You don’t have to look far these days to find some discussion of obesity and its causes. This week it was put to the British Medical Association conference that we should ban junk food from hospitals. Two days before this J T Winkler argued in the BMJ that we need a new “brutal pragmatism on food” and that the traditional instruments of public health were all ineffectual or unacceptable in the case of food.
The traditional instruments Winkler laments are education, taxation and regulation. He does though, comment positively on the Food Standards Agency (FSA) efforts to reduce salt consumption through reformulating food and public awareness campaigns. He is right to laud these efforts, which showed a decrease in average salt intake from 9.5 grams a day in 2000/01 to 8g/d in 2011 as well as adults becoming less likely to add salt at the table over the same period.
Despite concerns over the extent to which board members at the FSA may have had conflicting interests, it seemed generally well regarded and not subject to the severe scepticism which greeted the launch of the Public Health Responsibility Deals. These Deals have been criticised as allowing the food industry a seat at the policy making table, while it seems improbable to be in their interests to reduce the sale of unhealthy foods. We have recently seen strongly worded pronouncements that the food industry should have no role in the formation of nutrition policy, as well as being billed as vectors of disease by some.
Some of the scepticism over the Responsibility Deals comes from doubts over the extent to which industry interest will override health concerns, whether monitoring will ever truly be independent and their voluntary nature. A recent review of voluntary agreements between governments and business concluded that many countries are moving towards formal approaches to voluntary agreements and that some of the most effective contain sanctions for non-compliance. Some of the agreements included in their review don’t sound particularly voluntary at all.
This blurring of the line between voluntary agreements and regulation is, it seems, the reason why Winkler condemns regulation as ineffectual but praises the FSA efforts (which in my opinion seem closer to regulation than anything else). It is not clear whether the Responsibility Deals will make the nation healthier, and the review above noted that it is not currently clear whether (or in what circumstances) voluntary agreements can be more effective than more traditional regulation. What is clear is that scepticism around these Deals still remains, and that the potential benefits of reducing the consumption of salt, sugar and fat are still huge.