COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY
Inquiry into Obesity -
Institute of Public Health in Ireland
26 February 2009
Members present for all or part of the proceedings:
Mrs Iris Robinson (Chairperson)
Mrs Michelle O’Neill (Deputy Chairperson)
Dr Kieran Deeny
Mr Alex Easton
Mr Tommy Gallagher
Mr Sam Gardiner
Mrs Carmel Hanna
Mr John McCallister
Mrs Claire McGill
Witness:
Dr Jane Wilde, Institute of Public Health in Ireland
The Chairperson (Mrs I Robinson):
This evidence session will form part of the Committee’s inquiry into obesity. Members will find a briefing paper from the Clerk, and other relevant information, in their packs. We have already received a large number of submissions, copies of which are also provided for members’ attention.
Dr Wilde, you are very welcome. The usual format will apply — you will have up to 10 minutes for your presentation, after which members may ask questions.
Dr Jane Wilde (Institute of Public Health in Ireland):
Thank you very much indeed. First, I want to say how pleased we are that the Committee has chosen to hold an inquiry into obesity. In particular, we believe that a focus on prevention is a very important part of tackling the problem, and it is on that aspect that I will concentrate today.
I very much welcome the opportunity to appear before the Committee. I think that the best way to approach such a complicated subject is to select five or six points to talk about. First, I want to comment on the extent and impact of obesity. Secondly, I will talk about why I think there has been such a huge rise in obesity, and why we need a strategic response that is long term and sustainable. Of course, in the short term, we also need a response to the problems that currently exist.
Thirdly, I want to emphasise the importance of a cross-Government approach to this very important public health issue — and I am sure that the Committee has heard that point many times. However, I will also highlight the need to reach well outside Government to the community and private sectors, because if we do not do that, there is no way in which we can tackle this huge issue.
My fourth points relate to evidence: what we know, and how we need to build a better evidence base about what actually works and what will help to stop the big increase in obesity levels. Finally, I want to say something about what we need to learn from elsewhere, because, of course, very many countries are facing the same crisis.
I will start with the first point about the extent and the impact of obesity. There is no one here who does not know that obesity is on the rise. However, it is really alarming when one starts to examine the problem in more detail. Obviously, like yourselves, I was aware of the rise in obesity levels, but when I think of how obesity is a risk factor for so many conditions — whether it be heart disease, cancer, joint problems or hypertension — I begin to see that it really matters and has a profound effect on the health of people in Northern Ireland.
Recent data suggests that well over half of the adult population, nearly 60%, is either overweight or obese, with about a quarter of adults being obese. Of course, there is also a huge rise in obesity levels among children. Nearly one quarter of primary 1 children will be overweight or obese in the next few years.
We carried out a study to find out about the rates of diabetes, and we forecast that, between 2005 and 2015, the number of people in Northern Ireland with diabetes will rise by about 17,000. As a result of that increase, by the year 2015, about 84,000 people in Northern Ireland will have type 2 diabetes. We considered the issue across the island and reckon that that number will be 280,000. Therefore, the scope of the problem is large, and its impact huge. Not only is there a cost to individuals, but there is the cost to society through loss of productivity and the cost to the health and social care system.
Thus, we are facing a very big issue. Why is that happening? At the heart of the problem is the imbalance between what we take in and what we put out — in other words, the energy we expend. All the studies that have examined the issue from a scientific angle say that the problem will not simply be solved by individuals. Quite honestly, it is not as though half a million adults in Northern Ireland decided that they wanted to get fatter. It is not about that. Yes, that is an issue, but we really must take a wider view and see the problem in a social, environmental and economic context.
I very much hope that, during the course of the inquiry, the Committee will see the obesity problem as a wider societal issue. Although there is obviously a need to inform and educate individuals, any action must reach out to include the food sector, the planning sector, practically every Government Department, and people right across Northern Ireland. That is really all I want to say about the extent and impact of the problem.
