After the extraordinary decision to scrap Public Health England in the middle of the Covid-19 pandemic last summer, we had been waiting to hear what would happen to its vital functions. We now finally have some clarity: the government’s ‘Transforming the public health system’ policy paper heralded in the reign of the rather underwhelmingly named Office for Health Promotion, sitting within the Department of Health, as PHE’s successor.
Given the DH’s dismal failure to continue the successful reformulation programme that originally sat under the Food Standards Agency, the decision to create the OHP within the DH was baffling to say the least. More promising, however, is that the OHP will report to both Matt Hancock and Chris Whitty, the chief medical officer. The CMO’s authoritative team undoubtedly understand the multiple complexities of unhealthy food and obesity, and also are viewed as independent of government – that all-too-necessary element that PHE sorely lacked.
Another positive was the announcement that a cross-government board of ministers will oversee all prevention activities. However, it is unclear what the membership of this committee will be, or who they will report to. Bearing in mind the most successful policy on obesity prevention, so far, has been the Soft Drinks Industry Levy – without an HM Treasury representative on board and a mandate from the prime minister, its effectiveness could be severely curtailed before even getting off the ground.
The negatives are far more concerning. There doesn’t appear to be any extra budget for the new OHP, and there is no concrete information about their strategy, other than a mention of building upon the Prevention Green Paper. This thankfully highlights salt reduction, banning the sale of energy drinks, improving front-of-pack nutrition labelling and improving the nutrition quality of infant food as key priorities.
Also referenced is the recent ‘Working together to improve health and social care for all’ White Paper, which similarly highlighted front-of-pack labelling as a legislative priority. All other measures proposed in the Childhood Obesity Plan and the recent ‘Tackling Obesity’ strategy, released in July 2020, are not referenced. What’s more, those proposed measures are being systematically weakened. A key example is the food and drink advertising industry influencing the online advertising ban which, according to a recent leak, is to be scrapped. This would undermine the entire obesity strategy and raises a question: how can OHP fulfil its duties to prevent obesity if the government is not committed to doing so?
What concerns us most is that unhealthy food, and reformulation to improve the quality of this unhealthy food, are not championed in the government’s policy paper. Given that poor diet is one of the biggest causes of death and disability in the world and reformulation has been proven, both in the UK and worldwide, to be a cost-effective and impactful intervention, it would be scandalous to omit this. Indeed, there can be no serious prevention policy in the UK without the inclusion of reformulation.
Thousands of deaths could be prevented each year in the UK if we could reduce salt, sugar and saturated fat intake even just part of the way to the recommended maximum intakes. Government has learned some hard lessons from the Covid-19 pandemic and it must now put these into practice and urgently prioritise preventative measures to tackle obesity, high blood pressure and other consequences of unhealthy food. The UK’s vaccination programme demonstrates that they can do it, but is the DH sufficiently robust to beat an even bigger pandemic – that of unhealthy food?
Professor Graham MacGregor is chair and Mhairi Brown is policy and public affairs manager at Action on Salt and Action on Sugar