Things to do while waiting on the obesity strategy…



So government has delayed the Child Obesity Strategy till Autumn. It’s easy to greet this with dismay, but I think the tone struck by the Local Government Association – a reminder of the importance of this strategy being produced soon, with an equal reminder that it needs to be radical, worthwhile and effective when it does appear- is one that pretty well sums up my views on this.

Hence I refuse to be dismayed by this delay.  Moreover, I can’t honestly say I’m surprised. Strategic delay is something we’re used to from the Department of Health.(Remember the ever coming, almost never arriving guidance on Public Health transition?)  I’m not excusing it, I refuse to be dismayed by it, and I refuse to be derailed by it, either.

But it may well not be this.  Hugh Pym of the BBC says that the Prime Minister wants to lead personally on child obesity because he believes in it, but given other things on his mind (something about Europe I seem to recall) he might be rather busy for the immediate term.

If what Hugh says is true,  then we should definitely be encouraged by this, not dismayed by it, because it gives opportunity.  We mustn’t be derailed by this delay.

Generosity or suspicion?

So I’m going to view this delay with generosity, that government wants to get it right, that this is a time to do so, and that we will get a strategy at the end of it that has a number of measures for national government, and a number of things for local agencies to do. And if I’m wrong, well, I’ll cross that bridge if I come to it.

Turn the noise off and breathe

In any case, the debate has become so shrill or polarised in some places that it’s probably useful to have an opportunity to think and reflect and remind ourselves calmly what it is we really need from a strategy.  The delay provides us with one, it provides government with one, and that’s often a welcome sign in health policy.  And yes, you know by now that I’m going to say we need a systems approach to really address obesity. I’ve heard very little of that and far too much about sugar tax from every side, as if that’s the only thing that mattered.  Why don’t I want a single answer strategy? Easy, we could be derailed by it.

During the breathing space

I don’t know about you, but this last financial year has turned out to be a very different year, and to an extent my job is becoming a very different job, from the one I started the year with. £7.8m of cuts from a £50m budget that will undoubtedly hit the NHS and will almost certainly be counter-productive, with a degree of short-sightedness and bad economic sense that could reinforce the default of being ever in reactive mode in health and never in preventive mode.  I have work to do on that in short term. I refuse to be derailed by that or the strategy delay.

But, I have work to do on that now, to plan for the long term. I am prepared to admit that while the delay in the strategy is unhelpful in terms of planning what budgets we save and protect and what budgets we cut in public health, it also gives me an opportunity. What? To focus not just on making cuts to the budgets, but on working with partners to decide where we want public health to be, what is possible after the cuts, what is possible without money, and to start to plan to put us there. And when the strategy does come out, well, we have to fit that in. I can see how we can avoid being derailed by all of this.

Anyway, who says government has to do all the thinking? What the residents who pay me expect me to do hasn’t change. They and government still need me to help implement a whole system approach to Obesity, and with the best will in the world government won’t be able to think of everything even if they want to.

We in public health still have plenty of scope for leadership. I came into public health to apply science to problems, not for others to do my thinking for me. Working hand in glove local with national is what we need. Will we get it? Well, I don’t know. Even if we don’t I won’t be derailed from doing what I can while continuing to advocate with government for better.

We also expect this year a new strategy or plan to deal with worklessness and a new strategy on drugs and worklessness, or that’s the widely trailed news in Whitehall. So altogether it’s not like we won’t have enough to keep us occupied.

That doesn’t mean we stop advocating for what we feel will work. But we need to advocate in a different way, I think.

There is a time for campaigning – the loud, public campaign, and a time for lobbying – the quiet, open conversation about the nuance, the need, the art of the possible and how proposed or existing measures affect people well or badly. Campaigning can be useful but at the same time can bring too much noise and heat and too little nuance.

Lobbying can allow for quiet, sensible, and nuanced conversations but obviously carries the risk of compromise becoming the end rather than the means to achieve something. But sometimes campaigning – however well intentioned – can snatch from us what lobbying might achieve. We must continue to articulate, calmly and sensibly, what we would like from this strategy. Time to lobby, not campaign, now. We could stop the strategy from being derailed by this.

That sugar tax thing

I’m already hearing people say with some panic “the sugar tax is dead.” Well, we don’t know. And I cant help thinking that the loud (and let’s be honest, occasionally rather shrill) noise around sugar tax has sometimes obscured the nuanced debate we need to have around obesity: it isn’t simple, there is no magic bullet, we need a range of measures at different levels, and the real prize is for local and national measures and action to work together.

If the strategy delivers national measures which we can wrap round with local action, wonderful.  If it gives a steer to both, that might be to the good. If it contains a sugar tax in addition to other measures, then that may work. If it contains a sugar tax alone, then that’s not a rounded strategy and won’t be effective. If it doesn’t contain a sugar tax, then it’s not the end of the world. A sugar tax is not, to me, the absolute acid test of a rounded obesity strategy. Please don’t mistake this for complacency, it’s a commitment to work with what I’ve got to do what good I can, rather than demand everything must be perfect. It’s my way of refusing to be derailed from the ultimate goal of better, healthier, happier lives for everyone.

Some other stuff to do while waiting on the Strategy

Here’s a list of some of what I plan to do while waiting on a strategy:

  1. Make the cuts, but try to plan for where public health is going to be, and what the public health footprint should be.
  2. Articulate the next generation of our strategy, especially what we can do as a system to improve and protect health and our population
  3. Attend the LGA child obesity seminar on 17th March and see whose good ideas I can shamelessly steal for my local area. And, yes, it’s still going ahead. It’s before the strategy release, now, not after. Well, that lets us share what we’re doing already and advocate for what we think could go in.  Have you noticed how the LGA are refusing to be derailed by this?
  4. Start really thinking through the whole systems approach to obesity and what can be achieved before and after the strategy
  5. Stock up on summer reading
  6. Eat Less
  7. Move More
  8. Improve my barbell form
  9. Stop watching the letterbox.

There is lots to do. Strategic focus is the key. I will not be distracted by this delay.

Have I said I refuse to be derailed by this?