COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY
Inquiry into Obesity
Department of Health
18 June 2009
Members present for all or part of the proceedings:
Mrs Iris Robinson (Chairperson)
Mrs Michelle O’Neill (Deputy Chairperson)
Mr Thomas Buchanan
Mr Alex Easton
Mr Sam Gardiner
Mrs Claire McGill
Witnesses:
Ms Clara Swinson, Department of Health
The Chairperson (Mrs I Robinson):
We now come to the penultimate oral evidence session of the Committee’s inquiry into obesity. Members will recall that the Committee had planned to travel to London to meet the Department of Health and to examine how the obesity strategy is implemented at a local level by visiting a primary care trust, but, unfortunately, that was not possible. We are particularly grateful to Clara Swinson, deputy director of the cross-Government obesity unit in England, for accepting the invitation to come to the Assembly today to brief us on developments in England, and I welcome her to the Committee.
Members have a briefing paper from the Department of Health, a copy of the executive summary of the ‘Healthy Weight, Healthy Lives’ strategy and a briefing paper from Research Services. Ms Swinson will make a brief presentation, and that will be followed by members’ questions. Before you begin, Ms Swinson, I apologise for the length of time that you had to wait, but the matter that we were discussing has to be dealt with before summer recess.
Ms Clara Swinson (Department of Health):
Thank you; it is good to be here. I am the deputy director at the Department of Health with responsibility for the cross-Government obesity unit, which is responsible for obesity policy for central Government in England. I will set out the approach to obesity in England, and then I will, of course, be happy to take your questions.
Just like other nations, we have a growing obesity and overweight challenge. In England, about 60% of adults and 30% of children are overweight or obese. The Foresight expert review, launched in 2007, said that that figure would rise if nothing was done. The experts predicted various stages up until 2050, by which time the majority of adults would be obese and only 10% would be a healthy weight.
Obesity has a significant impact on individual health, the Health Service and the cost to society and the economy. The Government are, therefore, committed to tackling obesity in line with the best available evidence, which comes from the Foresight review. In 2007, we set ourselves a public service agreement, which are the central Government targets in England, with an overall ambition to ensure that everyone is able to reach a healthy weight. Starting with children, the target by 2020 is to have flattened and then reduced levels of childhood obesity to their 2000 levels.
With that ambitious ambition, our strategy is based on the areas that are identified in the Foresight report, which looks at both individual action and the wider environment because of the obesogenic and passive-obesity issues. It also looks at the role of Government, but certainly does not believe that Government can solve the problem alone, and at the role of society. The strategy also recognises that we need to try some things out, see how effective they are and learn as we go on, not to wait until we have a perfect evidence base.
The strategy, a summary of which has been provided for the Committee, first of all sets out for the individual what we are doing to help people to make healthier choices. A large part of that is the Change4Life movement and social marketing campaign, which was launched earlier this year. That will be extended to younger people with the launch of Start4Life in the autumn for children from 0 to 12 months old. That will be extended to adults next year.
We are looking to increase the information that is available to consumers through, for instance, nutritional labelling on products in supermarkets and stores, and labelling in non-retail settings such as fast-food restaurants. We also have a national child-measurement programme which weighs and measures all children in reception year and at age 11. That information can now be routinely fed back to parents.
That is what we are doing to help the individual to make a healthier choice. The second strand is very much about ensuring that the environment supports those choices and makes the healthier choice the easier choice. A lot of work has been done on children in early years and in the school environment; there are strict standards on food that is available in schools, increased focus on physical education (PE) and sport, and, from the early years, encouragement for breastfeeding and healthy habits.
On the “energy in” side of the equation, our healthy food code puts in one place the various things that we want industry to do, and consumers, too. Those range from labelling to portion size and product reformulation. I will not go through them all, but there are a whole set of issues around “energy in”. On the “energy out” side — we give each side equal weight — our aim is to help people to build physical activity back into their daily lives, focusing on programmes for individual walking and cycling. The programme also involves working with town planners on future development, and we have a Healthy Towns programme which is in its second year.
For adults, we are thinking about the role of the employer in encouraging healthy choices and about what employers in both the private and public sectors can do in respect of that. That is a brief overview of what we are doing about the environment.
Obviously, we need to provide services to those who are at risk and to those who are overweight and obese already. In England, we have the National Institute for Health and Clinical Excellence guidelines and primary care trusts (PCTs). We allocate money — £69 million this year — to PCTs for them to translate as they see fit into the weight-management services that they need to provide for their local communities. We do some work centrally to help them to make the case and to commission high-quality services.
