Reducing Health Inequality

Debate between Alison Thewliss and Sarah Wollaston

Thursday 24th November 2016 Commons Chamber

[Dr Wollaston]

Those are extremely important points. The Government can introduce policies and make sure that there are levers and incentives in the system to make that happen. The drink-drive limit is a very important example.

We are not likely to make a difference to the gap in disability-free life expectancy without tackling smoking, which is a key driver for health inequality and accounts for more than half of the difference in premature deaths between the highest and the lowest socioeconomic groups. Without tackling it, we will not make inroads.

I would like briefly to touch on obesity and on the Government’s obesity strategy, which the Health Committee has looked at. To put the matter in context, the most recent child measurement programme data show us that 26% of the most disadvantaged children leave year 6 not just overweight but obese, as do 11.7% of the least deprived children. Overall, of all children leaving year 6, one in three is now obese or overweight. The situation is storing up catastrophic lifetime problems for them, and we cannot continue to ignore that.

In our report, the Committee called for “brave and bold action”. Although I really welcome many aspects of the childhood obesity plan—such as the sugary drinks levy, which is already having an impact in terms of reformulation—it has been widely acknowledged that there were glaring deficiencies and missed opportunities in the plan.

I would like to have seen far greater emphasis on tackling marketing and promotion. Some 40% of food and drink bought to consume at home is bought under deep discounting and promotion, and that is one of the potential quick wins that I referred to. We often focus in this debate on what people should not do, and this is an opportunity to look at what they should do. Shifting the balance in promotions to healthy food and drink would have been a huge opportunity for a quick win, because one of the key drivers of this aspect of health inequality is the affordability of good, nutritious food. This would have been an opportunity to tackle marketing and promotion, and I urge the Minister to bring that back into the strategy. I also urge the Government to extend the sugary drinks levy to other drinks, including those in which sugar is added to milky products, because there is no reason why it should be necessary to add sugar to such drinks.

I also welcome the mention in the plan of the daily mile, which has been an extraordinary project. I have met Elaine Wyllie, who is one of the most inspirational headteachers one could meet, and she talked about the strategy and about how leadership from directors of public health makes a real difference. I hope that the Minister will update the House on how that will be taken forward. We should think not just about obesity, but about physical activity and health promotion, and about the benefits that they could bring to all our schoolchildren.

The Health Committee stressed in our report the importance of making health a material consideration in planning matters when money is so restricted. I do not think that to do so would be a brake on growth; it would be a brake on unhealthy growth, and it would give local authorities the levers of power when they are making licensing decisions and planning decisions for their communities. That is something that Government could do at no cost, but with enormous benefit.

The Health Committee is actively considering how we reduce the toll of deaths from suicide. The Samaritans have identified that men living in the most deprived areas are 10 times more likely to end their life by suicide than are those in the most affluent areas. Many factors contribute to this—economic recessions, debt and unemployment—but when we try to tackle health inequality, we will not make the inroads that we need to make unless we look at the inequality in suicide, particularly as it affects men. Three quarters of those who die by suicide are men. I hope that the Minister will look carefully at the emerging evidence from our inquiry as the Government actively consider the refresh to the strategy, and that they will do so at every point when they look at how to tackle health inequality.

I would like the Minister to look at the impact of drugs and alcohol on health inequality. The fact that there are 700,000 children in the United Kingdom living with an alcohol-dependent parent is a staggering cause of health inequality, which has huge implications for those children’s life chances and for the individuals involved. Again, alcohol has a deprivation gradient; the two are closely linked.

There is evidence about what works, and we have had encouraging news from Scotland. The Scottish courts, I am pleased to say, have ruled that minimum pricing is legal, although I am disappointed that the Scotch Whisky Association has yet again taken the matter to a further stage of appeal. As soon as those hurdles are cleared, I think it would be a great shame if England undermined the potentially groundbreaking work being done in Scotland by failing to follow suit and introduce minimum pricing at the earliest possible opportunity; if we failed to do so, people would be able to buy alcohol across the border.

[Alison Thewliss (Glasgow Central) (SNP)]

I thank the hon. Lady for giving credit to the Scottish Government for what they have done on minimum unit pricing. I reiterate what she has said: it is disappointing that the matter has been taken to appeal yet again. Does she agree that there is a lot to look at from Scotland in terms of the smoking ban, which England then took up?

[Dr Wollaston]

I congratulate the Scottish Government. It does seem to be the case that where Scotland leads, England will eventually follow. Scotland is particularly good at following the evidence, and I call on us to do likewise. I am particularly concerned that the benefits that will come about when Scotland introduces minimum pricing will be undermined if we do not follow suit here, so I call on the Government to do so as soon as possible.