To follow on from that, we have watched obesity levels rise over perhaps 20 or 30 years, so we must plan a long-term response. It will not be a case of being able to say in the next two years, “OK, we have sorted this problem out”. Yes, there could be short-term gains, but we really must be in this for the long haul, and we must have a strategic response. I know that the Department of Health, Social Services and Public Safety is putting together a briefing paper for the Committee to outline how the issue is being tackled, and hopefully departmental officials will appear before the Committee to explain it. I will not say any more about that because that is the Department’s work.
However, the purpose of the strategy is to ensure some coherence between what is happening locally and what is happening across Northern Ireland. Someone asked me whether much was being done, and I said that there are hundreds of small interventions in schools, communities, workplaces, and so forth. That must be set in a regional strategy so that there is some coherence between what happens across Northern Ireland and what happens locally.
We also have to be clear about who is responsible for what, because, with so much going on and so many people and organisations being involved, it is really important that there is some leadership, accountability, responsibility and a mechanism for reporting on what is happening. As well as the long-term strategy, we need things right now. Many adults are overweight, and we need to decide how we will help them and how we will stop them from becoming more overweight. I am not concentrating on the treatment care side, because that is not my prime business, but we need to be very careful, particularly with the recession, that what is happening with regard to eating and physical activity is not causing people more harm.
Cost is a big issue, and we have to think about the people who will be disproportionately affected by the recession and about what we can do to try to make it easier for people to eat healthy, nutritious food on a low income. That is an urgent issue, and some ideas about what we could do include, for example, having good studies and good co-ordinated action, particularly with young people.
What about cross-Government action? If one considers the reasons for obesity, it is clear that all Departments need to be involved. A major issue is how the Committee for Health, Social Services and Public Safety can help by advocating cross-departmental, cross-party support for such an important issue. I am not sure whether it is standard practice to write to all the other Committees.
The Chairperson:
We have done that.
Dr Wilde:
It is important to get a call from the other Committees about how they view the issue in relation to their policies, because the last thing that we need in Northern Ireland is one Department going in one direction and the other Departments going in a different direction. It is so easy for action in one area to undermine action in another area. For example, we could say that we want the built environment to concentrate on encouraging physical activity and by providing green space and play space, but, at the same time, other Departments could be developing plans for building on similar sites. If we were not to take that into account, it would totally undermine the health benefits.
Many of the issues concerning obesity are upstream, in that they are trying to create a wider social policy. During the recession, when finances are really under pressure, it is important that those sorts of issues do not get lost, and they can get lost. Therefore, I urge that some emphasis be given to those issues if possible.
The Committee could play a significant role by insisting on the health impact assessment of Government policy. All planning applications should be examined in relation to their impact on health and on the obesogenic environment — for example, questions must be asked about whether they are helpful or harmful with regard to obesity. I am sorry about the terminology.
Although the impact of obesity falls on the health sector, and there is much that the health sector can do, it is up to many other sectors outside Government to do something. For example, I am particularly interested in what the food sector might reasonably be expected to do about addressing obesity. Obviously, it is a complicated area. However, if we let the situation continue as it is, without some greater checks on what is happening to the food sector, we will do a grave disservice to people in Northern Ireland. There is a requirement on the food sector to act responsibly within a certain timescale. It is important to go beyond a voluntary approach by the food sector. It is such a big area that I hardly know where to start, but we are talking about issues such as food labelling, pricing, availability, subsidies, local production, and so forth. That is a crucial issue.
The issue of how to integrate research into policy is huge. Perhaps the Committee might consider convening a round-table meeting of some of Northern Ireland’s leading researchers on obesity, diabetes prevention, and so forth, to try to gather the scientific evidence that might help in order to have a conversation about what you need to know and what they have to offer.
It is important to bring research, policy and practice together to try to work out what we know and also to identify any gaps. There is every danger in Northern Ireland that there will be more and more interventions, and we will not know what is working or not working. The idea of a continuous improvement in evidence is very important.
At the institute, we are trying to develop an initiative, currently called an “obesity observatory”, to which we hope people will be able to turn for evidence when it is gathered. It will be a one-stop shop for evidence and data, particularly local data. People will be able to find out about the obesity situation, and obesity determinants, in their own council areas. I hope that that will be a helpful addition.
