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Foresight Review of Obesity

12.32 pm

The Secretary of State for Health (Alan Johnson): The chief scientific adviser and his Foresight team have today published the report, “Tackling Obesities: Future Choices”, which pulls together the latest evidence and expertise on this vital issue and seeks to answer the question: how can we deliver a sustainable response to obesity over the next 40 years? Foresight exists to challenge existing policy, and the report is nothing if not challenging.

The report predicts that, on current trends, by 2050, 60 per cent. of men, 50 per cent. of women and 26 per cent. of children and young people will be obese. Incidents of type 2 diabetes are set to rise by 70 per cent.; attacks of stroke by 30 per cent.; and cases of coronary heart disease by 20 per cent. Obesity-related diseases will cost the nation an extra £45.5 billion a year.

The implications for those individuals who are directly affected are profound. An obese young man who remains obese, as most are likely to do, will die, on average, 13 years younger than his peer group. However, the report is based on current trends. Our destiny need not be pre-ordained, and we can buck those trends, provided that we are all prepared to take the necessary steps. Indeed, the work assembled for this project gives the UK a platform to become a global leader in tackling a problem that is challenging policy makers across the world.

In recent years, we have focused more closely on child obesity. Sure Start children’s centres provide parents with high-quality health advice in the crucial pre-school years. We now intend to start earlier still with the proposed nutritional grants for pregnant mothers. Over the past three years, the share of children on the school fruit and vegetable scheme who are eating five a day has increased from just over a quarter to just under a half. We have introduced tough new nutritional standards; we are investing almost £100 million a year to improve school food; and we have added an entitlement to cooking lessons on the national curriculum. We have established the national child measurement programme, which will provide the largest database of its kind in the world on children’s weight. In 2004, only half of all pupils did two hours of high-quality PE and sport every week; today the figure is 86 per cent. We are now raising our sights so that every child has the chance of five hours sport every week, backed by a further £100 million of additional investment.

Working with the Food Standards Agency and the food industry, we have introduced front-of-pack labelling, and we have worked with Ofcom to prohibit television advertising of foods that are high in fat, salt and sugar during children’s programmes. This was a bold measure, but we are determined to go further if the evidence supports the need to do so. We will therefore be reviewing the impact of the restrictions on the nature and balance of food promotion to all children, across all media.

The Foresight report endorses interventions such as these, but argues for an even bolder approach. The report says that although personal responsibility is a
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crucial determinant of our body weight, our environment also plays a vital role. The chilling reality is that modern life makes us overweight. As Sir David King puts it:

Modern transport systems, sedentary jobs and convenience food make life more comfortable, but also lie at the heart of this dilemma. In a sense, we are victims of our economic success. The pace of technological revolution outstrips human evolution.

Tackling this problem calls for a fundamental shift in approach. Although the report projects us forward 50 years, it does of course require action today, and many of the areas identified in the report cannot be tackled successfully by Government alone. I hope this report will trigger the national debate that is essential if we are to rise to the challenge.

The report highlights the responsibilities of employers to look after their employees’ health, which is in the interests not just of their staff, but of the business: enhancing performance and improving productivity. The report also shows how small changes to everyday routines can make a real difference. For instance, employers might look at providing loans for bikes, not just season tickets; subsidising gym membership, not just canteens; and even putting out fruit at meetings, rather than biscuits. But the report also points to more substantial measures—for instance, with the built environment. Local authorities must ensure that healthy living is built into the infrastructure of our towns and cities so that planning systems improve our health and well-being.

The report examines the availability of, and exposure to, obesogenic food and drinks. Front-of-pack labelling is now increasingly prevalent, but industry has yet fully to embrace the colour coding system. There is emerging evidence that the FSA's labelling system is more effective at informing consumers and I want to work with the industry to see this adopted, but the report underlines the expectation for change. I have also asked the FSA to conduct an immediate investigation into the use of trans fats, to examine whether there is more we should ask the food industry to do in this area.

