Childhood Obesity

Caroline Johnson Excerpts

Tuesday 16th October 2018 Commons Chamber

[Ms Nadine Dorries (Mid Bedfordshire) (Con)]

Let me first declare an interest: I am currently taking part in a television experiment relating to obesity.

The United Kingdom is now the third most obese nation in the world. That is a shocking fact, especially when, as we know, the second biggest preventable cause of cancer is obesity. This is a crisis, and as always when there is a crisis, the innocent victims are the children. The obesity crisis that is hitting the UK is no exception: the victims are the vulnerable, the poor and the children.

I pay tribute to Andy Cook, the director of the Centre for Social Justice. The work of that prestigious organisation does not receive the praise or recognition that it should. A report produced by the CSJ, “Off the Scales”, provides an in-depth analysis of the obesity crisis facing the UK and makes a series of recommendations that complement the Government’s own obesity strategy report of 2016. However, the difference between the two reports is fundamental.

The CSJ report takes a holistic, headline view that is workable and suggests pathways towards the measuring of deliverable outcomes and progress. It highlights the success of implementing a joined-up cross-organisational and cross-departmental strategy to solve a problem that is costing the taxpayer more than £30 billion a year, and, more importantly, costing the lives of a future generation. It highlights some of the weak areas in the Government’s childhood obesity plan, which was published by the Department of Health in August 2016 and aimed to reduce childhood obesity rates in England over the next 10 years. It is a good plan, but it has little chance of making any impactful difference, as there is little in the way of joined-up thinking or leadership, or accountability, on the part of individual Departments.

Let me explain, in the starkest terms possible, why this issue is so important. For the first time ever, one in four children of the next generation will die younger than their parents. Nearly a third of all children aged between two and 15 are overweight or obese, as the Government report itself highlights. Younger generations are becoming more obese at earlier ages, and obesity doubles the risk of dying prematurely, so this is an incredibly serious problem. I am not sure that many parents know that, but they should, and we should be doing more to make sure that they do.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I congratulate my hon. Friend on securing this debate on such an important topic. Does she agree that this is a major health crisis affecting young children? Not only will those children die younger than their parents and before they would have expected to, but they will experience more suffering during their life due to the ill health caused by obesity.

[Ms Dorries]

I thank my hon. Friend for that intervention. She is a doctor and knows more than most about the health impacts of obesity, which include diabetes and other illnesses that are costly both to life and the Government.

--- Later in debate ---

[Ms Dorries]

The hon. Gentleman nearly got a speech in there. As I said, I will go on to address funding issues.

The parents on whom this issue impacts the most, and who are most likely to be affected, are those who make the poorest nutritional choices. They do not take The Times, or spend time on the internet reading the news or visiting any other sites where information about the effects of obesity on their children is likely to be repeated. They are also the parents who live in areas of higher deprivation. The fast-food, junk-food giants place more of their outlets in such areas than in areas of affluence, which makes the temptation easier and the consequences more impactful.

What can we as a Government do? I want to praise the headteacher and staff at Shillington Lower School in my constituency. Every morning after assembly, every child joins in with 15 minutes of vigorous exercise. Some are outdoors, running around the field perimeter, while others are in the hall doing boot camp with the cyber coach. That is in addition to their normal PE lessons and physical activities. The school actively encourages walking to school, and I have to say that Shillington Lower School’s efforts are there to be seen, but that is one approach, in one school in one village.

I am doing my little bit by embarking on a tour of schools in my constituency, and I am speaking to public health officers at Central Bedfordshire Council to find out how much more we can do locally in my Mid Bedfordshire constituency. However, this piecemeal approach is part of the problem. We have local council initiatives, as well as individual schools, teachers, parents, elected Mayors, public health officers, social workers and health visitors all doing their own little bit, and while that is all incredibly worth while, no one knows what the other is doing. The approach is taken on the basis of good intentions, but it is far from being an effective plan to deliver any measurable results.

This issue should be a governmental and departmental priority, regardless of Brexit and the noises off. This crisis has nothing to do with Brexit and everything to do with the lives of our children, yet there is no plan that co-ordinates a national strategy to make dealing with this issue a priority, and there is zero leadership from the top—I am very sad to say that. A national crisis requires leadership and a holistic, co-ordinated headline plan. Tackling this problem needs to be one of the Government’s top five priorities, and that needs to include funding.

The Minister is very much doing his bit, in line with the Government’s obesity plan. That is a great achievement, but sadly it is nowhere near enough to tackle the problem. The Minister is a good, conscientious and pragmatic man, and the father of healthy and very beautiful young children. I know that he personally is as worried about this as anyone else, but he is just one Minister in one Department, although I accept that his is the Department that should be leading on this, in accordance with the Government’s aims and objectives in this area. However, if we had some high-level leadership and direction, we could have all the Departments working together towards one strategy and working together as one taskforce to establish our short, medium and long-term goals to reduce the weight of the nation and in particular of our children.

