Big tobacco, the new politics, and the threat to public health
BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2164 (Published 15 May 2019) Cite this as: BMJ 2019;365:l2164
Whatever the eventual consequences of Brexit for the NHS,12 an article published in the Daily Telegraph in March made it clear that an even greater threat to public health in the UK may emerge from the battle for control of the Conservative Party.
In an essay published on 31 March, titled “The next Tory leader must be a bullish libertarian,” the director general of the free market think tank the Institute of Economic Affairs (IEA) set out what amounted to a manifesto for the new party leader.
The leadership election, wrote Mark Littlewood, was a chance “to rediscover an agenda supportive of . . . free markets and a smaller state.” Theresa May’s successor should ensure that “the plethora of censorious and hectoring measures over what British adults choose to eat, drink and smoke must come to an end.”3
What the IEA says matters. Credited by Margaret Thatcher in 1979 for having “created the climate of opinion which made our victory possible,”4 its free market fundamentalism is now back in vogue. “Bullish libertarianism” appeals to a significant faction of the Conservative Party, and, as the showcasing of Littlewood’s prescription in the Telegraph attests, any prospective leader is likely to emerge from the ranks of those who subscribe to the IEA’s ideology.
The institute has a longstanding commitment to dismissing public health initiatives as “nanny state” interventions.56 Its recent research publications have challenged the childhood obesity strategy,7 dismissed “sin taxes” as regressive,8 and ridiculed the link910 between fast food outlets and obesity.11 In the past year alone it has issued more than a dozen statements criticising everything from alcohol controls to sugar taxes as “pointless,” “absurd,” and “draconian” (see box B).
All of this might not be quite so worrying were it not for two facts: the IEA is or has been funded by some of the very industries that stand to gain commercially from its attacks on public health initiatives, and it is connected—ideologically, financially, or both—to no fewer than 25 serving Conservative MPs, including several candidates for May’s job (see box A).
The IEA is secretive about its funding sources, but The BMJ can report that the organisation is part funded by British American Tobacco. In the past it has also taken money from the gambling, alcohol, sugar, and soft drink industries. Meanwhile, politicians with links to the IEA seem to be progressing ever closer to power. The concern is that public health policies could be put at risk under a new Tory leadership, including current plans for calorie labelling and for advertising restrictions designed to tackle childhood obesity, as well as progress towards a minimum unit price for alcohol (see box C).
Political links
Among the MPs most closely and publicly associated ideologically with the IEA is Dominic Raab, MP for Esher and Walton in Surrey since 2010.
Raab, backed for the leadership by a “Ready for Raab” social media campaign1213 launched within days of his resignation in 2018 as secretary of state for exiting the European Union,14 has performed well in Tory grassroots polls,15 had his candidature endorsed by David Davis (another former Brexit secretary),16 and this month set out his stall as a tax-cutter-in-waiting in a flattering interview in the Sunday Times.17
In 2015 he spoke at the IEA’s 60th birthday celebrations, where he acknowledged his ideological debt to the organisation. In his speech he recalled the time he had gone for a swim off a Brazilian beach and found himself pleasantly swept along the shore by an unseen current. In “the fight for economic freedom,” he told the audience, “the IEA . . . will be like the warm, irresistible tide on that Brazilian beach—gently, powerfully, sometimes without us even knowing it, shifting the debate to a whole new place.”18
Raab remains close to the institute. Last month he appeared in an online video to launch the Richard Koch Breakthrough Prize, an annual essay competition run by the IEA.19 The institute, he said, was “well known for promoting free market principles, and they’re absolutely essential, now more than ever . . . get thinking, send us your ideas.”20
Asked by The BMJ whether Raab supported Littlewood’s libertarian call to arms, a spokesperson for the MP sought to distance him from the IEA’s view that public health initiatives were undesirable “nanny state” interventions that should be scrapped.
“Dominic has always been a strong supporter of public health initiatives to make the UK healthier and reduce pressures on the NHS [and] a big believer in the power of sport to transform people’s mental and physical health and the need for more education to tackle issues like childhood obesity,” the spokesperson told The BMJ.