The report talks about the importance of targeted public health interventions. There are regional disparities in the prevalence of obesity and I hope that primary care trusts will look at what more can be done through advice and training in health consumption and activity to help obese people to achieve sustainable reductions in their weight. Underpinning all this is an acknowledgment that Government must do more. We will develop a comprehensive cross-government strategy on obesity to respond to the evidence in this report. Because of the need for concerted action on a number of fronts, I will convene a cross-governmental ministerial group to guide our approach.

We will continue to focus particularly on children. More than 80 per cent. of obese 10 to 14-year-olds remain obese into adulthood. As part of the spending review, we have already set our ambition to reverse the growth in obesity so that, by 2020, we reduce the proportion of overweight and obese children to the levels in 2000. Ensuring that our health service is as
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focused on prevention as it is on treatment is already a priority, and obesity epitomises the need for that change.

In the past, tackling obesity has always been regarded as a matter of personal will-power, but as the report starkly demonstrates, people in the UK are not more gluttonous than previous generations and individual action alone will not be sufficient. Obesity is a consequence of abundance, convenience and underlying biology. Solutions will not be found in exhortations for greater individual responsibility, or in what the report calls the futility of isolated initiatives.

Let us begin the national debate here in Parliament today, and let us use the report to forge the consensus that will allow the UK to pioneer the new long-term integrated approach that the issue desperately requires. I commend the statement to the House.

Mr. Andrew Lansley (South Cambridgeshire) (Con): I am grateful to the Secretary of State for advance sight of his statement. Indeed, I am grateful—I hope that the House is grateful—to all those who worked on the Foresight programme and for their report.

The Foresight programme makes a clear argument: our human biology has not much changed, but our environment and our society have. We lead less active lives; we enjoy plentiful energy-dense foods. It has become normal to be overweight. It will become normal to be obese if we do not act now. Our response to this needs to change or the slide into obesity will create an epidemic of disease and the national health service will not cope.

The public health Minister, the right hon. Member for Bristol, South (Dawn Primarolo), called this a “wake up call”. If it is, the Government have been asleep for the past decade while the alarm bells have been ringing. When the Labour Government came to office, they abolished the target on obesity that was set in the 1992 “Health of the Nation” White Paper. In 2004, the Health Committee’s report on obesity said:

In 2004, the Government abandoned their previous stance and set a target to halt the rise in childhood obesity by 2010. Since then, the rates have continued to go up, and what has been the Government’s response to that? It had been to push the target back from 2010 to 2020. Frankly, we can see why they have failed. The Secretary of State talked about the child measurement programme, but what is the point of a programme that does not lead to any action? Children are measured so that there is an ability to take subsequent action. This is the way in which the Government work: targets as a substitute for achievement when what we really need is action—not gimmicks or one-off initiatives, but a sustained plan. As the Foresight programme makes clear, that plan has to tackle the whole map of factors that contribute to rising levels of obesity.

The plan must start with nutrition in pregnancy and early years. There is no evidence that the Secretary of State’s voucher scheme alone will work. The National Institute for Health and Clinical Excellence has proposed guidelines for early years nutrition and all those proposals need to be supported. The plan must
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include the reformulation of foods. My colleague in the European Parliament, John Bowis, earlier this year led a parliamentary initiative to ban synthetic trans fats in Europe.

As the Government said earlier this year, saturated fats are the greater public health hazard. We need a supply chain initiative that will reduce fats, sugar and salt progressively and substantially. We must also promote good diet, targeting certain junk foods—today the Prime Minister called them “unacceptable foods”. Nutrient profiling that stigmatises all cheese as a junk food just forfeits credibility.

Three years ago, when the Government published their public health White Paper, I argued for a combined traffic light and guideline daily amount system of front-pack food labelling. The Government got it wrong then, and now we have several confusing labelling systems. Will the Secretary of State today agree that the Government will back a combined traffic light and GDA labelling scheme?