I have not mentioned the role of different sectors of the Health Service, whether in primary care or public health; I hope that there may be some questions or debate about that.
Northern Ireland is not the only place that is facing this problem. It is a major issue for all middle- to high-income countries, and is, sadly, becoming an issue in low-income countries. Not only are there one billion people across the world who do not have enough to eat but one billion people who have had too much to eat and are overweight or obese. We are facing an amazing global situation in relation to food.
Closer to home, what can be learned from Europe, the UK and the island of Ireland? We can probably learn quite a lot, but we are all struggling. The big issue might be for us to decide what we want to co-operate on rather than simply saying that we should have good relations with other parts of the UK and other parts of Ireland. Let us actually decide what it is that we want to learn from other places, and what we can test to help other places.
I will finish by acknowledging that the issue of obesity is very important and to wish the Committee good luck with the inquiry. I am happy to answer any specific queries. Thank you.
The Chairperson:
Thank you very much for your presentation. It is an all-encompassing issue. We have written to Departments, but I think that, so far, there has been very little uptake.
The Committee Clerk:
There have been a couple of responses.
The Chairperson:
The deadline has just passed, so those Departments have not stepped up to the chalk line.
Mr Gardiner:
It is lovely to see you, Jane, and you are very welcome. I will give you a little bit of encouragement; I was pleased to hear yesterday evening, at a meeting of the board of governors of Dickson Primary School in Lurgan, that an additional 10 children now attend the breakfast club. That is where we have to start — the primary school. Parents are dropping their children off — I will not saying “dumping” — on their way to work, and whereas those children would normally have had a packet of crisps and a bar of chocolate or something like that, they are now eating healthy food and fresh fruit. I welcome that.
Those children all have their own bottles — plastic, admittedly — with their names and the name of the school on them, and there is a water fountain so that they can get water as often as they need to during the day. I think that we are making a start. We must start at an early age.
Perhaps it is slow learners or people with a disability who are not active or fit who fall into the category of obesity. How do we get over that difficulty?
Dr Wilde:
Breakfast clubs play an important role not only in nutrition but in wider health and well-being, social cohesion, and so forth. They are to be welcomed and should be protected during any public finance pressures.
Your second point was about the connection between obesity and people who have difficulty learning. There is ongoing research in your local health board area into that issue. I do not know whether there are any results yet, but I know that special programmes have been developed.
Mr Gardiner:
Is that happening in areas other than Craigavon?
Dr Wilde:
I do not know, but that is well worth exploring.
Mr Gardiner:
It is worth checking out.
Dr Wilde:
I am happy to follow that up.
Mr Gardiner:
More publicity is needed on the subject to bring it home to people.
The Chairperson:
Quite a number of schools across Northern Ireland have embarked on breakfast clubs with an emphasis on healthy eating. As Sam said, many parents have to hold down two jobs and are, therefore, rushing off to work and are leaving — not dumping — their children off as soon as the school gates open, so it is good to know that they are getting a sensible breakfast. That is important to the education of young people.
Mrs O’Neill:
Thank you, Jane, for your presentation. A key point that you made was that the impact falls on the Department of Health, Social Services and Public Safety. Although a consistent approach must be taken across all Departments, the brunt of the financial cost of tackling obesity and the associated health problems falls on that Department. That is important for the Committee’s inquiry.
Many good things are happening, but, according to the University of Ulster, no country has led the way or been able to bring a marked turnaround or a significant change in how obesity affects their country. Are you aware of examples of good practice to which we could look? The Department’s submission states that there is an opportunity for it to take a leading role in that worldwide problem. That is an ambitious target. There is much work to do, including pushing Departments to work together and to co-ordinate their approach as to how they tackle it. What are your thoughts on that?
Dr Wilde:
You raised the issue of whether any country has really cracked the problem of obesity. Many countries have good strategies and plans, but the issue is to find out what is actually working. Norway, for example, has been able to shift its national diet in a positive way. It has done so by a combination of pricing, subsidies, information, education and labelling. A strong Government–society approach was taken seriously, and a major effort was made.