Raab also believed that “all interventions need to be proportionate and evidence based. He therefore fully supported measures such as the ban on smoking in public places and better labelling and information on calorie content.”
The spokesperson declined to be drawn on whether Raab was aware that the IEA was funded by a major tobacco company.
Matt Hancock, England’s health secretary and considered to be a frontrunner in the Conservative leadership race,21 does not have direct links with the IEA but in recent years has received funding from Neil Record, who became chair of the IEA board of trustees in 2015. From 2010 until his appointment as health secretary in July 2018, Hancock received a total of £32 000 (€37 100; $41 700) from Record, the founder of a currency management company who joined the IEA’s board of trustees in 2008.
The funding, given in a personal capacity by Record in support of Hancock’s “parliamentary work and travel costs” as an MP and recorded in the Register of Members’ Financial Interests,22 ceased before Hancock became health secretary.
In 2016, as paymaster general and minister for the Cabinet Office, he sided with the IEA’s view that charities funded by the government should not be allowed to lobby it. “When government funds the lobbying of itself,” the IEA has argued, “it is subverting democracy and debasing the concept of charity.”23 In February 2016 Hancock announced that charities and other organisations receiving government grants were to be banned from lobbying the government.
A press release issued jointly by the Cabinet Office and Hancock began by crediting the IEA for having “undertaken extensive research on so-called ‘sock puppets,’ exposing the practice of taxpayers’ money given to pressure groups being diverted to fund lobbying rather than . . . good causes.”24
Since his appointment as health secretary Hancock has shown that he is aligned with the IEA’s position on minimum unit pricing (MUP) for alcohol,26 prompting concern in the public health community that he might be “listening to the views of . . . vested interests above those of the health community.”2728
Hancock did not respond directly to The BMJ’s request to confirm whether he had been aware that the IEA was funded by a tobacco company when he accepted donations from the chair of the institute’s trustees. A spokesperson said only that “all donations have been declared in line with parliamentary regulations.” Hancock also did not respond directly when asked whether he supported the IEA’s call for the next Tory leader to scrap “censorious and hectoring” public health measures. Instead his spokesperson referred to a speech Hancock gave at the International Conference on Obesity.29 Here, Hancock highlighted initiatives such as calorie labelling in restaurants and restrictions on advertising of junk food and cited the success of the sugar tax in reducing sugar in soft drinks as evidence that “population-wide measures work, and are necessary, alongside promoting healthier behaviours and empowering individuals to make better choices.”
But he added, “I am no fan of nanny state interventions that treat everyone the same, or punish the masses for the problems of a minority . . . the modern public health problems of largely non-communicable diseases need a . . . much more targeted approach.” On alcohol pricing, he added, “For 95% of people, the alcohol we drink is perfectly safe and normal. Let’s not punish the masses for perfectly healthy behaviour.”
The IEA has long expressed opposition to MUP303132 and did so once again in an April article by Christopher Snowdon, its head of lifestyle economics. MUP, he wrote, was “a shamelessly paternalistic and patently regressive policy. Unnecessary and seemingly ineffective, it has no place in a free society.”33
The institute has repeatedly refused to confirm that it is, or has been, funded by the alcohol industry. But, in a rapid response to a 2014 article in The BMJ,34 Snowdon seemed to imply that it was35—and, in an undercover recording made by Greenpeace in 2018, IEA’s director general Littlewood, illustrating for the benefit of a supposed prospective client how the IEA worked, admitted that “we would take money from alcohol companies.”36
It certainly has no objection to working with them. At the Conservative Party conference in 2017 the IEA hosted one debate on alcohol policies (“How much is too much?”) with the drinks company Pernod Ricard UK,37 and it staged another (“Standing up for the British beer industry”) with the support of the world’s largest brewer, Anheuser-Busch InBev.38
Snowdon’s article about MUP had first appeared on the website of a new organisation called Freer, whose purpose is to “refocus the political debate, shifting attention towards free enterprise and social freedom.” Although Freer is “financed, run and operated by the IEA,” based at the IEA’s offices and headed by Rebecca Lowe, a research fellow at the IEA,39 it is not registered as a charity and is therefore not subject to the same political lobbying restrictions that constrain the IEA’s activities.