In fact, the Minister is the only person who is accountable for tackling this national crisis. As “Off the Scales” highlights, there is little or no direct accountability among Departments for the childhood obesity plan, other than the Department of Health and Social Care and a small requirement on the Department for Education. What about the Ministry of Housing, Communities and Local Government? What about the Department for Digital, Culture, Media and Sport, given that sport is one of the biggest players in the fight against obesity? What about the Department for Environment, Food and Rural Affairs, the Department for Transport and the Treasury? We know that the Treasury is the place where all good ideas go to die, regardless of which party is in power, and it is not giving this national crisis serious consideration. So many people—from the wonderful staff at Shillington Lower School all the way up to the Department of Health and Social Care—are doing their own thing, but, sadly, none of this can be monitored or measured, because it is all entirely disjointed and unconnected.

The NHS has recently enjoyed a £20 billion cash injection. At present, only 0.2% of the NHS budget is allocated to Public Health England to deal with obesity and to put in place preventive strategies with regard to childhood obesity, yet the Government’s plan places huge responsibility on Public Health England to tackle this issue.

[Dr Caroline Johnson]

Does my hon. Friend agree that money spent on managing obesity is money well spent? In fact, the money that is invested in helping people to be more healthy will be recouped, because there will be less NHS spending on their ill health.

[Ms Dorries]

I think that my hon. Friend has seen my speech; my next point is that we are putting the cart before the horse.

There is a huge responsibility on Public Health England, yet it has only 0.2% of the NHS budget. The Government have reduced the public health budget by £600 million between 2015 and 2018 and increased the NHS budget for acute and hospital care. This complements my hon. Friend’s point, because they are pumping all that money into hospitals and acute care, but putting very little into strategies to prevent people from going into hospital in the first place. This imbalance in the NHS budget demonstrates how little attention and importance are being given to this crisis at the top of the Government by No. 10 and No. 11—particularly No. 11 and the Treasury.

As I said, the cart is being put before the horse. As a nation, we are allowing people to become ill. We are failing to prevent that from happening, but we are providing state-of-the-art hospitals and doctors in our amazing NHS to treat them. We should be placing our focus on preventing obesity, which is the second biggest preventable cause of cancer after smoking, and keeping people out of hospital.

Of all the nations that fund healthcare, we have one of the highest healthcare budgets in the world. We spend more each year on treating obesity and diabetes then we spend on our police, our fire service and our judicial system combined, yet we allocate only 0.2% of the NHS budget to Public Health England. When we cost out Public Health England and take out its accountable costs, we see that only a tiny fraction of that 0.2% is given over to obesity prevention and treatment in real terms. The chasm between treatment and prevention highlights the critical need for the Government to develop their approach to the delivery of public health services further and to ensure that prevention receives the investment it so desperately requires.

It is time for the Treasury to think forwards, not backwards, by reversing the reduction in councils’ public health budgets and providing local councils with the funding they need to tackle this problem head on. Local councils should be the major player in this strategy, yet they have seen their funding for public health services cut. They know their own demographics. They know the problems in their area, and they know how to deal with them. Local councils have already engaged as much as they can with this issue, and they are saving the lives of the next generation.

I cannot say it often enough or strongly enough: one in four children will die younger than their parents. If we lined up 50 parents and told them that figure, they would be shocked. Parents needs to know that information.

How much of the new £20 billion that the Government are allocating to the NHS will be made available to Public Health England and, in turn, towards funding the Government’s childhood obesity plan of 2016? As much as people scream and shout that the NHS is being starved of funding, the truth is that the recently announced £20 billion, along with savings from the £20 billion Nicholson challenge, amounts to a £40 billion uplift to treat people who are taken to hospital with illnesses induced by obesity.

Given that Public Health England has been given responsibility for decreasing the proportion of children leaving primary school overweight over a 10-year period, why is so little of the NHS budget allocated for preventive medicine? What uplift was PHE given to address this childhood obesity crisis? How is it supposed to achieve the aims and objectives set out in the 2016 plan? Does the Minister not believe that there should be a cross-departmental strategy, devised by Ministers, to set out in detail what each Department will do to achieve pre-determined goals? If that is not the case, we should engage in a national information and media drive to warn parents of the dangers of obesity. Allowing a child to become obese is almost as dangerous as putting cigarettes in their mouth.

I understand why the Department of Health and Social Care introduced a policy to cap the calories in various types of junk food, but it will not work—people will buy two. The voluntary sugar reduction targets in the 2016 plan have not been met by the main producers and providers of these foods.