Will the Secretary of State commit today to a national research centre on obesity? Will he commit to a nationwide programme to identify cardiovascular risk? Will he commit to supporting proven exercise referral schemes? Will he commit to ring-fenced public health budgets so that we cannot carry on seeing such budgets being raided to meet national health service deficits? Will he explain to the House why the number of public health staff has halved? Will he explain why primary care trusts are not on track to have trained school nurses in place by 2010, as was promised? Will he tell the House why the lottery funding for community sport has been halved, when half the population do no sport and take no active recreation?

Today, the Secretary of State said that he will develop a comprehensive cross-Government strategy on obesity. Three years ago his predecessor said at the Dispatch Box that he would develop a cross-Government campaign on obesity. The words do not change, but delivery never takes place. For a decade, the Government have presided over an escalating public health crisis. A succession of gimmicks has had little impact. There has never been the comprehensive action that is required. The issue is not just about individual choices; it is about social responsibility—our responsibility for our health. It is about stronger families that give young people the guidance and self-esteem necessary to make healthy choices and lead healthy lives, stronger communities that promote activity and sport, and corporate social responsibility to promote good diet and cuts to fats, sugar and salt, and to ensure that affordable diets are on offer in the most deprived areas.

There is an analogy to climate change. In both cases, we need a cultural shift, technological innovation, a framework of legislation, and Government action, and we need individuals to respond. My right hon. Friend the Leader of the Opposition and the Conservative party have led the argument for a greener Britain through social responsibility. I can today commit the next Conservative Government to meeting our obesity and public health challenges, through social responsibility, to ensure a safer, greener and healthier Britain.

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Alan Johnson: I echo the hon. Gentleman’s words about the work of the Foresight team. The review is a comprehensive piece of work. A group of experts spent two years formulating the evidence, and the review gives us an opportunity to become world leaders in tackling the problem. I really do not want to look back—

Mike Penning (Hemel Hempstead) (Con): I bet you don’t.

Alan Johnson: Well, I just think that the report deserves discussion in Parliament, rather than a simple Punch and Judy show. [Interruption.] Well, I do believe that. I believe that obesity is one of the long-term issues on which politicians have an obligation to forge a consensus. I do not expect the Opposition to be in power for at least another 20 or 30 years, but undoubtedly Governments will change. Undoubtedly the Opposition will be in power at some stage over the coming years—I leave aside the Liberal Democrats. We must forge a consensus on the issue that allows the British people to believe that whatever Government come along, there is a comprehensive, integrated strategy to deal with what the Foresight report says is one of the most profound dangers and threats that the world faces.

Having said that, I will go through the points made by the hon. Member for South Cambridgeshire (Mr. Lansley) before I end my response by saying that I agree with much of what he said about the need to tackle the issue of good diet and the need to involve Ofcom more closely. Any objective look at what has happened in the past few years would suggest that, as the Foresight report recognises, the Government have taken a number of measures that are crucial to tackling the issues, and child obesity in particular. The first thing to say is that we commissioned the report. We set up the Foresight unit specifically to look at the issues long-term.

Secondly, we introduced the tough new nutritional standards that have been in place since September as regards the rubbish that was in vending machines in our schools. Over the past three years, the share of children on the school fruit and vegetable scheme who eat five a day has gone up from a quarter to just under half. Some 86 per cent. of school children now do at least two hours of high-quality sport or physical education. The Department for Transport is investing £15 million in the national cycling network, and 450 schools are due to benefit from that. We put £1 billion more into sport in this country. All of those measures and more are important, but that brings us back to the Foresight group’s comment about the futility of isolated initiatives. What we need is much greater integration, and the Government need to do more in that regard as well, but we need to forge a political consensus on the matter across the House.

The hon. Member for South Cambridgeshire (Mr. Lansley) says that we have abandoned the target for 2010. We had a fairly modest target of stopping the rise in childhood obesity by 2010. As part of a discussion of the latest round of public service agreements, and educated by the early draft of the Foresight report, we decided to be far more ambitious and say that rather than halting the rise, we should reverse it to 2000 levels. That will take longer than 2010, which is why the aim is to achieve the target by 2020.

