Lessons from the smoking ban suggest that the public may not be ready for a sugar tax. Instead, a broad range of targeted initiatives on obesity need to be mobilised now in order to pave the way for greater intervention if necessary.
A growing problem
“Almost 25% of adults, 10% of 4 to 5 year olds and 19% of 10 to 11 year olds in England are obese, with significant numbers also being overweight”.
The latest Public Health England obesity figures are stark. Their recent report on sugar reaffirms the link between excess sugar in our diets and obesity. With the devastating impact of obesity on individuals coupled with the cost to the NHS of treating obesity and its consequences – estimated to be £5.1bn every year – change is needed.
And the sense of urgency is acute as the obesity problem develops into a crisis. Public Health England estimate that by 2050 obesity will affect 60% of adult men, 50% of adult women and 25% of children.
So is major government intervention, like a sugar tax, required to take on the vested interests that continue to peddle us sugar by the bucket load? Will it change behaviours so that the public make healthier choices?
Lessons from the smoking ban of 2007 are pertinent. The smoking ban did not suddenly materialise: it was the culmination of decades’ worth of action to tackle the problem. Incremental shifts made steady changes to the general public’s behaviour and choices. This paved the way for increasingly interventionist action.
For instance, the complete ban on Tobacco TV advertising came in 2005, four decades after it was first addressed (in 1965). Efforts to curb smoking levels did not stop with the 2007 smoking ban; in 2012 tobacco displays in shops ended and since last month parents are no longer able to smoke in their cars with children present.
The statistics on smoking rates reflect the shift over time. In 1974 45% of people in Great Britain smoked. By 1994 the rate was 27% and by 2013 it was 19%. This decline is encouraging and has undoubtedly improved lives and reduced the potential burden on the NHS.
The challenge for government is that the obesity crisis is already a health and financial crisis. It does not have decades to intervene gradually and shift public opinion. This is why the sugar tax is treated as a silver bullet – a leap to the most high-profile, hard-hitting intervention. However, this is just one option to an extremely complex issue. In fact it may be distracting us from more appropriate options.
In order to tackle the obesity crisis with the urgency it deserves we need to accelerate the level of change and look at introducing a plethora of initiatives at every level of government, rather than pin everything onto a sugar tax.
More partnerships and sophisticated coordination will be required from government, health partners, local government, the third sector and employers to deliver the change we need.
Last year, Moorhouse supported the work of Boris Johnson’s London Health Commission in publishing Lord Darzi’s brilliant and ambitious Better Health for London. The report made clear that a myriad of public health initiatives are required to make the long-term changes needed to bring down obesity levels. Recommendations for London ranged from mandatory traffic light labelling and nutritional information on menus in restaurants and food outlets to encouraging more activity through Transport for London and Oyster schemes.
Enabling local solutions whilst introducing national level action will speed up the process of change without exceeding the tolerance threshold of the public; nudge theory on fast forward. Remaining outcome focused will be essential to bind mutually supportive programmes targeted at different levels of society into a common goal. More partnerships and sophisticated coordination will be required from government, health partners, local government, the third sector and employers to deliver the change we need.
We owe it to the next generation to take multipronged, targeted and coordinated action now.
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