It is not controversial to say that an unhealthy diet causes bad health. Nor are the basic elements of healthy eating disputed. An excess of sugar, salt and fat increases vulnerability to stroke, heart disease and diabetes. Obesity raises susceptibility to cancer, and Britain is the sixth most obese country on Earth, according to the Organisation for Economic Co-operation and Development. That is a public health emergency. But naming the problem is the easy part. No one disputes the costs in quality of life and depleted health budgets of an obese population, but the quest for solutions gets diverted by ideological arguments around responsibility and choice. And the water is muddied by lobbying from the industries that profit from consumption of obesity-inducing produce.
Historical precedent suggests that science and politics can overcome resistance from businesses that pollute and poison – whether dealing in pesticides or tobacco – but it takes time, and success often starts small. So it is heartening to note that a programme in Leeds has achieved a reduction in childhood obesity over the past four years, becoming the first UK city to reverse a fattening trend. The prevalence rate fell from 9.4% to 8.8%, which may not sound dramatic, but is a significant accomplishment. The best results were among younger children and in more deprived areas. When 28% of English children aged two to 15 are overweight or obese, a national shift on the scale achieved by Leeds would lengthen hundreds of thousands of lives. A significant factor in the Leeds experience appears to be a scheme called Henry (an acronym: health, exercise, nutrition for the really young), which helps parents reward behaviours that prevent obesity in children. Its effectiveness, according to satisfied users, comes through empowerment – sharing strategies that work without hectoring or shaming.
Many Tory MPs are uncomfortable even with their own government’s anti-obesity strategy, since it involves a “sugar tax” and a ban on the sale of energy drinks to under-16s. Bans and taxes can be blunt instruments, but their harshest critics can rarely suggest better methods. These critics just oppose regulation per se.
The relationship between poor health and inequality is too pronounced for governments to be lackadaisical about large-scale intervention. People living in the most deprived areas are four times more likely to die from avoidable causes than counterparts in more affluent places. As the structural nature of public health problems becomes harder to ignore, the “nanny state” complaint loses potency.
In fact, the polarised debate between libertarians and statists over public health interventions should have been abandoned long ago. Government action works when individuals are motivated to respond, as in the Henry programme in Leeds. Individuals need governments that expand access to good choices. The Henry programme was delivered in part through children’s centres. Closing such centres and cutting council budgets doesn’t magically increase reserves of individual self-reliance. The function of a well-designed state intervention is not to deprive people of liberty but to build social capacity and infrastructure that helps people take responsibility for their wellbeing. The obesity crisis will not have a solution devised by left or right ideology – but experience indicates that the private sector needs the incentive of regulation before it starts taking public health emergencies seriously.
