The Sugar Tax…I love joined up thinking

I love joined up thinking on building a healthy, economically thriving population. Unfortunately my penchant for analysing everything that comes in my direction tells me that’s not what we got today on sugar.

A taxing issue

The Chancellor has announced in the Budget, within the last couple of hours, a levy on the manufacturers of sugar sweetened drinks. I nearly fell off my chair. There are various bits of various devils to be included in detail but:

  • it will be graded,
  • it will come in two years from now,
  •  there will be a consultation (but basically we know it’ll happen)
  • it will raise £530m for spending on school sports
  • some drinks may be banned altogether
  • Some speculation breakfast clubs included (good idea and wholeheartedly support this)

A victory for public health, I hear some acclaim. Well, I can agree that health motives were stated as front and centre in the Chancellor’s thinking today on this one.

But a victory?  I’m not so sure.  A little cool-headed policy analysis suggests to some of us that this is only one measure – however welcome it is – among a range of measures we need to get our population to a healthy weight.

The Cabinet Minister and Paymaster General Matt Hancock MP is saying on BBC news as I write this  that the evidence for sugar tax is “pretty strong, and overwhelming.” I think that’s a little overstated. The evidence suggests a tax would lead to reduction in consumption, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/470179/Sugar_reduction_The_evidence_for_action.pdf but we also need other measures too. The BBC suggest this is a government turnaround from what was said earlier in the year.

What’s good about this

It’s great that money is being pumped into school sport. Sport is great for children for all sorts of biological, psychological and social reasons. Wonderful!  A rousing cheer. Brilliant move. I couldn’t be happier in and of itself just because of the wonderful benefits physical activity can bring to physical, cognitive and social development of young people. And putting some money behind our vital schools in their role of socialising the future of our country – our children – is great. But let’s remember some schools are struggling to deliver free school meals with the money they have already.

Here comes the but…

But however welcome the £530m is, sport in and of itself is not the answer to obesity. It can and should be part of an answer. But a nuanced reading of the evidence suggests that however useful a tax might be it isnt a solution in and of itself .  This tax measure wasn’t nuanced. There are all sorts of sources of junk calories in childrens’ diets way beyond sugary drinks, and all sorts of influences to help us gain weight that no amount of sports lessons will outweigh. This tax wont touch any of that. We still need a joined up obesity strategy.

Diet is hugely important for healthy weight. Physical activity is also hugely important but no amount of sport will save you from an appalling diet. The best way to keep a healthy weight is eat right AND exercise, not just exercise.

So from my own public health perspective, the logic here feels a bit awry. I know others disagree with me. Spending more money on school sports is immensely welcome, but that  won’t replace the cuts to obesity programmes because of cuts in public health money.

We’ve had 16% cuts announced over four years to public health budgets, budgets which fund child healthy weight services. However much putting money into schools and school sports is something I think is great, it does feel like with one hand a significant amount of money at least some of which was being spent on effective obesity reduction interventions has been taken away, to be replaced by £530m from a tax source to fund something which however good it is will not of itself be even the major factor in getting our population back to a healthy weight.

Whatever else it is, this is not a victory for joined up public health, or joined up thinking.

Better ways of spending £530m

I don’t want to appear churlish; but  this in and of itself will not give us the answer to child obesity. We need other measures too, so we still await the obesity strategy coming later in the year.  Using the money to deliver whole school approaches to healthy weight (cooking classes, healthy eating across the day, engaging parents in those, physical activity across the day) would be better.

Please, Sir, I want some more…

Tomorrow we have the LGA national event to look at what we’d like from the Obesity Strategy.  Reformulation of food, access to services, ability of local councils to fund healthy weight services, whole school day approaches to nutrition and restrictions on marketing to kids. Local and National measures have to work together to reduce the growth in unhealthy weight. This tax, and the money it generates, is just one measure. And frankly I doubt it’s the most important.

If this tax is all we get, it will not deliver the change we need as a population. As one measure among others, it is welcome. But it isn’t comprehensive and we shouldnt be distracted by the fact that this is political move as much as it is a public health one.

It’s brilliant that government really wants to do something on keeping our population healthy. Now let’s have something more effective than this.

 

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Don’t be so fast to dismiss One You as patronising…some folk find it helpful.

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Into my inbox early this morning popped Public Health England’s new one you survey, aimed at folks like me who are officially middle aged (I’m 50 and a half if you must know.)  So I filled it in https://www.nhs.uk/oneyou/hay#fvoDxZkV4IiFYg8c.97

There’s been a lot of noise this morning about how patronising some people feel this is and how it’s a waste of money.  And while I was going through the questions there were a couple of times when, to be honest, I quite felt like shaking whoever came up with some of the language warmly by the throat (Whoops, bad for my blood pressure).  BUT….and there is a but.

As I said when interviewed on one of our local radio stations, it’s actually really good! (Yeah I know, I would say that wouldnt I? )

Ok, the language, tactics and some of the messages have been criticised. Indeed one or two of us have been scratching our heads about some of the messages at petrol pumps. But there is a convincing rationale that this reaches and has been tested on some folk who are not me, even if it turns me off.  Others I know have been given pause for thought by stuff which has wound me up. So neither I nor you are abiters of what works for everyone here.