Freer’s co-chairs are the Conservative MPs Luke Graham and Lee Rowley. Contacted by The BMJ, Graham declined to say whether he supported the IEA’s “nanny state” stance but said, “The Freer initiative, like the IEA, has no corporate line on public policy proposals. It is united by people who broadly support free markets and free people. All views published by the IEA or Freer are the author’s own.” Rowley did not respond to a request for comment.
On 16 July last year Freer held a summer party at the IEA’s offices, featuring speeches by Liz Truss, chief secretary to the Treasury, and Raab.40 Freer’s launch in 2018 was also attended by a number of MPs including Truss, Raab, and Michael Gove.41 In April, Freer published On Social Freedom,42 its first collection of essays, featuring contributions from the Conservative MPs Truss (“On the nanny state”), Graham (“On cannabis”), and Ben Bradley (“On taxing meat and sugar”), as well as the IEA’s Snowdon (“On minimum unit pricing”).
Opaque funding
The IEA makes much of the fact that it seeks and receives no government funding. It is, however, less forthcoming about where it obtains its money.
In a recent appearance on BBC Two’s Politics Live Littlewood repeatedly avoided answering direct questions from the presenter, Jo Coburn, about whether his organisation received money from the sugar, tobacco, alcohol, or casino industries.43
As a charity and a private company limited by guarantee, the IEA publishes accounts with the Charity Commission44 and Companies House,45 but there is no legal requirement to identify individual donors, and the IEA does not. The most granular funding detail offered is that, in 2017, its income of £2m came primarily from unnamed “foundations and trusts” (23%), “large businesses” (23%), and “individuals, entrepreneurs and family firms” (20%).
Despite the IEA’s penchant for secrecy over funding, details of its involvement with a range of industries whose products are bad for public health have trickled out over the years. For example, in 2012 the National Casino Industry Forum gave £8000 to the IEA after the publication of a discussion paper written by Snowdon.4647
In 2013 the cigarette companies Philip Morris International, British American Tobacco, Japan Tobacco International, and Imperial all confirmed that they had financed the IEA,48 which had campaigned against plain packaging of tobacco products as “a draconian attack on the freedom of smokers, retailers and manufacturers.”49 These relations came as little surprise to anyone familiar with the multiple references to the IEA in documents that emerged during litigation between US states and the tobacco industry, which are now held in the Truth Tobacco Industry Documents online archive created by the University of California, San Francisco.505152
What is surprising, however, is that at least one major tobacco company says that it continues to support the IEA to this day, as The BMJ has discovered.
One document in those archives is an IEA fundraising prospectus aimed at potential US based corporate donors, who are promised “immediate access to IEA’s network of experts—authors, policymakers, business leaders and media.”53 Prepared for use by the American Friends of the Institute of Economic Affairs,54 the document lists more than 153 corporate supporters of the IEA in the UK.
On the list are several companies whose products had public health implications and would clearly have benefited from the IEA’s commitment to deregulation, including British American Tobacco, Rothmans UK Holdings, Tate and Lyle, Whitbread, and Coca-Cola Great Britain and Ireland.
Although undated, the document seems to be from about 1999. In the intervening 20 years many companies on the list have been restructured or have changed owners, but The BMJ asked a number of them whether they still supported the IEA. Some declined to comment, and others were evasive. But one company admitted that it still supported the IEA: British American Tobacco.
“We support like minded organisations on issues that are important to our business and our consumers,” Simon Cleverly, British American Tobacco’s group head of corporate affairs, told The BMJ. A spokesperson confirmed that the company was a current supporter of the IEA but declined to say how much money it gave.
The MPs Raab, Hancock, and Truss, as well as Record (chair of the IEA trustees) and IEA’s life vice president Nigel Vinson, did not respond to requests from The BMJ to clarify whether they were ever aware of the institute’s financial relations with British American Tobacco, which was part of an industry responsible for “the single largest cause of preventable deaths and one of the largest causes of health inequalities in England.”55
An IEA spokesperson declined to confirm that it was receiving money from British American Tobacco or from any other company or industry body producing food, soft drinks, alcohol, or tobacco products. “We respect the privacy of our donors and don’t place a list of them in the public domain,” she told The BMJ. “It is a matter for individual donors whether they wish their donation to be public or private.”