Mauritius and Brazil have also had strong initiatives. Brazil promoted physical activity, and Mauritius focused on food. I hear that the levels of obesity are levelling off in France, but I do not think that we can turn to any one country, particularly one that is close to us, and copy it. All countries are struggling with the problem a little bit.
If we decided that we wanted to become the best country in that regard, we could do so. However, that would take some going. I would love to be able to be part of Northern Ireland’s becoming the best at obesity prevention. We would be doing such a wonderful thing for the health of people in Northern Ireland, and we would save a fortune in lost productivity and health and social care costs. Who knows what the opportunities might be for local food co-operatives and for achieving better educational results in schools from children who were well fed? The benefits could be gigantic. That would happen only if the issue of obesity were made a serious cross-Governmentpriority, and that is a big ask.
Mrs O’Neill:
A Programme for Government commitment is to halt the rise in obesity by 2011, so at least that is down on paper.
Dr Wilde:
It is down on paper, and that must also mean something serious in practice.
Dr Deeny:
You are very welcome, Jane. I agree with you; those of us who provide primary care must do our bit as well.
I want to focus on education; which is a cross-departmental issue. Nowadays, some schools place a great deal of importance on academic qualifications and do not give enough time to sport, exercise and physical education. That is a concern in my local area. Should schools be required to devote a certain amount of hours in the week to physical exercise and sport? I am worried that children are very wrapped up in GCSEs and A levels.
I am not one to talk; I need to lose a bit of weight myself. However, there is a huge difference between Omagh 15 years ago and the town today. I see young girls who are much heavier than girls of the same age 15 years ago. I do not think that they are getting the amount of exercise and physical education in school that they should. Academic achievement is so important now, that exercise is not a priority. Should the Department of Education say to schools that they should devote two or three hours a week to physical exercise for their pupils?
Dr Wilde:
Absolutely; I totally agree with you. To go back to the previous question: can we be the best? Yes we can, but only if we have that kind of serious commitment. What you are saying is spot on. I echo the point that you made. One only has to walk around to see what is happening. Children do not engage in enough physical activity, but that could be changed.
Mr McCallister:
You have probably gathered that the Chairperson’s suggestion to hold this inquiry received unanimous support. It is such an important issue for the Committee. Most of my colleagues are in agreement; one of the biggest difficulties for the Committee and for the Department of Health, Social Services and Public Safety is getting other Departments to buy in and invest in what is needed. There is no financial reward; as Michelle pointed out, the burden falls entirely on the Department for Health, Social Services and Public Safety.
Committee members spent the morning with representatives of the British Heart Foundation and discussed the problems of obesity and diet. You mentioned diabetes; in your opening remarks, you also mentioned writing to other Committees. I sit on the Committee for Regional Development, which takes a significant interest in initiatives such as the Safe Routes to Schools programme. That programme is running in 18 schools across Northern Ireland, and it gets parents and kids to walk to school in order to build an exercise regime into their day and take away their excuse that they do not have time to take exercise. We must replicate that across all Departments.
As Kieran said, the Department of Education must have a role, and so should the Department for Regional Development. We must make exercise safe, accessible and easy for people. The Department of Education can play a role in teaching people about diet and about preparing a healthy meal on a budget. There are many issues to discuss.
I come from an agricultural background, so food labelling has always been a concern. I was speaking to my colleague Jim Nicholson MEP a few nights ago, and he told me that the European Parliament has been discussing food labelling for more than 20 years, and whether food labels should include health information and other details such as the country of origin and the ingredients. There is also an issue about making such information easy to read. Those are important matters for us all; European rules limit what we can do in Northern Ireland about food labelling.
Dr Wilde:
You identified excellent local interventions and asked whether they can be mainstreamed across Northern Ireland. It would be great to have the determination not to leave such interventions to be replicated at a gradual pace. Rather, on recognising a good intervention that is seen to work, whether it is regulatory or involves physical activity, it should extend to all schools.
Europe presents a difficulty in that measures that were introduced to protect people now act against them. However, there are ways in which Northern Ireland can get round some of the difficulties. It is amazing how many people are interested in obesity. Even as I waited before today’s meeting, I talked to various people about the subject. Everyone has a part to play, and everyone has an idea about what could be done better to tackle obesity. Of course we should be able to introduce good labelling systems here, and we should not tolerate systems that are bad for our health. Why should we? It is ridiculous.
