the first place it saves money as well.