Funders, she added, were “not permitted to influence the conclusions of our analysis, neither across a programme nor within a single publication or communication about it. We uphold strict rules to protect our academic independence, including clear guidance to potential donors and a rigorous system of peer review.”
The BMJ also asked for comment from Record and Vinson on whether they agreed with the institute’s characterisation of public health initiatives as undesirable “nanny state” interference. They had “nothing further to add” to the IEA’s statement, the spokeswoman said.
The IEA’s most generous known benefactor is the Nigel Vinson Charitable Trust, which donated a total of £450 000 to the organisation from 2013 to 2018.56 Vinson, who from 1968 to 1975 was a member of the Sugar Board, joined the IEA board in 1971 and, since stepping down in 2004, has remained a life vice president.
In 2016 he gave £5.5m to the University of Buckingham to create a Centre for Economics and Entrepreneurship in collaboration with the IEA. The university, which offers a range of medical courses in addition to degrees in economics and entrepreneurship, declined to discuss the appropriateness of establishing such a relation with the IEA, an organisation that accepts funds from the tobacco industry. A spokesperson told The BMJ, “We can’t speak on behalf of other organisations but are committed to the principles of academic freedom and free speech and encourage debate on matters of public policy.”
The Register of Members’ Financial Interests57 shows that, in the past 10 years, direct funding of MPs by the IEA itself, rather than by senior figures on its board of trustees, has been rare. Although the amounts have been insignificant, the significance lies in the ideological relations the payments highlight.
For example, in September 2014 the IEA gave £735 to Phillip Lee, a part time GP who is the Conservative MP for Bracknell, to facilitate his attendance at an IEA conference on privatisation in Slovenia. In January 2018 the Daily Express reported that Theresa May was considering Lee as Jeremy Hunt’s successor as health secretary,58 and in March he was reported to be “considering a run” in the Tory leadership race.59 Lee did not respond to a request for more information about his relations with the IEA.
The register of interests also records that, in November 2018, the IEA paid for David Davis to fly to the US for meetings in Washington and Oklahoma. His travel expenses cost the IEA £1949. Davis was accompanied by another Conservative MP, Owen Paterson, who recorded a contribution of £84 from the IEA.60
In 2014 Paterson, a former environment secretary, formed his own “independent centre-right think tank” called UK 2020, set up “to produce a manifesto for the Leader of the Conservative Party contesting the General Election in 2020.”61 In 2016 UK 2020 published its first report, written by Kristian Niemietz, the IEA’s head of political economy, which compared the NHS unfavourably with other national health systems.62 In a speech launching the report Paterson questioned whether “a centralised state-run monopoly of healthcare is the best and only way to run a universal healthcare system that is fair.”63
Paterson has complied with parliamentary rules by declaring receipt of donations from his own think tank, which does not reveal its funders, but he has declined to say where its money comes from.6465
Links between the IEA and other leading Conservative MPs emerged in September 2018, when the organisation published a controversial report, Plan A+—Creating a Prosperous Post-Brexit UK, dismissed by one of many critics as a “product of fanaticism [with] dangerous consequences for the NHS.”66 At the launch were the MPs Davis and Jacob Rees-Mogg, and Boris Johnson hailed the report as “a very good piece of work.”67
The Charity Commission was less impressed. The report and its launch, it said in a statement in December 2018, “sought explicitly to change government policy on an issue unrelated to the charity’s purposes—furthering education—which constitutes a breach of the Commission’s guidance on political activity and campaigning.”68 The official warning issued to the IEA under section 75A of the Charities Act 2011 called on the IEA to remove the report from circulation, which it did.69
Uncertainty over the Conservative Party’s future direction will continue for some time. In the meantime, no progress is likely on any public health initiatives in the works, such as plans to introduce calorie labelling on food consumed outside the home or further restrictions on advertising to reduce children’s exposure to products high in salt, fat, and sugar (see box C).