I want to pick up on the cost to the Health Service. It occurred to me that, although much of the cost falls on the Health Service, if we consider the issue in a wider sense and take into account the loss of productivity, and so forth, a significant amount of the cost falls on other Departments; but it is not necessarily calculated in the same way. Perhaps more evidence to demonstrate that might stimulate other Departments to make further efforts.
Mr McCallister:
To follow on from employment issues, time lost as a result of obesity and, as Kieran mentioned, its effects on education, perhaps the cost to business could also be measured. In the Department of Health, Social Services and Public Safety, the cost is measured in pounds, shillings and pence.
Dr Wilde:
Given the huge impact of obesity on the people of Northern Ireland, it seems strange that it is not a high priority across Government. It is not as though the people who make policies and devise programmes are immune to the harm that we are discussing.
Mrs Hanna:
Good afternoon, Jane; you are most welcome. We all have a personal interest in trying to control our weight.
The Programme for Government identifies obesity as an issue, which is a start. The Committee has talked about having a cross-departmental meeting on children’s mental health with the Committee for Education. Obesity, with its effect on self-esteem, creates huge mental-health issues for children, particularly if they continue to carry excess weight that they find more and more difficult to lose. The Committee has discussed and analysed obesity, and there is a huge interest in the subject. You mentioned evidence, and that is important; many pilot schemes are not picked up on because of a lack of evidence that they work.
I am trying to think of small, practical measures that could make a difference. Schools, for example, can take practical initiatives, such as having breakfast clubs and making sport fun rather than purely competitive, which applies to girls in particular. Girls tend not to play sport and seem to walk around eating crisps. When driving through any town or through the countryside at the end of a school day or at lunchtime, boys are at least kicking a ball around.
More legislation is also required, particularly in the food sector, because nothing changes behaviour more than that. Any legislation must be based on ensuring that people understand obesity, and it must take into account the issues of poverty and affordability. Some people do not have the choice, even when they know that they should be eating more fruit, to go to Marks and Spencer to buy lovely berries, mangoes, and so forth, and they need much more support.
I hope that tackling obesity will be a priority of the new public health agency, and that you and others who have been working on the issue will have a huge influence on that. At an informal meeting, the Committee heard an extremely interesting presentation on obesity. I cannot remember the doctor’s name, but much of his presentation focused on mind over matter and the psychology of obesity.
The Chairperson:
The doctor is called Michael Ryan.
Mrs Hanna:
Michael Ryan; I found him fascinating. People need to be motivated and to want to change. It is not that we do not all want to lose that half-stone, stone, or whatever; it is about being so motivated that it will happen. Much more interesting work could be done. I know people — not too far from me and from my heart — who have an issue with their weight. It is difficult, because people get very defensive and upset when they talk about losing weight, even though they want to. It is a hugely difficult area, and the psychology around it is important. That, along with the small, practical things that we can do at the start, make a difference.
Dr Wilde:
The evidence shows that most children who are overweight or obese carry that through the rest of their lives. There is a high risk that, if a child is overweight or obese, he or she will be overweight or obese as an adolescent and as an adult, which has a harmful effect on people’s psychological well-being.
What role could the new public health agency and the new structures play? I would like the issue to be co-ordinated and, as they say, “rolled out”. One often asks what small, practical things could happen. Part of my difficulty is that I find it hard to grasp what is happening across Northern Ireland. I would like the agency to play some role in putting together an inventory of what is happening, but I do not mean that it has to spend five years doing that. It could highlight what is working, what may be working and what is not working. We should be replicating situations that are working. It is not that I have a whole range of other small ideas; in fact, lots and lots of small ideas may not be the way forward. However, that is not to take away from the urgency of the situation. We must develop a system whereby we learn from what we are doing, rather than doing this, that and the other, and seeing how it goes.