In summary—I know that many other Members wish to speak—there is a huge amount that we can do, and not all of it has a cost. I urge the Minister, in summing up, to look at all the possibilities. I urge her to stick with the Marmot agenda and to take a cross-Government approach, but to make sure that there is leadership at the highest level. The Prime Minister’s words in Downing Street were hugely encouraging. The Health Committee calls on the Prime Minister to appoint somebody at Cabinet level to take overarching responsibility for health inequalities and to put those fine words into action.

Childhood Obesity Strategy

Debate between Alison Thewliss and Sarah Wollaston

Thursday 21st January 2016 Commons Chamber

[Alison Thewliss]

I absolutely agree with what my good friend says. Bottle feeding tends to be at a set time—“Is it time for the baby’s feed yet?”—rather than when the baby actually needs to be fed, whereas breastfed babies are fed little and often on demand, which is a slightly better habit to get into.

There is also a beneficial effect on breastfeeding mothers. As well as reducing the risk of cancer and diabetes, breastfeeding burns calories and helps to get mothers back to their pre-maternity weight—for me the prospect of burning an extra 400 to 500 calories just by breastfeeding my baby was very attractive, and it certainly helped me to fit back into the clothes that I wore before I had my children, both of whom were breastfed for two years.

I was interested in the findings of the Select Committee report, and I particularly note the points about marketing and sugar content in foods. I was a wee bit disappointed that it does not contain much discussion on baby foods and toddler milks, as there are significant issues in that area regarding the advertising and the content of the products. In evidence to the Committee, Dr Colin Michie of the Royal College of Paediatrics and Child Health stated:

“Follow-on formulas are not necessary for human beings, but it would not seem so if you watch television. The problem is we are all very convinced by the stories. There are other issues that have parallels for what was said earlier in that the milk companies sponsor education, training, events and an awful lot of professional activities, which again does exactly, to our minds, what we heard it does to infants’ minds: when we see brand names, we equate certain things with them. It is an insidious business that we know enough of to be very wary of.”

The artificial creation of a market for follow-on or toddler milks is of some concern, because those products are not subject to the same level of scrutiny as formulas for very young babies. Research gathered by the First Steps Nutrition Trust suggests that

“Growing-up milks and toddler milks contain almost twice as much sugar per 100 ml as cow’s milk, and some Aptamil and Cow & Gate growing-up milks and all SMA growing-up milks contain vanilla flavouring. It is unclear whether repeated exposure to sweet drinks in infancy and toddlerhood might contribute to the development of a preference for sweet drinks in later life.”

It is important to take cognisance of that and consider the issue as part of the obesity strategy.

[Dr Wollaston]

I thank the hon. Lady for her powerful contribution, and I completely agree with what she says. I also agree that the advertising of follow-on milks is a covert form of advertising infant formula. Does she feel that that should be completely banned?

[Alison Thewliss]

Absolutely, and a lot of the advertising is very—I supposed we could say cunning. Products are made to look the same on the shelves and to match the adverts for follow-on milks, rather than those for the younger infant formulas, and more needs to be done about that.

The sugars in follow-on milks are not always made clear on the packaging, and that should certainly be of concern to us in this House. Establishing a sugar habit at such an early age should be discouraged, and as was said earlier, that also has an impact on the teeth of a growing child. Baby Milk Action has campaigned tirelessly on the marketing of formula, and it has been involved in challenging those issues in the European Parliament. There are related issues concerning the marketing and composition of baby food, and about the jars and packets found in supermarkets, which are often marketed at babies under six months, contrary to World Health Organisation advice.

Pressure from groups such as Baby Milk Action, and actions by MEPs such as the Green MEP Keith Taylor, led yesterday to the European Parliament rejecting draft EU rules on baby food. If they had been approved, they would have allowed baby foods to contain high levels of sugar, and products to be labelled for use from four months of age, rather than from six months, which is the advice. As a result, the Commission has been forced back to the drawing board to bring the regulations in line with recommendations of the WHO and the World Health Assembly, and to fit better with the international code on such issues. I would like further debate on the composition of baby foods, how they are marketed, where they are placed in supermarkets, and what advice is given to parents. Again, the sugar content and the rationale behind waiting until six months before bringing babies on to solid foods is not always made clear to parents.

Advice on such matters has changed over the years and has sometimes been conflicting, and well-meaning advice from family members can cause doubt in the minds of new parents. People need to have the best advice on feeding. All agencies should be clear about the advice that they give out, and we must guard the most vulnerable babies in our society against the vested interests of wealthy baby food and formula companies that seek to exert influence on professionals and groups giving out that advice. I hope that these issues will be given due consideration in the debate on obesity, and that thought will be given to the contribution that breastfeeding can make to improving infant and maternal health.