Is it not time to introduce a mandatory approach? I am aware that the money raised by the sugar levy—I probably should have mentioned this earlier—is to be allocated to implementing some of the aims and objectives set out in the 2016 plan, and the Government’s approach is a welcome step, but where and to whom will that money go? Will it be allocated to local councils? Is it enough?

As we have seen with food producers that are not meeting the requirement to reduce sugar in food, will the same happen with the sugar levy? Will it actually make a difference? Will it give us the funding that we need to tackle this crisis? I would say not, because we are basing our plans on something subjective and unknown. We do not know how much the levy will raise. We do not know whether producers will reduce sugar in drinks and food. We do not know to what degree the sugar levy will work. As this is such a crisis, should we not be looking at more quantifiable measures?

Where will the money go? Is it not time to consider the recommendations of the Centre for Social Justice and develop a frontline approach? I cannot think of any Government policy on which all Departments work together and on which there is a non-political taskforce above the Departments run by an independent body to pull together policies from each Department to tackle an issue—that goes entirely against our culture—but that is what we need. Should we not work with companies that load food with sugar and set them mandatory goals, not voluntary goals, to reduce the amount of sugar over a period of time? Should we not introduce financial penalties? We have seen producers of products such as breakfast cereals do just that, but the problem is that it is not happening fast enough, it is not consistent and it is not equitable, because only some producers are doing it.

Only by adopting a long-term approach that is nationally led and locally driven, with the councils involved and heading it, that is overseen by an independent body outside the influence of party politics and that is championed by committed political, cross-party leaders will an effective childhood obesity plan ever be delivered. I do not want to chuck a bucket of cold fizzy drink over the Minister’s 2016 plan, because it is a great initiative and I hope it will make some difference, but I hope he understands my concern that the money just is not there to tackle this problem head on now. I go back to the substantive point in what I have just said: 0.2% of the NHS budget going to Public Health England, despite the sugar levy and the taxes we are going to raise, is just not saying, “We are committed to doing this,” and the money has to go to local councils.

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

Let me start by reiterating what my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), my good friend, has said: childhood obesity is one of the top public health challenges for this generation, if not the top one. I thank her for mentioning my two beautiful children—we are not sure where they get it from, although undoubtedly it is Mrs Brine. They are watching us right now, so for once I shall be useful to Mrs Brine and say, “Surely it must be time for bed after you’ve seen daddy.”

As Members will be aware, figures released only last week in the national child measurement study continue to show that our child obesity rates remain far too high. About a fifth of children are overweight or obese when they start primary school, and that rises to about a third by the time they leave. What is worse, as we have heard, is that the burden of obesity does not fall evenly across our society. The number of severely obese children living in the most deprived areas is more than four times that of those living in the least deprived areas—this is one of the burning injustices of our age. The effects of obesity have a profound impact on a child’s opportunities in life—on both their physical and mental health. We know that obese children are more likely to be bullied and have low self-esteem as a result. They are also more likely to become obese adults, which will give them a higher chance of developing certain types of cancer, type 2 diabetes, and heart and fatty liver disease.

So the Government are determined that we will lead the way in tackling childhood obesity. We have already heard from my hon. Friend about our 2016 childhood obesity plan, part 1—there was a clue in the title—and I agree with her that it is a good plan. It introduced bold, world-leading measures, such as the sugary drinks levy. I was in Argentina at the G20 earlier this month, giving a presentation about the work we are doing in this area. Many other countries around the world look to what is happening in England and are copying it. Since bringing in the levy, we have seen the equivalent of a staggering 45 million kg of sugar taken out of soft drinks through reformulation. As a result, hundreds of millions of pounds have been poured into improving opportunities for physical activity for children. My hon. Friend asked where the money was going—that is where it is going. It is going into the sport premium in schools. The Treasury has kindly agreed to double that sum. I will expand on the point about where it is being spent. She mentioned one example, but I have others.

We also challenged manufacturers to reduce the sugar content in some of the foods children eat most, and they responded. Tesco, Lucozade Ribena Suntory, Kellogg's, whose people I met this afternoon, Waitrose and Nestlé are just some of the companies that deserve credit and deserve a mention, as they are dramatically lowering levels of sugar in their products.

[Dr Johnson]

Will the Minister give way?

[Steve Brine]

Very briefly, because we do not have long.

[Dr Johnson]

I have a quick question: are these manufacturers of food and drinks products removing the sugar and making the products less sweet, or are they replacing the sugar with artificial sweeteners?

[Steve Brine]

They are doing both. As the representatives from Kellogg’s were at pains to say to me today, it is about healthy eating and quality taste. I passionately believe that that is true.

