Feature Public Health

Is the UK turning the clock back on public health advances?

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c6691 (Published 23 November 2010) Cite this as: BMJ 2010;341:c6691
  1. Jacqui Wise, freelance journalist, London
  1. jacquiyoung1{at}gmail.com

With the white paper on public health due out any day now Jacqui Wise asks whether the coalition government’s anti-regulation, pro-industry approach is ill judged

The coalition government in the UK stands accused of allowing the food and drink industry to dictate public health policy. This follows the revelation that the newly formed committees charged with “creating a new vision for public health” are packed with industry representatives from companies such as McDonalds, PepsiCo, and Kellogg’s.

A number of other moves have also been made. Since coming to power in May the government has dropped the traffic light food labelling scheme, rejected minimum pricing of alcohol, and refused to honour the Labour government’s pledge to extend free school meals to all children living below the poverty line. The coalition has also suggested that it may overturn the ban on cigarette vending machines and point of sale advertising of tobacco, which was due to come into force starting next year.

Many of the announcements made by health secretary Andrew Lansley have been positively received. He has announced there will be a new Public Health Service with a ringfenced budget. In addition there will be a cabinet subcommittee on public health. The role of local government in improving public health will be strengthened.

But aside from the rhetoric the signals coming out of Whitehall might not look good to public health professionals. The recent “bonfire of the quangos” led to the loss of the Health Protection Agency, the independent body giving advice on public health matters. The Food Standards Agency has been radically reorganised so that it is a shadow of its former self, having lost responsibility for nutritional policy and food labelling.

The FSA led calls for the Europe-wide introduction of a traffic light system that required food companies to label their products with red, amber, or green symbols to denote the amounts of fat, saturated fat, salt, and sugar contained per serving. This was buried by the European parliament when MEPs backed a rival system of guideline daily amounts favoured by industry. The food industry had lobbied intensively against the scheme sparking accusations that the government had “caved in to big business.”

Professor Lindsey Davies, president of the UK Faculty of Public Health, said: “I am very disappointed about the food labelling decision. I know there were EU considerations but countries can be brave about such issues. I think it is surprising as this government says they are all about making choices easier for individuals.”

Professor Martin McKee, professor of European Public Health at the London School of Hygiene and Tropical Medicine, added: “The evidence on food labelling is unequivocal. A failure to introduce a traffic light scheme is the clearest possible indication that the food industry is in the driving seat.”

The coalition government has also axed the marketing budget for Change4Life, the healthy living campaign, calling on the food and drink industry to fund it instead. Lansley said in July: “We have to make Change4Life less a government campaign, more a social movement. Less paid for by government, more backed by business.”

The government has said it wants to work with business to draw up new “responsibility deals” based on social responsibility not state regulation. The aim is to create a new vision for public health where all of society works together to get healthy and live longer. Further details of how this will be achieved and the remit of these responsibility deals are not yet known but are due to be published in the forthcoming white paper.

What is known is that of the 24 members of the overarching public health responsibility deal, more than half are from industry (see box). These include representatives from the five biggest supermarkets, Unilever (manufacturer of Pot Noodles and Walls ice cream), the Wine and Spirits Trade Association, the Food and Drink Federation, the British Hospitality Association, and Diageo (spirit and beer producer).

Members of the Public Health Responsibility Deal—overriding body

  • Andrew Lansley, health secretary

  • Paul Burstow MP, care services minister

  • Anne Milton MP, public health minister

  • Cancer Research UK

  • British Retail Consortium

  • Dame Carol Black, national director for health and work, Department for Work and Pensions

  • The Co-operative

  • Tesco

  • Diabetes UK

  • Sainsbury’s

  • Fitness Industry Association

  • Unilever UK & Ireland

  • Which?

  • Compass Group

  • Wine and Spirits Trade Association

  • Local Government Association

  • Lindsey Davies, president, Faculty of Public Health

  • Food and Drink Federation

  • ASDA

  • National Heart Forum

  • Morrison’s Supermarket plc

  • Susan Jebb, head of nutrition and health research, Medical Research Council

  • Advertising Association

  • British Hospitality Association

  • Diageo GB

  • Yvonne Doyle, regional director of public health, South East Coast SHA

The chairs of each of the five networks
  • Food network—Susan Jebb, Medical Research Council

  • Alcohol network—Jeremy Beadles, Wine and Spirits Trade Association

  • Health at Work network—Dame Carol Black, National Director for Health and Work

  • Physical Activity network—Fred Turok, Fitness Industry Association

  • Behaviour Change network—Paul Lincoln, National Heart Forum

Under this main public health deal there are five networks covering food, alcohol, health at work, physical activity, and behaviour change. Two of the five chairs are from industry—Jeremy Beadles, chief executive of the Wine and Spirits Trade Association, is to chair the alcohol network and chairing the Physical Activity Network is Fred Turok from the Fitness Industry Association.

