Food: Regulation and Guidance

Lord Rea Excerpts

Thursday 7th October 2010 Lords Chamber

[Lord Rea]

My Lords, I thank the noble Earl for giving us a little light relief in a debate on rather a serious topic. I especially thank my noble friend Lord Whitty for bringing this subject to our attention. Faulty nutrition today is of huge importance for public health. As almost every other noble Lord has said, it plays an important part in causing obesity, type 2 diabetes, arterial disease and high blood pressure, which lead to coronary heart disease and stroke, as well as some cancers.

Today it is mainly overnutrition with the wrong nutrients, rather than undernutrition, which is the main problem. However, too many elderly people are undernourished when they are admitted to hospital and sadly still are when they are discharged. Evidence is also emerging of the importance of nutrition for mental health and behaviour, particularly in corrective institutions. I declare an interest as chairman of the All-Party Food and Health Forum, a trustee of the National Heart Forum and a former trustee of the Caroline Walker Trust, a charity that aims to improve “public health through good food”.

The history of public health in the UK since Edwin Chadwick’s monumental report on The Sanitary Conditions of the Labouring Classes in England in 1842 has been one of regulating or restricting activities or products that are harmful to health, and setting up local and national bodies to ensure that necessary measures are taken to achieve those aims. We benefit to this day from some of the subsequent results of the Public Health Act 1848, including London's water supply and sewerage system. That is only now being replaced, so well was it built by Joseph Bazalgette. His project was hastened by the “great stink” of 1858, when Parliament had to cease its activities until the weather changed and it was washed away.

These early measures, such as sewerage and clean water, were driven by the need to control illness caused by pathogenic bacteria, although to begin with it was not known that they were the cause of such illnesses. It has been so successful that now infection, while still with us, has been supplanted in importance by chronic diseases, mainly affecting adults in the second half of life. However, it has been shown that these conditions, like mental health problems, often have their origins in early childhood. Poor nutrition in infancy, and even pregnancy, can plant the seeds of chronic disease later in life. That was fully discussed earlier by my noble friend Lady Finlay.

Improving public health may mean restricting the freedom of individuals and commercial enterprises; Chadwick’s Public Health Act 1848 had many enemies. If these restrictive measures result in loss of livelihood or lower profits, they will naturally meet with resistance, and they do. After all, we live today, as in 1848, in a competitive, capitalist world dependent on profit whether we like it or not. This resistance may take the form of denial of the deleterious effects of the product or activity concerned. Considerable resources may be put into efforts to discredit the evidence and disprove the need for public health measures. The long-running rearguard action of the tobacco industry is one of them. It is still running in resisting the banning of tobacco displays in shops and the banning of vending machines. Another example was the initial reluctance of the food industry to accept that high salt intake was a cause of hypertension.

As many noble Lords have pointed out, it is unlikely that voluntary guidelines will be followed if they have an impact on profits. There must be legislation, or the serious prospect of it—the sticks—or, on the other hand, incentives—the carrots—to encourage or enforce compliance. This does not apply only to the private sector. A rather sad example of this, recently described by Sustain, is the series of programmes, taskforces, plans and packages which have exhorted hospital trusts to improve the quality of the food given to patients over the past decade. There is no evidence that they have had any lasting effect, despite costing at least £54 million. The quality of hospital food is still poor in many hospitals, as we know, particularly also in care homes. The proportion of malnourished elderly patients admitted to hospital is still high and has not changed much in the past decade. Department of Health figures reveal that in the past decade 2,600 patients died in hospital in the UK directly as a result of malnutrition. More important were the many others whose poor nutritional state may have contributed to deaths from other causes. The exact size and impact of the problem is not known and urgently needs research. I hope that the noble Earl will urge that to be done. The Conservative Party said that malnutrition in hospital needed to be tackled when it was in opposition. I hope that it will now look into this matter and do something about it. Hospital food could be immediately improved if standards were made mandatory rather than relying on well-meaning but rather ineffective guidelines.