A point was made about making things attractive. At the heart of the matter, there is the issue of how we make it attractive to eat more fruit, vegetables and salads, and how we make it attractive to exercise. That is what the creation of a better social environment is all about. We should learn a little from what has happened in other public-health issues, such as smoking. Everybody tried to turn the tide from smoking being seen as attractive thing to do, to smoking being seen as not attractive. There are definite possibilities in relation to physical activity and nutrition.
Mrs Hanna:
What is your view on mind over matter? Michael Ryan had a theory that people needed to be put into a particular frame of mind to be ready to lose weight.
Dr Wilde:
That makes sense to me. However, I do not know enough about the science of it. Nevertheless, one could imagine that that is true. If one is feeling low, one does not believe that anything can be done. It reminds me of the question about Northern Ireland being the best. It will not be the best if everyone believes that they are hopeless.
Mrs Hanna:
Dr Ryan said that there are techniques to motivate people.
The Chairperson:
One of the saddest things that I heard some time ago was about children who were afraid to get dirty because of the nature and quality of their clothes. I thought that it was very sad that children were afraid to get their clothes dirty and that their mothers did not allow them to go out to play. They then become couch potatoes and obese because there is no physical activity in their lives. If we are to consider children specifically, we also want to get them away from sitting for hours on end at computers. That is another area that needs to be addressed.
There is great concern in respect of those people in areas of deprivation. However, another tier of people is falling into that trap because of high mortgage payments going out, while their properties are worth less than half the value of what they used to be. They too are struggling, and something has to give; sadly, that is usually the quality of food. As houses are taken over by building societies and banks, I think that we will see more people fall into the trap of need.
Mr Easton:
I have just eaten a packet of Minstrels so I am feeling a bit guilty. I consider myself to be a typical ordinary person who goes out shopping and, I have to be honest, does not read labels — my wife should be doing that but she is not. I believe that the majority of people do not read labels, and therefore, it will be a really tough task not only to educate people, but to try to make them do it. I do not know what the answer is; it is going to be very difficult. I am guilty of it and I will admit to that.
I do not understand why the cost of food is so high among all the big retailers, given that oil prices have gone down. In shops such as Tesco, there will be two packets of biscuits for the price of one, or something like that, and, I have to admit, I will buy them. Reductions do not tend to be on the good food, they are always on junk food. We need to look at what can be done to try to make retailers reduce the price of good food. I am guilty of all those things; however, I acknowledge that there could be huge savings for the Health Service, and an improvement in people’s general health, if something could be done.
The Chairperson:
To save your marriage — and you are only just married — I will presume that you meant that you and your wife should do the shopping together. [Laughter.]
He is only a few months married, so one has to give him a little bit of leeway.
Dr Wilde:
I totally understand your position regarding labels; apart from anything else, the labelling is usually so small that you need to have very good eyesight to read it. Other things, such as the traffic light system — which I am sure you have heard of — are more straightforward, and organisations such as the Food Standards Agency will be able to give you information about that system.
There is the further issue of how to make sure that what is sold in supermarkets is not always biased toward the unhealthy option, and it would be good to have some conversations on that with the food industry in Northern Ireland. You are similar to many in the population, in that for at least half the population, health is not a driving force when they go shopping. Therefore, we have to acknowledge that people are not necessarily going into shops to look for the healthy option; they are going in for high quantity and low cost. It is quite unrealistic for us to be pushing the healthy option if that is not aligned with the cost option. We have to take that on.
The Chairperson:
The manufacturers and the food industry have to revisit the whole concept of how they promote foods, given that, worldwide, there is an economic spiral which does not seem to be petering out.
Mr Gallagher:
Do you view alcohol and its associated lifestyle as a problem? Are there measures that should be taken to tackle problems such as alcohol advertising?
Dr Wilde:
Public health problems such as alcohol, obesity, diabetes and heart disease — and the approaches to them that would make a difference — are all related. Education, for example, should be provided on all aspects of health, including alcohol, mental health, food and exercise. There should be an integrated approach to health and to cross-Government interest in it.
If I were asked whether obesity should be the top priority, I would say that it must be a key priority. The top priority should be to have a strong public-health approach that recognises the need to integrate our education, school, food and private-sector policies. Otherwise, it will be a case of having a discussion about obesity, then a discussion about alcohol, and then a discussion about something else. That is not the way forward.