But please, have a listen before you bang on about Nanny State:

I think of myself as fairly healthy. I have good reason to seek to be, apart from being 50. I come from a family where blood cancers are common (I’ve had it myself.) I grew up in a context where many of the people in my extended family (working class Scots/Irish) and many of those in my village and others nearby died from heart disease, cancer, diabetes or stroke.  And most of that was lifestyle related, with some genetic predisposition, if we’re honest.

And I want to keep myself well so I dont end up anytime soon by winning what feels to – what’s left of – my family to be the Celtic Lottery of death through preventable causes .

Why is this important?

Diabetes has nearly doubled in the past twelve years in England, obesity is rising, cancers caused by lifestyle are on the increase and disability caused by lifestyle is too. And the costs associated with treating and responding to it are increasing dramatically.  So even if you think this is nanny state, the fact remains several million of us could do better at preserving our quality of life by making some gentle changes in our lifestyle.

I’m not 35 anymore, I can’t do what I want to without risking my health and I am – I hope – going to get older. Feeling good, fit and healthy is very important to me so being as independent as possible for as long as possible is something I value much more than my freedom to consume enough sugar to induce diabetes. Drinking sensibly, eating well and keeping active doesn’t spoil the party for me. It is the party! And it’s a fun ride.

Believe me, having had a weight problem most of my life, and having been through cancer, I feel better, fitter and happier than I ever have, except the day after leg day at the gym.

Anyway, the survey gently took me through things and yes, I got a good result, 9 out of 10 if you must know. But actually it challenged me.  It challenged me to look and review.

Why did it challenge me?  Well finding what you need to know to be healthy isn’t actually obvious in a world where there are so many fads and fashions.  And yes, health professionals often do a very bad job of communicating. We can do better. We must do better.

The good things about this survey

A great thing about this survey is that it asks really good questions like strength building  activities and relates the activities to real life that I guess even most GPs wouldnt think to ask you. Why should we care?  Well, you want to be able to be independent and not have mobility problems as long as possible, don’t you?  Dont’ you?  I’ve never met anyone who currently can walk who actually wants to be unable to walk or hold a kettle by the time they’re 70.

Why won’t we leave you alone?

We know that getting health information does help some people make the right choices. Ok, some of us may feel the messages here or implementation could be improved. But the point is some people want this information, and some people will act on it.  If you don’t want that then fine, don’t engage. But you don’t have a right to prevent that reaching others. Their choice and right to be informed matters every bit as much as your right to disengage.

Why are my taxes being spent on this?

I understand that some people may not want their taxes spent on this but other taxpayers do. They want a healthier population because they don’t want their tax bill to increase year on year because of preventable disease and disability and the massive cost in human misery, not to mention the huge bill for health and care services, that comes with it.

Right now, the NHS and local councils are struggling to cope with a massive number of people  who dont have the strength to stand up, who have falls, the misery, pain and loss of independence associated with it, never mind the cost to the NHS, social care and your taxes. And at least half of this is preventable.

We’ve heard a few saying today  that this is a waste of money. Actually, while there are some things I wonder about, on the whole I disagree.  This campaign will cost less than it will cost to treat a dozen cases of diabetes type 2 (lifestyle related) or 10 cancer cases over a lifetime. And the evidence suggests that it will help change people’s lives. The alternative is your taxes keep going up and up to pay for avoidable disease. The simple answer is we can’t afford not to prevent disease any more. We need this.

Perfection this is not

So this campaign isn’t perfect. But give it a chance. One You isn’t about telling me to be dull and give up every pleasure I have. It is about keeping ME healthy and fit because I want to be, and giving me some tools to do that in a world where health messages are confused. I want to be independent for as long as possible. I want to enjoy life. And I do. And being healthy is a key ingredient for me.

And if you really don’t care, well that’s your choice.  But don’t spoil the party of feeling and being happy and healthy for those of us who do want to stay fit and healthy, or those who would if they took this simple survey.

If you complain that telling you to be healthy is taking away your choice not to be, that’s fine, and those of us who try to keep our population healthy have a duty to make the messages clear, the steps easy and not patronise you. Sometimes we don’t do a great job of that.  But this cuts two ways..isn’t your telling us not to do this taking away other peoples’ choices to be healthy?  Wouldn’t you want people to have access to information that can help them make choices, just like you have made your choice not to engage?

You may ask what right the public health world has got to give these messages. The question cuts both ways: what right have you got to say it shouldn’t, especially since the take up of ONE YOU is already high?

Some in the public health world haven’t done our efforts any favours by the way ideology feels like it gets in the way of evidence. Look at the hostility to vaping, for example. I think vaping is a real public health gain. I wish many more of my peers would come on board. And yes, probably some money spent helping people make the choice to give up tobacco should highlight vaping as a much, much, MUCH safer strategy than smoking.

Public health as a movement doesn’t exactly have a blame-free record in helping people. But that’s no reason to damn this programme before it even starts. Any by early reports I have heard, this ONE YOU thing is going down rather well.

A few of us at work have completed it now and all of us have found it useful, and all of us have found things we didn’t know. Some found the language off-putting but actually some found it OK and quite engaging. So this thing may not be to your tastes, but it clearly is to that of others.

Not perfect then, but do I support this?  Yes. Can I see the benefit? Yes.  Do I wish this had happened ten years ago so I could have made myself healthier then?  No contest.