The Cedar Lounge Revolution

Making a meal of it… promoting healthy eating. July 15, 2010

You’d be hard pressed to find a better example of how debased some areas of political discourse on social policy issues are becoming than this article and the accompanying threads on the Guardian website. You’d also be hard pressed to get a better read on how the new coalition government in the UK is going to treat matters of public health over the next few years of its existence (well, other than the Budget… but that’s another days work).

The National Institute for Health and Clinical Excellence (Nice) will say in a major hard-hitting report that diet is not just a matter for the individual consumer. In what will be interpreted as a significant attack on the food industry, it recommends a series of changes…

Well, who’d have thunk it?

They argue that there should be a:

• A total ban on trans fats.
• Halving the individual daily salt intake.
• Legislating if necessary to encourage manufacturers to slash the content of hidden saturated fats in all food products.
• Ensuring low fat and low salt foods are cheaper than unhealthier versions.
• Banning television adverts for high-salt and high-fat foods before the 9pm watershed, to protect children.
• Urging local councils to forbid take-aways and junk food outlets near schools.
• Bringing in the “traffic light” colour coding system to show whether a product has high, low or medium levels of salt, fat and sugar.

Cue in the comments on the Guardian website vociferous complaints from some about ‘government interference’, ‘busybody organisations’ and ‘telling you what to eat’. What’s most bizarre is that there is such defensiveness about the proposals (few of which are likely to make it into legislation).

Now to me those seem, bar the total ban on trans fats, to be relatively uncontentious. And I exclude that because that could be transitioned to. There’s study after study that has demonstrated the negative effects of high salt and high fat diets. So this isn’t exactly controversial in health terms, well, no more so than the pernicious effects of cigarettes on human health.

What’s bizarre as well is that trans fats are such a relatively recent innovation. It’s not as if they’re some sort of cultural tradition that should be held up as a token of a pluralistic society. And far too often the complaints seem to be one where ‘you have the right to introduce any old crap you like and try to sell it to people, but woe betide you if you dare to curtail that on health grounds’. It’s here that we see a certain form of knuckle headed libertarianism (and there are entirely thoughtful versions of libertarianism, agree or disagree with them – Murray Rothbard is example A, so that’s not a tautological statement) colliding with a sort of blimpish complaint about ‘busybodies’ combined with a defense of the status quo, any status quo. Just as long as it stays the same, whether it was that way five years or five minutes ago.

Unfortunately personal choice doesn’t operate rationally in such areas, any more than in financial matters – and depending upon people to do the right thing when they are not in full possession of the facts is to essentially deny them agency in regard to one of the most fundamental aspects of their lives. Even if we eschew banning the least that could be done is to allow people the space and information to make informed decisions.

But that’s easier said than done.

I’m not a vegetarian and I’ll eat most foods bar white fish, but I’m no fan of hydrogenated vegetable fats, indeed I’ll usually inspect reasonably closely most processed foodstuffs to ensure I’m not going to eat them. But as those of you who share that particular tic will know it’s difficult to tell often what the contents of a product are. And the current GDA (guideline daily allowance) labelling, where it is applied, is both woefully difficult to parse out when one is in a hurry and doesn’t bother to cover trans fats. Where it isn’t one has to try to do math on the fly reading what is quite literally the small print.

So, one could argue, park banning trans fats – at least for the moment, and let’s have a traffic light system and clearer indications of what fats are used in making a product (by the by, most of us will now be familiar with the reality that most products that laud their low salt, low fat content will have something nasty squirreled away in them be it trans fats or high sugar content).

And then if one takes the personal responsibility line that it is up to the individual to make a choice then at least we can be more comfortable that people are making informed choices before they launch into the pack of Cheezles.

But as was noted in the comments section the UK government response isn’t much cop, and in particular one aspect of it.

“The best way to prevent cardiovascular disease is for people to eat better and be more active,” a government spokesperson said. “The NHS provides high quality cardiac care and there has been a reduction in cardiovascular deaths of about 50% over the last 15 years through better prevention and better treatment.”
The statement went on to suggest that Nice might have over-reached itself.
“Today’s recommendations are extensive and wide ranging, but it is not practical to implement certain proposals in this guidance, for example on the mandatory use of traffic lights alongside GDA [guideline daily allowance] in food labelling. It is extremely important that work by Nice is methodologically robust and includes fully workable proposals,”
Cardiovascular disease is responsible for at least 150,000 deaths a year, mostly through heart attacks and strokes. About 40% of those who die are under 75.

Erm… the NHS provides ‘high quality cardiac care’… That’s highly comforting, pass me the chips and dip them in that bowl of lard while you’re at it.