Few in public health will be happy at the prospect of the Conservatives adopting a leader wedded to the IEA’s anti-“nanny state,” free market ideology, but the signs are not good. Three days before Littlewood’s rallying cry in the Telegraph, a round-up of contenders published by the New Statesman listed no fewer than seven serious candidates for the job who had demonstrated various degrees of involvement with IEA or empathy with its views. They included Davis, Raab, Truss, Hancock, and Lee.70
Thirty two Conservative MPs linked financially, directly or indirectly, to the Institute of Economic Affairs
MPs who have received funding directly from the IEA
David Davis (Haltemprice and Howden):
Flights, travel, expenses and hospitality, meetings with US business interests in Washington and Oklahoma, 2018. Total declared value: £1949.
Owen Paterson (North Shropshire):
Expenses and hospitality, meetings with US business interests in Washington and Oklahoma, 2018. Total declared value: £84.
Phillip Lee (Bracknell):
Transport, accommodation and meals, attendance at IEA New Frontiers in Privatisation Conference, Slovenia, 2014. Total declared value: £735.
Twelve Conservative MPs who received funding from Neil Record, chair of the IEA’s board of trustees, worth a total of £77 750
Matt Hancock (West Suffolk):
Funding/sponsorship from Neil Record “in support of my parliamentary work and travel costs in my capacity as an MP.” Total declared value: £32 000 (Nov 2010: £2000; Nov 2011: £4000; Nov 2012: £4000; Nov 2013: £4000; Nov 2014: £4000; Nov 2015: £4000; Nov 2016: £4000; May 2017: £2000; Nov 2017: £4000).
Jesse Norman (Hereford and South Herefordshire):
Donation to constituency party or association. Total declared value: £5000, registered 20 Mar 2014.
George Eustice (Camborne and Redruth):
Donation to constituency party or association. Total declared value: £5000, registered Feb 2015.
John Stevenson (Carlisle):
Donation to constituency party or association. Total declared value: £5000, registered Mar 2015.
Paul Uppal (until 2015 Wolverhampton South West):
Donation to constituency party or association. Total declared value: £5000, registered Mar 2015.
Eric Ollerenshaw (until 2015 Lancaster and Fleetwood):
Donation to constituency party or association. Total declared value: £5000, registered Mar 2015.
Flick Drummond (until 2017 Portsmouth South):
Donation to constituency party or association. Total declared value: £5000, registered May 2015.
Luke Hall (Thornbury and Yate):
Donation to constituency party or association. Total declared value: £5000, registered Jun 2015.
John Lamont (Berwickshire, Roxburgh and Selkirk):
Donation to constituency party or association. Total declared value: £2000, registered Jun 2017.
Paul Scully (Sutton and Cheam):
Donation to constituency party or association. Total declared value: £3000, registered Jul 2017.
Hugo Swire (East Devon):
Donation to constituency party or association. Total declared value: £2000 received May 2017.
Will Quince (Colchester):
Donation to constituency party or association. Total declared value: £3750, registered July 2017.
From 2008 to 2017 Neil Record also gave a total of £418 790 to the Conservative Party.
Eighteen Conservative MPs who received funding or gifts from Michael Hintze, IEA trustee and founder of asset management company CQS, worth a total of £89 200:
Nicholas Soames (Mid Sussex):
Donation to constituency party or association. Total declared value: £5000, registered July 2014.
Support received by local party organisation or indirectly through central party organisation, registered Jun 2015. Total declared value: £5000.
Lorraine Fullbrook (until 2015 South Ribble):
Tickets to Carlton Politician Dinner, Sep 2010. Total declared value: £1500.
Tickets to Black and White Ball, Feb 2011. Total declared value: £1000.
Tickets to Conservative summer party, Jun 2011. Total declared value £1000.
Mark Garnier (Wyre Forest):
Tickets to Black and White Ball, Feb 2011. Total declared value: £1000.
Ticket to Conservative summer party, Jun 2016. Total declared value: £500.