The Department of Health refused to give out the full list of members of the five networks but according to the Guardian it includes fast food companies McDonalds and KFC and processed food and drink manufacturers such as PepsiCo, Kellogg’s, and Mars. All a spokesperson would say was: “For the forthcoming Public Health White Paper we’ve engaged a wide range of people, to help us develop the Responsibility Deal drawn from business, the voluntary sector, other non-governmental organisations, local government, as well as public health bodies. The Deal needs to result in practical changes which help people make healthier choices about what they eat and drink and how to become more active. Change is needed from national level right down to grass roots.”

Professor Andy Haines, former director of the London School of Hygiene and Tropical Medicine, said: “There is a good case for consulting with the private sector but they have obvious conflicts of interest. It seems to me that the balance on these committees is too far in favour of industry.”

Vivienne Nathanson, head of BMA science and ethics, agrees: “I worry that policy seems to be being led by industry not the other way round. It would be difficult to make joined up policy in this way.” She adds: “We know that the tobacco industry was very successful in slowing down legislation on tobacco and we worry that the food industry may slow down effective policies in the same way. Does the government make policy on the basis of good scientific evidence or on the terms of what is feasible or easy for industry?”

The Faculty of Public Health, which has called for a ban on transfats in food, minimum alcohol pricing, and a ban on junk food advertising in pre-watershed television, is represented on many of the Responsibility Deal groups. Professor Davies said: “We had a long and hard discussion about joining. Of course we had concerns about it but the overall view was that it was important that our voice was heard and to give it a go. I think there has to be a conversation between industry and the profession.”

Dr Alan Maryon-Davies, honorary director of public health at King’s College, London, is on the physical activity network. “It’s early days yet and there is all to play for. It is up to the public health people to engage with the discussions and get the best out of it. But I would like the deliberations to be open and transparent and minutes to be publicly available if possible.”

Another concern of public health doctors is that the coalition may overturn the ban on cigarette vending machines and point of sales advertising passed in the last few months of the Labour government. The Tobacco Act requires supermarkets to get rid of point of sale displays by late 2011 and newsagents by October 2013. Those who manufacture and sell tobacco products have lobbied hard against this law. The coalition has suggested it may overturn the ban saying in a parliamentary question earlier this year that it would give further consideration to the policy because of the challenges facing “business competition and costs.” Cigarette manufacturers have also threatened to seek a judicial review of the ban. However, the government is said to be considering forcing tobacco companies to package their cigarettes in plain brown wrappers in a move that has been welcomed by health campaigners.

The BMA has called for government to commit to banning tobacco displays in shops after research published this week in the journal Tobacco Control shows that similar legislation in Ireland has not harmed business and has helped young people to quit smoking.1 Dr Nathanson said: “This will be an important marker of the government’s intentions on public health. It will be a line in the sand. It will be very worrying if they don’t go ahead with this. “

Lansley’s approach is one of individual engagement and responsibility. He has said he wants to move away from “lecturing or nannying” instead “nudging individuals in the right direction.” Dr Maryon-Davies comments: “The whole anti-regulatory or ‘light touch’ regulatory approach does bother me. I know from bitter experience that voluntary agreements don’t really work unless they are backed by the threat of regulation. One example was in salt reduction.”

And Dr Maryon-Davis again: “One general concern with the white paper is that a lot of change is going through at the same time as a lot of cuts are happening. It is going to be a real challenge. In a recession people rely even more on props such as smoking and cheap food. It is important to make the healthy choices the easy choices.”

Much of the forthcoming white paper on public health is expected to focus on the organisation of the new public health service and detail how local authorities will work to improve public health. However, it should also give an indication as to what the government’s intentions are regarding the balance between regulation and personal responsibility. As always the devil will be in the detail.

Public health initiatives axed or under threat

  • Free school meals—currently available only for families receiving unemployment benefit. The coalition government has said it will not honour the planned extension of the scheme to all families below the poverty line, which is calculated at £19 500 a year for a couple with two children

  • Free swimming—the scheme for the under-16s and over-60s was launched by the Labour government two years ago as a London 2012 Olympic legacy initiative. But the Sports and Olympics minister, Hugh Robertson, said that the scheme was “a luxury” that could no longer be afforded

  • All ringfenced funding for school sport is to be cut

  • Speed cameras—the government has stated it will not fund any more new fixed site speed cameras. It has also announced a 37% reduction in the road safety support grant funding provided to local authorities for road safety purposes

  • Traffic light labelling of food—will not now go ahead after the European parliament backed industry’s preferred option of guideline daily amounts

  • Minimum pricing of alcohol—recommended by NICE, the Royal College of Physicians, and others but rejected by the coalition government (as it was under Labour)

  • Point of sale advertising of tobacco—the coalition has suggested the forthcoming ban may be overturned

Notes

Cite this as: BMJ 2010;341:c6691

Footnotes

  • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

References