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.
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