Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7129 Volume 316 News Saturday 7 February 1998 Food is a public health issue Professor Philip James has been the driving force behind Britain's Food Standards Agency, which is due to be set up in 1999. But, as he tells Caroline White, the battle to put food on the public health agenda is far from over Professor Philip James has long been convinced that something "very dramatic and different" had to be done to strengthen the weak links in the food chain. He submitted a report to the British government in May and is delighted that so many of his recommendations have found their way intact into last month's white paper on the Food Standards Agency in spite of persistent lobbying from sectors in both the food industry and the medical establishment (17 January, p 171). He feels that the whole tenor of the white paper is absolutely in keeping with what is required - that there needs to be a major overhaul of food standards "from plough to plate," which would prioritise the interests of consumers and preclude the agency from becoming "a disaster agency just explaining the cock ups." He had wanted, however, to give the Food Standards Agency clout by obliging other bodies to come through the agency to set the agenda. Professor James says there are "food ghettos" within Britain Photo: ABERDEEN JOURNALS So he is disappointed that responsibility for the food safety evaluation of pesticides and veterinary medicines will remain with the Ministry of Agriculture, Fisheries and Food. And he had wanted the Public Health Laboratory Service to report directly to the agency, from which the service would also receive funding for its work related to food. As director of the Rowett Research Institute in Aberdeen and a current or past member of the principal United Kingdom, European, and United Nations committees on food issues relating to public health, Professor James says that he would not have the time to lead the agency, even if he were asked to do so. "Because the agency must be very proactive in the public interest, it must choose people who carry weight, are competent, not easily intimidated, and who will not automatically follow the Ministry of Agriculture, Fisheries and Food," he cautions. How the agency will be funded has still not been resolved. But Professor James thinks that a proposed licence fee to fund about £60m ($96) of the projected £100m that the agency will cost, deftly avoids the requirement to provide new money from taxes or the public sector borrowing requirement. But this does not address what will happen as the agency develops and expands its activities. But the greatest victory, he feels, is that won for public health. The inclusion of advice and education on nutrition into the agency's remit was one of the most hard fought battles and has drawn fire on the grounds that it smacks of a nanny state. "You cannot generate a coherent strategy on health without including nutrition, and successive governments have had a hopelessly naive approach to it . . . half the middle aged people in Britain have overt nutritional disease when you think of the prevalence of coronary artery heart disease, hypertension, and diabetes." Britain lags a long way behind other industrialised nations in seeing diet as intrinsic to public health - an attitude for which he holds doctors largely responsible. "The medical establishment finds it hard to believe that food and nutrition have much to do with public health. For the past 50 years the NHS has fostered a pill popping culture, and doctors look for proof by virtue of intervention; drug trials are easier to organise, and food trials are notoriously difficult." Doctors, he says, simply haven't taken on board modern nutritional concepts or the fact that moderating diet can sometimes have a greater impact than drugs. One of the greatest challenges for the agency, Professor James thinks, is to address the basis for the confusion in the public's mind about diet and nutrition - in spite of the fact that all the major expert committees tackling the subject have reached similar conclusions. Part of the problem, he thinks, is that despite the considerable amount of food research carried out by the Ministry of Agriculture, Fisheries and Food, there has been little follow up of the recommendations. Nutritional advice is also important in restoring public confidence, he contends. "Other agencies which maintain public confidence always set standards on nutrition . . . Consumers have always been manipulated by industry on nutrition, and the fact that the industry is so uptight about it demonstrates why nutrition needs to be part of the agency's work." He believes that the way to tackle diet is to start young, with schools taking a much more proactive role than they do at present. He describes the weaning diets of British children as "appalling," and the diets of preschool children as "outrageous." He thinks that Britain needs "a complete revolution in the way in which we think about educational activity" and a strategy to narrow the social divisions in Britain, which, he says, produce "food ghettos." But for now the major challenge, he says, is how to tackle broader issues of public concern relating to food, for which "there are no instant answers." But one way forward, he suggests, might be to seek the public's views or to develop discussion forums. He cautions that the new agency needs to be careful not to define itself too precisely initially. "It needs to evolve and learn from its mistakes." It has been suggested that the agency should model itself on the Food and Drugs Administration in the United States, but that organisation is subject to considerable political pressure and does not involve the public, says Professor James. He would prefer the model to be based on Sweden's food agency, and he is clear that he wants Britain's agency "to expressly reject the confrontational model of British behaviour" so favoured by the legal, political, and medical systems. But he is certain that the government must have the courage of its convictions. The white paper is only the second stage in the consultation process in setting up the agency; there is still some way to go: "We now have the opportunity to create a new intellectual and social base for public health and make up for our failure to give it the really high profile it deserves." 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