We were always clear that our 2016 plan was just the start of the conversation, and we are clear that more needs to be done. We always said that we reserve the right to do more, which is why in June this year we published chapter 2 of the child obesity plan. My hon. Friend the Member for Mid Bedfordshire asked whether there is a cross-departmental strategy; yes, chapter 2 is very much a cross-departmental strategy. It sets a bold ambition—what we like to think of as a north star—to halve child obesity and significantly reduce the gap in obesity between children from the most and least deprived areas by 2030. As with our initial plan, the new policies were informed by the latest research and emerging evidence, including from many debates in Parliament and various reports from key stakeholders. Those stakeholders include the Health and Social Care Committee and, yes, the Centre for Social Justice. In fact, the latter’s “Off the Scales” report is on my coffee table in the Department. It was the Centre for Social Justice that told me all about Amsterdam and it is because of it and its good work that I went to Amsterdam to see the work being done there.

Key measures in the next chapter include looking to address the heavy promotion and advertising of food and drink products high in fat, salt and sugar on television, online and in shops. Alongside that, we want to equip parents with the information that they need to make healthy and informed decisions about the food that they and their children eat when they are out and about.

My hon. Friend mentioned Brexit. Of course, there is never a debate in which we do not mention it, but there is a Brexit connection for this debate. One thing that campaigners call for is traffic-light labelling on the front of products. We are unable to do that while we are an EU member state, but once we are no longer, we will have new freedoms in that regard. I do not know whether that is what was meant by taking back control, but I put that on the record for the House.

I was pleased to hear of the efforts of Shillington Lower School in my hon. Friend’s constituency. Staff there are obviously doing all the right things to encourage children to take part in physical activity. I have seen great examples in my own constituency, most recently at Western Primary School, and I am sure that many other Members have seen good examples, too. Yes, it is about recognising that we need foods to be reformulated, but it is also very much about the importance of physical activity in tackling obesity. Yesterday, I opened a major physical activity and health conference across the way at the Queen Elizabeth II centre. It is going on all week and will consider the benefits of physical activity and health. As part of chapter 2, we are promoting a new national ambition for all primary schools to adopt the initiative of an active mile—or healthy mile; people call it different things.

I agree with my hon. Friend that achieving our ambition to reduce child obesity will require a concerted effort from many others, including families, schools and local authorities, which she mentioned. At the recent Local Government Association conference, I announced the trailblazer programme, which will work closely with local authorities to show what can be achieved and find solutions to barriers at a local level to address child obesity. I took great inspiration from what has been done in the city of Amsterdam. My hon. Friend is absolutely right that local authorities know their local areas best. By sharing ideas with each other—some very good things are going on—they can achieve the full potential of the powers and levers that they have. Many local authorities already have great powers and levers to change their areas. For instance, they have powers over junk-food advertising in the areas around schools. We want to see those powers used better.

As part of the second chapter, we have already launched the consultation on banning the sale of energy drinks to children—the message is clear: we do not think that they are appropriate for children—and the consultation on calorie labelling for food and drink served outside the home, or in the out-of-home setting, as they say. Later this year, we will launch consultations on restricting the promotion of fatty and sugary products by location and by price, and we will consult on further advertising restrictions, including a 9 pm watershed on high fat, salt and sugar products. Currently, products deemed HFSS are banned from being promoted only during programmes predominantly aimed at children. We will consult on taking that through to a 9 pm watershed. That work is with the Department for Digital, Culture, Media and Sport, the sugary drinks levy—the sugar tax—work is with Her Majesty’s Treasury, and the trailblazer programme work is with the Ministry of Housing, Communities and Local Government, so I gently reject the idea that this is not a cross-Government strategy. These consultations are genuine and are open to everybody, and we welcome full and considered responses from across society and industry.

So far as the future is concerned, we continue to learn from the latest evidence; my hon. Friend mentioned evidence. The Policy Research Unit informs us all the time of new approaches from across the UK. We welcome the action taking place in Scotland, which is consulting on its own obesity plan at the moment. It is good to see that many of our ambitions align. As I said, I often talk to partners in other countries about work going on internationally—I have mentioned Amsterdam a couple of times—and about where we can learn from them and, possibly, where they can learn from us..

My hon. Friend is also right to mention the additional £20.5 billion a year for the NHS that will support the new long-term plan. I cannot pre-empt what the NHS will put into the plan—the Prime Minister set NHS England the challenge of writing it—but we have been clear from the outset, and the new Secretary of State has been clear, that prevention should be a key part.

Our ambition is bold but simple. We have a lot to gain by reducing obesity, and we have an awful lot to lose. We believe that the hard, evidence-based actions that we propose will encourage healthier choices and will make those choices more readily available and identifiable to parents. Taken together, we are confident that those actions will have a real impact on child obesity. We will continue to monitor progress and emerging evidence. As we have always said, this is not the end of the conversation. We watch things like a hawk.

Finally, I reiterate my thanks to my hon. Friend for securing the debate, and to you, Madam Deputy Speaker, for facilitating it.

Question put and agreed to.