Andrew Bingham (until 2017 High Peak):
Tickets to Black and White Ball, Feb 2011. Total declared value: £1000.
Ticket to Conservative summer party, Jun 2016. Total declared value: £500.
Helen Grant (Maidstone and The Weald):
Tickets for her, her husband, and her son to attend Chelsea v Newcastle football match, Sep 2010. Total declared value: £1500.
David Cameron (until 2016 Witney):
Loan of private jet for flight from Newcastle to Biggin Hill, Mar 2008. No value declared.
David Davis (Haltemprice and Howden):
Donation for office research and other expenses, Aug 2007. No value declared.
£2000 donations accepted 29 Oct 2009.
£5000 donations 29 Aug 2007.
George Osborne (until 2017 Tatton):
Loan of private jet for flight from Newcastle to Biggin Hill, Mar 2008. No value declared.
Support for office costs, 2008. No value declared.
£12 500 donations 1 May 2009.
£12 500 donations 6 Jan 2009.
£12 500 donations 8 Jul 2008.
Liam Fox (Woodspring):
Contribution to staffing and running of private office, 2008. No value declared.
£10 000 donations 24 Jan 2007.
James Arbuthnot (until 2015 North East Hampshire):
Tickets to Conservative summer party, June 2008. No value declared.
Philip Hammond (Runnymede and Weybridge):
Support received by local party organisation or indirectly through central party organisation, registered Jul 2017. Total declared value: £5,000.
Robert Buckland (Swindon South):
Ticket to Conservative summer party, Jun 2016. Total declared value: £500.
Caroline Nokes (Romsey and Southampton North):
Ticket to Conservative summer party, Jun 2016. Total declared value: £500.
Boris Johnson (Uxbridge and South Ruislip):
Support received by local party organisation or indirectly through central party organisation, registered Jun 2015. Total declared value: £5000.
£2000 donations 25 Feb 2008.
£2000 donations 4 Dec 2007.
Patrick McLoughlin (Derbyshire Dales):
£2000 for visit accepted 21 Sep 2011.
Theresa May (Maidenhead):
£1200 hospitality 22 Sep 2009.
Adam Holloway (Gravesham):
£1500 donations 11 Oct 2008.
David Willetts (Havant):
£5000 donations 19 Dec 2007.
£10 000 donations 9 Jul 2007.
£10 000 donations 4 May 2007.
From 2002 to 2018 Michael Hintze also gave a total of £3,920,386.00 to the Conservative Party.
From 2007 to December 2007 Hintze gave a total of £89 200 to 18 Conservative MPs.
From 2005 to 2009 Vinson gave £4000 to the Conservative Party. In 2012 his wife, Yvonne Vinson, gave £10 000 to the UK Independence Party.
Source: Register of Members’ Financial Interests, 2008 to 2018: https://www.parliament.uk/mps-lords-and-offices/standards-and-financial-interests/parliamentary-commissioner-for-standards/registers-of-interests/register-of-members-financial-interests/.
Source: The Electoral Commission: https://bit.ly/2HbKJHV.