A major difficulty in improving eating patterns today is the high proportion of our diet that consists of processed food, as other noble Lords have pointed out. It is impossible to tell by appearance or taste alone how much salt, sugar, saturated fat, trans fat, preservatives, artificial colouring or flavouring is incorporated in many popular brands; hence the need for a clear, easily understood system of food labelling, which was also discussed by many other noble Lords. The Food Standards Agency’s research found that the simple traffic light system was the most popular among consumers, and some retailers have adopted it—about half of supermarkets—but it is not popular with the food industry since a red light label indicates that a product should be consumed sparingly. The industry’s preferred labelling system, using the RDA or recommended daily amount, is more confusing and shoppers find it difficult to understand. Some retailers use a combination of both. The labelling system in use is voluntary and therefore inconsistent. Progress is slow as we have had to conform to EU guidelines, as has been said. However, there are ways around EU regulations by citing particular public health problems. The Government could explore how that provision could be used more fully.

Many manufacturers market healthy versions of their products, thus indicating their social and ethical responsibility. They may hope to attract a greater market share. These healthier options, such as low saturated fat, low trans fat, low sugar or low salt products, may indicate the direction that ideally the rest of their products, and those of other manufacturers, should follow. The food industry would then become part of the solution, not part of the problem. However, progressively increasing the market share of these good foods is likely to be very slow or incomplete unless the healthy ranges cost less than the standard range. Unfortunately, the reverse is usually the case. The National Consumer Council, before it changed its name, reported in 2006 that many economy-range foods contained more salt, fat and sugar even than the standard products. Thus the poorer sections of the population, the people on tight budgets who most need an improved diet, will continue to buy this energy-dense, less nutritious, obesogenic—I like that word—food, thus perpetuating the increasing health divide in obesity, heart disease and cancer.

If statutory regulations were to ensure that all manufacturers sold food products that conformed to an optimum standard, this problem would be solved. In fact, several manufacturers and at least one major catering firm, Compass, have said that they would welcome legislation of this sort. It would not end competition, but all products would have to conform to the nationally agreed standards. These standards should be set by the Food Standards Agency—of which more later—which should act on the expert advice of the Scientific Advisory Committee on Nutrition.

This brings me to an important question for the noble Earl. In the bonfire of the quangos that was trailed in the Daily Telegraph two weeks ago, SACN was included among the 170-odd bodies to be abolished—as was the School Food Trust and a number of other health-related organisations. If these are to be abolished, what is to take their place? The Government will always need expert advice, particularly now that we have major nutrition-related health problems. I hope that the noble Earl will assure us that these useful—I would say vital—watchdogs will be retained. If not, I hope that he will explain what is to take their place.

A crucial feature of scientific advisory committees is their independence from government and from industry. How is this to be retained? Perhaps the noble Earl will bring us up to date on the future of the Food Standards Agency. Which of its functions will be retained by the part of it that remains and which will be merged with existing departments? The current information is that its nutrition division is to go to the Department of Health and its food safety responsibilities to Defra. If so, this would be a backward step indeed, since the FSA was created in part to take this responsibility away from Defra following its mishandling of the BSE epidemic. What will happen to the much admired independence and transparency of the FSA?

I think that noble Lords will see where I am coming from. If we wish to see an improvement in the nation's health, more use must be made of statutory regulation of food manufacturing, advertising and marketing. This is another area that I would like to cover, but I have not got time. The noble Lord, Lord Whitty, spoke about advertising, as did other noble Lords. I think that regulation will be effective, even sometimes without being enacted, if the industry feels that there is an imminent possibility of its introduction. That may set the ball rolling, as we have seen in the case of salt reduction. However, here, as other noble Lords have said, there is still a long way to go.

In conclusion, I think that the Government would be wise to follow more closely the independent scientific advice which is available on the action that needs to be taken to improve our diet and thus reduce the burden of chronic illness.