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The point that the hon. Gentleman makes about the national weighing and measuring programme is right. I agree that we need to give that a legislative push. From the early results, it looks as though we are getting about 90 per cent. compliance, but that must be properly tested.

I do not agree with the hon. Gentleman about ring-fenced budgets. I am surprised by his remarks. Opposition Members have been speaking about the need for the NHS to be separated from politicians, with no targets and with the money being handed down and local trusts allowed to get on with it. The right approach is for us to give the money out to health trusts and to make them responsible for dealing with the issue, ensuring that there are indicative measures. The proper place to put the emphasis on public health is through the operating framework. We will do that at the end of the year.

The hon. Gentleman’s other point—on public health staff—is a hardy perennial, and I was disappointed that he raised it in this debate. The number of nurses working in primary and community care settings has increased by 31,500 or 40 per cent. since 1997. That includes a 35 per cent. increase in the number of school nurses, so the number of people working on health in communities has increased enormously, as has the budget for public health and throughout the health service. All our aims are predicated on the massive increase in investment that we have put into the health service since 1997.

I agree with the hon. Gentleman about where the focus needs to be now. Indeed, I dealt with that in the statement. We need to ensure that we go further on colour coding and that we talk to the industry. We do not want to be attacked for unnecessary regulation. We want to persuade the industry, with the benefit of the report, that we all have a responsibility. Of course the Government have a huge responsibility, but so do others. If the Foresight report does not point us in the right direction, nothing will.

Norman Lamb (North Norfolk) (LD): Another day, another health statement. It is good to be back.

Dr. Julian Lewis (New Forest, East) (Con): Another day, another Lib Dem leader. [Laughter.]

Norman Lamb: The humour from the Conservative Benches is wonderful, but the guffaws are slightly forced.

I thank the Secretary of State for early sight of the statement. He is right that the report must be taken seriously. Unless we take decisive action, the consequences for people’s health of obesity, such as diabetes and heart conditions, could be devastating and will bankrupt the NHS. It is important to stress that we should all take personal responsibility as individuals and as parents. Perhaps the three of us Front-Bench spokesmen should take part in the Great London run next year. I invite the Secretary of State to join me. I did it this year, and the Lib Dem health team is in pretty live condition— [Interruption]. Mr. Speaker, come to my aid. There is an awful lot of noise in the background.

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Mr. Speaker: Order. In order to help the hon. Gentleman out, we must let him speak and ask questions.

Norman Lamb: It is also right that we should hold the Government to account for their action or inaction. Is this not a case of “here we go again”? In 2004 the White Paper promised a long-term strategy to tackle obesity, and Wanless urged joined-up thinking. In a high-profile announcement the Minister for Employment and Welfare Reform, the hon. Member for Don Valley (Caroline Flint), who was a Health Minister at the time, was put in charge of tackling obesity. Now, after three years of inaction, what do the Government propose? They propose a three-year comprehensive strategy on obesity. I know that the Government are famous for repeating announcements, but to take three years to repeat the announcement seems to take the biscuit.

Dr. John Pugh (Southport) (LD): Not the biscuit!

Hon. Members: The fruit.

Norman Lamb: Indeed, take the fruit.

We also have the inevitable, rather vacuous claims that the UK can be a world leader on the subject, yet in the real world the problem is getting massively worse and the UK compares badly with most other countries. Why did Derek Wanless conclude that his 2004 recommendations had effectively been ignored? Why have the public health budgets been raided to stave off financial crisis in many parts of the health service? Why have we no idea about how much we are spending on public health? How on earth can we monitor it if we do not measure how much we are spending on it in a given year? Why has the number of public health consultants and registrars declined?

Why has the take-up of school meals declined by almost 500,000 in the past two years? Schools now have to weigh their children, but why is there no follow-up action to give the schools the opportunity to do anything to tackle the problem that they uncover? Is it not right that the top priority must be to tackle child obesity, both through more exercise and through better diet?

The report highlights the risk of polarisation of society between

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