Finally, we look at the whole delivery system. There is a role for central Government. I spend a lot of time cross-Government working with my colleagues in other Government Departments. We report to a ministerial committee that has 10 or 12 Departments represented on it. There is a lot of work for local government in schools and the wider public sector. There is a large task of building a coalition of the willing with commercial and voluntary sectors so that everyone plays their part in creating a society where we can all reach a healthy weight.
We are doing a lot to increase our knowledge. As I said at the start, we do not have a perfect evidence base, and, therefore, we still work with the advisers who were involved with the Foresight report. We have a national obesity observatory. We evaluate what we do. We are committed to producing an annual report that sets out what we have done each year and that also looks at what we have learnt in that year so that we can amend policy as required.
I hope that that gives a helpful overview. We are by no means there yet. It has been years in the making and it will take years to tackle the problem fully. However, I believe that we have a comprehensive strategy, with some exciting bits of work under way. The Government are certainly taking a leading role, but we know that Government alone cannot change the situation.
The Chairperson:
Thank you very much, Clara, for that very interesting presentation. Given their usage of computers and so on today, children become couch potatoes and do not get a lot of exercise. Do you work closely with local authorities to deliver free entry to their recreational facilities for children to use the football pitches and other equipment in those areas?
Ms Swinson:
Yes; you are quite right that changes over time have made us more sedentary. We have two messages for children: 60 active minutes and activity in school. For local authorities it is very much about making sure that their open spaces and what can be done for free are attractive and that people know about them. As regards other recreational spaces, one particular initiative is the free swimming that is available in many areas of England now for the under-16 and over-60 age groups. As you said, we need to build regular activities into children’s lives from an early age.
Mrs O’Neill:
We also recognise that the problem is not going to be fixed overnight and that it is a societal thing. Any changes will be seen over the longer term.
We had the Department of Education along last week and we were talking about PE in schools and about how some schools deliver two hours of physical education each week but others do not. The direction from the Department is that schools should provide two hours. We discussed whether that should be made a mandatory minimum requirement for schools. Are there any targets or mandatory obligations on schools to provide more PE? Obviously, if children and young people are provided with encouragement to take part in physical activity at an early age, they are more likely to carry that on into adult life.
I would also like more information on the healthy community challenge fund referred to in the paper to the Committee.
Ms Swinson:
Yes, schools should provide two hours a week of PE, and about 90% of children now receive that. Many schools offer an additional three hours of activity that need not be standard PE or sport but that could be offered to children through after-school clubs, at lunchtime, or throughout the day rather than just in PE lessons. That is what is happening in schools.
The healthy community challenge fund, which we abbreviate to Healthy Towns, is a fund of £30 million over three years. We looked at some successes achieved in towns in France through the Epode project and developed the idea for England. Evidence shows that, although no society as a whole has tackled obesity, there has been some success on a community level when people really got together and worked across agencies.
Therefore, we set out what we wanted to achieve but did not specify to areas what they had to do. Instead, we asked for proposals. Some of the proposals focused on food and others on activity. They all had to involve both local authorities and primary care trusts, but the proposals varied depending on whether they focused on infrastructure or prevention.
We were seeking seven or eight applications but received more than 160. We went through a process that led to the selection of nine towns — one in each region of England. The programme was also match-funded; the aim was not to tell people what to do, but to let them know that money put forward for their proposal would be matched by central Government. We have now signed off on all the Healthy Towns project plans and they have been granted their second year of funding.
At a national level, we are also conducting an evaluation of the nine Healthy Towns. By the very nature of what we asked for, their projects were very varied. Therefore, in another year or two we will have the results of their first year or 18 months in operation.
Mr Gardiner:
I am chairman of the boards of governors of two primary schools that have breakfast clubs to encourage healthy eating. Rather than bring in sweet stuff to eat, the children are dropped off at 8.00 am and they have breakfast at school. We are not doing away with flowers or things like that, but our children plant apple trees, carrots, parsnips, beetroot and the like, and the children are taking an amazing interest in a healthier lifestyle. The schools also provide water coolers and containers with which the children can get water at any time during school hours. Therefore, we are on that track and trying to overcome this problem that we are facing by cutting down on sweet stuff.
Ms Swinson:
Many groups in our society need to reconnect with basic knowledge about food such as vegetables and basic cooking skills that have been lost over the past few decades. That should be encouraged when people are young.
Mr Gardiner:
Are we on the right track, then?
Ms Swinson:
Yes.
The Chairperson:
In the absence of any other questions, I thank Ms Swinson for coming all the way from London and wish her a safe journey back to the mainland.