Regulating for health – to nanny or not to nanny

I went to an extremely interesting FABResearch conference last week – Sugar, Fat & Addiction: New Approaches to the Public Health Crisis; I will be reporting on the medical aspects in next week’s newsletter. However, two of the presentations focused not on the medical aspects of the crisis but on how a public health policy addressing it could actually be implemented.

Professor Graham MacGregor is an eminent medic specialising in cardiovascular medicine and hypertension, but he shot onto the front pages in the late 1990s with his CASH (Consensus Action on Salt and Health) Campaign. He had concluded that excess salt was one of the prime causes of heart disease and stroke. So, with the backing of Food Standards Agency, he persuaded the major players in the food industry to incrementally lower the levels of salt in manufactured foods such as bread by 15% over a period of 8 years. Given the food industry’s paranoia about competition and failure to agree on almost anything, this says much for the professor’s negotiating skills. And without doubt, the reduction in salt consumption has contributed to the drop in the rate of heart attack and stroke across the population – the professor claims to the tune of 18,000 strokes or heart attacks a year.

He now wants to apply the same tactics to sugar which he blames, along with ultra-processed fast foods, for the obesity and diabetes crises.

The Professor does not mince his words. The current government’s platitudes about ‘freedom of choice’ are rubbish. The socially deprived do not have choice in what they buy to eat. They buy the cheapest and most easily available food because it is cheap and available 24/7 and because they are constantly bombarded by above and below the line promotion for that food by the 10 multinational food giants who manufacture 90% of the food that we eat.

The only way that anything can be done about it is if the food manufacturers, under pressure from government, incrementally reduce sugar in all products by 40% (especially and most urgently, soft drinks), cease all forms of advertising including sports sponsorship for ‘junk’ foods, reduce portion size and limit the availability of these foods. Meanwhile, the government needs to introduce a sugar tax and, essential for all of this to happen, both scrap the current ridiculous ‘Responsibility deal’ in which the food industry ‘polices’ itself – and remove responsibility for nutrition from the Department of Health and return it to an independent agency such as the Food Standards Agency.

Gosh….. Although, given the Professor’s success with salt, who knows what he can achieve with sugar!

Somewhat more nuanced, but no less persuasive, arguments in favour of government intervention were also made by Professor Simon Capewell, Professor of Clinical Epidemiology at Liverpool University.

Even though, in the current political climate,  government intervention is seen as intrusive ‘nannying’, looking back over the last 200 years, it is clear that government intervention has been crucial in all the major improvements in population health and well being: the provision of safe drinking water, sanitation, clean air, tobacco control – even the abolition of slavery.  Advice, pubic health leaflets, ‘nudging’ simply does not work – regulation does.

Professor Capewell then gave an interesting insight into why the advice module in public health at least, even when supported by apparently incontrovertible evidence, does not work.

The common belief is that research is linear. Research is done,  conclusions are drawn from it, those conclusions are put to the people in power and they act upon them. But that is not how it works.

In the NHS, the people who actually make the decisions are the mid level managers. Public health advisers/researchers have no power, they are merely consulted. These mid level managers have little scientific knowledge or experience, but are subject to all kinds of other practical and financial pressures which may actually militate against the implementation of the researchers’ conclusions. Researchers need to understand and allow for this if they are to get their conclusions acted upon, but few do.

Ten multinational corporations control 90% of high street food and make all of the ultra processed junk foods that Professor MacGregor maintains (with good reason) undermine public health. But these corporations  are motivated by profit. If improving public health affects their bottom line they will only change policy if forced to – and the most effective way to force them is by regulation.

His blueprint for successful intervention goes something like this:

• Convincing scientific evidence of the need for change and of what that change needs to be to.
• Gradual spread of understanding of the need for change throughout the scientific and regulatory community.
• The media get on board and public opinion starts to get behind the needed changes.
• Opposition within the regulatory community gradually overcome.
• Regulation, taxation – success!!

For more on the wonderful FABResearch see their site here. For e report on the full conference see the FoodsMatter site here.

Btw… Did you know that one Big Mac with chips and a Coke is the calorific equivalent of 18 oranges or 11 bananas! But, because it does not give you a feeling of fullness (more of that in the report) you do not feel full after it. See the image of the kids above…