Legislation on alcohol is a completely different issue, about which I did not come prepared to talk. I may have missed the point of your question. Perhaps I would be in a better position to respond if you clarified your thinking on the matter.
Mr Gallagher:
There is a rise in alcohol consumption here, and I think that there is health damage associated with that. I want to know what you think about that issue.
Dr Wilde:
There are major public-health issues associated with alcohol and young people’s use of alcohol. There are also issues in relation to pricing and availability. The general points that I have made about obesity also apply to alcohol.
Mr Gallagher:
Is there a link between alcohol and obesity?
Dr Wilde:
Alcohol is full of calories and could, therefore, be related to weight. I am not sure about the exact nature of the relationship between alcohol and obesity. Perhaps Kieran could help me out on that point; I need some assistance. [Laughter.]
Dr Deeny:
The relationship is basically as you have described — it concerns the amount of calories that alcohol contains.
Dr Wilde:
Alcohol is a risk factor for most of the illnesses for which obesity is a risk factor, such as cancer, heart disease, high blood pressure and stroke. Part of the purpose of trying to do something about obesity is to reduce levels of heart disease, cancer, and so on. Therefore, we should be doing something about alcohol as well.
The Chairperson:
All of the members who indicated that they wanted to ask questions have done so. I will read a piece of information and then ask a couple of related questions.
Research Services’ ‘Obesity Inquiry Research Paper’ quotes ‘Tackling Obesities: Future Choices — Project Report’ and states:
“Research commissioned by the UK Government’s Foresight programme examining ways of tackling obesity, revealed that, ‘the causes of obesity are embedded in an extremely complex biological system, set within an equally complex societal framework [and] will take several decades to reverse those factors driving current obesity trends.’ ”
It goes on to state that a key difference between the devolved regions in addressing obesity is the setting of obesity-related targets. England and Northern Ireland — where the current targets set by the Department of Health, Social Services and Public Safety are to halt the rise in obesity by 2011 — have set direct obesity-related targets, but Wales and Scotland have not.
Is setting such a general and short-term target realistic? Is it achievable or measurable? Can I canvass your views in relation to the effectiveness of setting targets as part of an overarching strategic framework?
Dr Wilde:
I will answer the second question first, on whether I think that setting targets is a good idea. I personally think that it is a good idea, because it gives us something to aim for. It forces us to measure things which will help us to work out what the gap is: it is only when you set the target that you can see what needs to be done, and where we are in relation to that.
There are issues around whether the targets should be as general as halting the rise in obesity, or whether it should also be about setting specific targets for men, women, young people, and different ethnic and geographical groups, as the Northern Ireland Audit Office report recommended, which would make this a bit more sophisticated. I think that we should be doing that. In some cases, we do not have the information or data to be able to do that, but a debate around targets would encourage us to get that information, which I believe is important.
The important thing is not to have endless discussions about what the targets are — that would become a complete waste of time — but to set some general targets, like halting the rise in obesity, and then set some specific targets. The halt in the rise of obesity target is aimed at children. We should have a target for adults, and we should have a target for men and women, but we really need to think, not just about end-point targets, but about what the intermediate indicators are, that would be a bit more practical.
For example, to return to Kieran’s point about physical activity, we could gather information on how many hours of physical activity that children get in schools, and set a target for that. We could find out how many people are eating five portions of fresh fruit and vegetables a day, and so on, and that would help us to work out where we are in relation to what might be called intermediate indicators, that we assume would lead to a reduction in obesity.
Yes, there should be a good monitoring system with good targets, and good data to support that, which would be fed back. One of the things that I did not say is that in all of the work that is going on, and as the Department develops its strategy, it is really important that things are put back into the public domain so that we know what is happening; so that people like you, the politicians, get a sense of what is going on. That would help to better inform the public about what action is happening, and I think that targets can help that.
The Chairperson:
Thank you, Jane for your time and for answering questions. It is a huge subject matter, which is far-reaching, and affects all Government Departments and every walk of life. It will be interesting to see what comes out of the inquiry.