Public Health England’s blueprint on how to get us all to eat less sugar is an important, detailed and necessarily bold document that could – if ministers act on it – change and extend lives. Having sifted the available international evidence on what works, its authors conclude that only truly radical action will make any real difference to the unfolding health disaster of our time.
Governments claim to want policymaking to be evidence-based. On obesity, and specifically sugar’s contribution to our expanding waistlines, here is the proof. It has been collated by the government’s own experts on public health; not campaigners or academics. As such it should be the roadmap that David Cameron tells the team of ministers and civil servants currently drawing up the government’s promised strategy on childhood obesity to follow.
The report’s impressively clear-eyed view of the scale of the problem is obvious from the first sentence. “We are eating too much sugar and it is bad for our health,” it says simply. We should get no more than 5% of our daily energy from sugar. In fact we get up to 15% of it from the substance that as long ago as 1972 was described by a British professor, John Yudkin, as “pure, white and deadly”. Obesity, one of sugar’s many medical end-products, costs the NHS £5.1bn a year and rising. Sugar rots teeth; it encourages a lifetime of addiction; it leads to type 2 diabetes, with all the horrors that brings.
Most of PHE’s eight recommendations for action certainly require a level of intervention, regulation and enforcement by the state at least on a par with seatbelt use and not smoking indoors. It recommends slapping a 10-20% tax on heavily sugared drinks and foods in an attempt to reduce consumption. It also proposes a crackdown on the disgraceful free-for-all that is the advertising and marketing of unhealthy products to children, and on the buy-one-get-one-free offers that shops and supermarkets endlessly provide, almost always on sweets, biscuits and cakes.
The backing of medical groups, health campaigners and star names such as Jamie Oliver means that a sugar tax gets the most attention. Sources closes to Cameron say he is adamantly against such a move and that he favours other means of achieving sugar reduction. But the PHE suggestion that is most likely to change our dietary habits is for widespread and ongoing reformulation of foodstuffs to strip out all that added sugar that boosts food firms’ profits while adding to our calorie overload. Big Food will resist the call for “a broad, structured and transparently monitored programme of gradual sugar reduction in everyday food and drink products, combined with reductions in portion size” every bit as fiercely as the sugar tax.
This report is a potential game-changer. Sadly, though, both past and recent experience suggests that the government action that follows will be inadequate to the almost mind-boggling scale of the task. In 2007 the then Labour administration published the groundbreaking Foresight report, at the time the world’s most in-depth piece of work on obesity. Compiled by 200 scientists, it was full of (evidence-backed) dire warnings about how more and more of us would become dangerously overweight if nothing was done. Its findings prompted Alan Johnson, the then health secretary, to describe obesity as a “potential crisis on the scale of climate change” and warn that “it is in everybody’s interest to turn things round”. Labour made school food healthier, revived school sport and used the Food Standards Agency to push ahead with some reformulation, notably of salt, but obesity levels kept rising.
The coalition government’s approach to the same problem was to rely on the so-called responsibility deal to deliver progress. But its abdication of the traditional role of government in regulating vested interests amounted to little more than asking profit-driven food manufacturers and retailers to voluntarily – please, please – do a bit more to make their products healthier, and the marketing of them less in your face, especially to children. The shamefully limited progress that has ensued, and refusal of many of the biggest names in the food sector to participate, underline its total failure.
PHE quietly points out the advantages of acting. “If the nation dropped its sugar intake to recommended levels within 10 years, over 4,000 early deaths and over 200,000 cases of tooth decay would be avoided and the burden of diseases associated with obesity such as diabetes would be reduced, saving the NHS around £480m every year.”
But implementing its recommendations will require political courage on a vital matter of public health not seen since the battle in 2005/6 over banning smoking in public places. There will be sceptics to be faced down – the “nanny state gone mad/attacking individual choice” brigade. Big Food firms will argue, lobby, obstruct and potentially legally challenge anything that will hit their profits, as actually tackling obesity would do, just as the Scotch Whisky Association is trying to thwart the Scottish government’s introduction of minimum unit pricing of alcohol.
Can PHE persuade David Cameron to do what his advisers say is the urgent, overdue, right thing? The signs are not promising. But the childhood obesity strategy, due by the end of the year, will reveal whether he has chosen to put evidence before instinct and make the nation’s health his top priority.