It’s hard to understand the idea that ‘it is not practical to implement certain proposals in this guidance, for example on the mandatory use of traffic lights alongside GDA [guideline daily allowance] in food labelling’ Er. Why not? It would simply be an additional labelling system.

Just looking at a packet in my hand here I can see four different recycling logos on it so this surely isn’t a question of print costs. It’s been notable how rapidly Non-GMO labelling has attached itself to some products. And one would imagine that food manufacturers who are able to incorporate the GDA system wouldn’t find it beyond their wit or comprehension to go that extra inch to use a traffic light system.

But no. The food industry, or more accurately portions of it – because some companies do take their responsibilities seriously, doesn’t appear to want to do anything that might deter people from purchasing their wares. Nothing at all… let alone banning certain products. So perhaps the truth is that no measures at all are what would satisfy them. Which makes me think that stronger action might well be necessary.

And this, this is above all else a class issue.

“These are eminently preventable deaths,” said Klim McPherson, professor of health epidemiology at Oxford University and chairman of the Nice committee which deliberated for more than two years.
Poorer people have up to a threefold increased risk of heart disease over those who live in more affluent areas of the country. The focus for the Nice committee was safeguarding the population, rather than advising the individual who may have limited options.
“It is about busy people having a lot to do, having to make choices on the fly, making pragmatic choices on how they feed themselves and their children,” said McPherson. “Commercial organisations are very good at exploiting people who make choices on price and convenience.”
The government would not be breaking new ground if it were to legislate on healthy food, he added. “We think it is commensurate with other bits of policy government gets involved with, like speed limits and clean air,” he said.

But allied to that are the costs that could be saved to the public purse…

Simon Capewell, professor of clinical epidemiology at Liverpool University and a public health physician, said the changes would make economic sense too. “We’re looking at well over £1bn a year in savings, not just to the NHS.” That included, for instance, fewer people being forced to give up work to care for somebody who was disabled through heart disease.
The committee was very concerned about the salt, fat and sugar levels in children’s diet, which could predispose them to unhealthy eating patterns and to heart disease from a relatively early age.
The Nice guidance calls for action on the way food is marketed to children – with a 9pm watershed on advertising unhealthy food.

The industry itself has responded as one might imagine:

The Food and Drink Federation said Nice was out of touch with what was happening, claiming voluntary measures by the industry had already substantially brought down salt, sugar, saturated fat and trans fat levels.

Which is trueish. There’s been some movement, and as noted above some companies have responded excellently. But I’m sceptical as to the efficacy of voluntary measures – particularly those made during economic booms, and such scepticism is borne of seeing how well such regimes have worked in this state. If they stick during less remunerative times…

And really, if people want more salt on their food, or whatever… The solution is very simple. Here I agree with the anti-busy bodies, it’s a matter of personal choice. I disagree with their criticism though. Do what humans have been doing from time immemorial. Buy some and add it themselves…

As for the broader UK government response? Well reading the latest missive
from that source one would be hard-pressed to see any genuine effort to tackle the situation…

The time had come, said [UK health secretary, Andrew] Lansley, to accept that “lecturing or nannying” people to change their behaviour did not work. He said business people “understand the social responsibility of people having a better lifestyle and they don’t regard that as remotely inconsistent with their long-term commercial interest”.

He may well be right, but given that the industry resiles from clearer health coding systems it’s hard to accept that such measures ‘don’t work’. How can we know? But it gets worse…

Lansley added: “No government campaign or programme can force people to make healthy choices. We want to free business from the burden of regulation, but we don’t want, in doing that, to sacrifice public health outcomes.”

Well, a government campaign to force through legislation the food industry to cut salts and fats would quite clearly work. As have similar campaigns (and increased taxes) on cigarettes. But what does he mean exactly?

Beer companies, confectionary firms and crisp-makers will be asked to fund the government’s advertising campaign to persuade people to switch to a healthier lifestyle and, in return, will not face new legislation outlawing excessively fatty, sugary and salty food, the health secretary, Andrew Lansley, announced today.
In a move condemned by campaigners as the government “rolling over on their backs in front of the food lobby”, Lansley told a conference of public health experts that he wanted a new partnership with food and drink firms. In exchange for a “non-regulatory approach”, the private sector would put up cash to fund the Change4Life campaign to improve diets and boost levels of physical activity among young people.

So… er… because government campaigns can’t force people to make healthy choices the only solution is an… erm… government initiated and largely industry funded campaign. Presumably to… force (on some level) people to ‘make healthy choices’.

Yeah. That’ll work.

And perish the thought that government might actually do something concrete above and beyond ‘campaigns’ to deal with this issue.