“Pointless, absurd, authoritarian, arbitrary, draconian and unnecessary”: a year of IEA assaults on public health initiatives
28 Mar 2019: “Comparing drinking to smoking is pointless and misleading”
27 Mar 2019: “Banning discounts on food will hit the pockets of the poorest the hardest”
17 Mar 2019: “Banning food advertisements to stop people eating too much is absurd”
8 Mar 2019: “Public being misled about the clampdown on ‘junk food,’ says new IEA briefing”
https://iea.org.uk/media/public-being-misled-about-the-clampdown-on-junk-food-says-new-iea-briefing/
27 Jan 2019: “The Lancet’s diet prescription is authoritarian and undemocratic"
7 Jan 2019: “NHS long term plan falls short of offering real solutions to improve patient outcomes”
26 Dec 2018: “Calorie caps are arbitrary, unscientific, and unrealistic”
17 Nov 2018: “Banning product placements unnecessary and draconian”
6 Nov 2018: “Taxing red meat is the next battleground for the nanny state”
30 Aug 2018: “Banning sale of energy drinks to teenagers draconian and unnecessary”
24 Aug 2018: “Move for more ‘alcohol control’ is paternalistic and ignores scientific evidence”
https://iea.org.uk/media/move-for-more-alcohol-control-is-paternalistic-ignores-scientific-evidence/
25 Jul 2018: “Sin taxes can cost poor families up to ten times more than they cost the wealthy”
17 Jul 2018: “NHS needs structural reform, not just short term cash injections”
1 Jun 2018: “IEA welcomes WHO decision to exclude taxes on food and drink from recommendations”
22 May 2018: “Public Health England sugar reduction scheme has led to ‘shrinkflation’ rip-off”
17 May 2018: “Reduction in fixed odds betting terminals stakes will have unintended consequences”
17 May 2018: “WHO proposals on sin taxes could increase a British family’s food bills by nearly £500 each year”
1 May 2018: “Minimum alcohol pricing in Scotland will do nothing to help consumers
27 Apr 2018: “The poorest would be hit the most by a tax on sugary snacks”
24 Apr 2018: “The true absurdity of the ‘junk food’ advertising ban, revealed”
Policies at risk: calorie labelling and advertising restrictions designed to tackle childhood obesity
Government plans to oblige all cafes, restaurants, and meal delivery companies to give calorie information about the food they sell are already in the IEA’s sights.
At the end of last year the Department of Health and Social Care (DHSC) ran a three month public consultation on the proposals, which it said were designed “to make sure that people have clear and accurate information about the calorie content of the food and drink that they and their families are eating when dining out, so that they can make informed and healthy choices for themselves and their children.”
The initiative, it said, was driven by concern that “nearly 1 in 4 children in England are obese or overweight by the time they start primary school, and this rises to 1 in 3 by the time they leave primary school.”
Obese children, as the DHSC noted when it launched the consultation, are more likely to become obese adults, “and obesity in adulthood increases a person’s risk of developing type 2 diabetes, heart disease, fatty liver disease [and] a number of cancers.”71
The DHSC says that it is still analysing feedback to the consultation, which ended in December. On the day it was launched Mark Littlewood, IEA director general, told the Daily Telegraph that the scheme was “yet another example of the government using a sledgehammer to fail to crack a nut” and that, while this would not change consumer habits, it would harm business. It was, he said, “disappointing that the government seems increasingly obsessed with further adding to the red tape that afflicts British business.”72
The stand-off perfectly illustrates the problem at the heart of the IEA’s business-centric, free market philosophy. As was made clear in the DHSC’s economic assessment of the impact of a range of options, from a mandatory energy labelling scheme for all businesses to one excluding smaller businesses, the sector would face total costs over 25 years ranging from £220m to an estimated maximum of £630m. The benefits to society as a whole, however—in terms of reduced health and social care costs and increased economic activity by a healthier labour force—would range from £4.84bn to £10.57bn.73
The DHSC said originally that it would respond to the consultation by Easter. Now, a spokesperson told The BMJ, “We plan to respond in the coming months,” as “the consultation received a high level of interest and it takes time to analyse the feedback.”
The DHSC is also running a consultation on introducing further advertising restrictions to reduce children’s exposure to products high in salt, fat, and sugar, which is due to close on 10 June this year.74 The measures were proposed as part 2 of the department’s plan for action on childhood obesity, launched in June 2018.75
The IEA’s views on childhood obesity have been expressed frequently. Obesity is “a statistical invention,”76 created by “flawed methodology” that “has led to the number of obese children being greatly exaggerated.”77
The prospect of an IEA fellow traveller and free market ideologue taking the reins of the Conservative Party fills Martin Caraher, professor of food and health policy at City University of London, with dismay. In an editorial in The BMJ in March, Caraher welcomed the DHSC’s proposals to further cut salt levels in food, especially in the out-of-home food sector.78 Tougher policies, he argued, were necessary to make fast food healthier.79
Now he is “desperately concerned” by the message being put out by the IEA. He says, “I thought that as a society we’d reached an understanding that some protection is needed at least for some people in society, if not all. The free market offers no protection in health, and society simply has to pick up the costs down the line.
“The ‘nanny state’ gets criticised, but it isn’t taking away people’s free choice—it’s just saying that, in terms of health, ‘This is what we recommend and we’ve set some limits.’ The companies themselves make these decisions for us every day, and nobody objects to that.
“We think that we have choice, but that’s determined by where you live, your social profile, and whether you have a Waitrose or Tesco nearby. All that the state is doing is introducing a little control.”
Comments from public health figures
For Graham MacGregor, professor of cardiovascular medicine at the Wolfson Institute of Preventive Medicine and the founder of the medical charities Action on Sugar and Action on Salt, the prospect of a government following the IEA’s lead is “extremely concerning.”
Tim Lang, professor of food policy at City University London, says that, although the IEA’s views will come as no surprise to anyone in the public health community, Mark Littlewood’s leadership manifesto “should ring alarm bells.”
“Over the past nine years the catastrophe of obesity has become ever more clear, and since 2010 three Conservative led governments have only with great reluctance added some public health protection measures,” says Lang. “Now the IEA is saying, ‘We don’t like this,’ and I think that serves as a very good warning to people in public health that the gloves are coming off.”
Ian Gilmore, director of the Liverpool Centre for Alcohol Research and chair of Alcohol Health Alliance UK, fears that “public health would be an early victim of populist free marketism and the victims would be the most vulnerable—including children.” He adds, “We are already in the middle of a public health crisis through the move of public health into local government and central government cutting funding to local authorities. ‘Shrinking the state’ would make this even worse.”
Public health interventions, says Corinna Hawkes, director of the Centre for Food Policy at City, University of London, “are ultimately about what future we want our children to have. Do we want as a society to do everything we can to support children in making healthy decisions? If the answer is yes, then we need public health interventions that prevent the intrusion of negative influences into children’s lives.
“If banning cartoon characters provides an environment that makes it easier for children to accept a wider range of foods, that’s increasing choice, not removing it.”
Nick Sheron, head of the Population Hepatology Research Group at Southampton University, says, “The prime health challenge of the 21st century will be the diseases caused by alcohol, smoking, and obesity. The vectors for these diseases are profitable commercial organisations who consistently and forcefully oppose effective, evidence based measures such as protecting children from marketing or increasing price through taxation.
“There is clear blue water between the health of populations and the shareholder wealth of commercial interests, and previous conservative leaders have tended to float offshore. They have actioned evidence on smoking, done a bare minimum for childhood obesity, and completely failed to tackle alcohol. The results are clear to see: tremendous reductions in smoking deaths, a future health crisis from obesity, and colossal increases in alcohol related deaths, to the extent that more working years are lost from alcohol than from the 10 most frequent cancer types combined.
“The consequences of a future leader aligning against health and in favour of the tobacco, alcohol, and obesity industries are deeply concerning. The cost will be premature mortality and the utter despair this causes families, higher workloads for the NHS, and reduced productivity for the economy.”
John Coggon, codirector of the Centre for Health, Law, and Society at University of Bristol Law School, says, “In a lightly regulated marketplace, the impacts of large corporations on people’s decisions are enormous, potentially coming at the cost of great personal and social harm and without the sorts of democratic checks and transparency requirements against which public actors and agencies are held to account.
“Within the small state, the power to influence health-affecting decisions, however negatively, is considered to be benign to the point of being a fundamental right when in the hands of big business, notwithstanding overarching organisational aims to maximise wealth; yet health-affecting interventions, however positive, are considered an unjustifiable interference with freedom when exercised by agencies whose remit is promotion of the public interest.
“A small state perspective would see the manipulation of choice by commercial actors—for example, through advertising obesogenic products to children—as a welcome right that should trump any public interest considerations. A shift towards a small state system of government would mean a radical move that would not be for the benefit of individuals or the quality of the environment in which they make decisions. Rather, it would privilege the freedom of private corporations to maximise profits, insisting that government commits to a cold indifference to the public’s health and wellbeing, and pretends to neutrality when in effect it provides a platform for the primacy of corporate self interest.”
Footnotes
Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.