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 “The Prevention Green Paper” Response: We need much more, much faster

In July, the Department of Health and Social Care published a Green Paper on Advancing our health: prevention in the 2020s outlining the government’s planned approach for “proactive, predictive and personalised prevention” of the major preventable health problems facing people in the UK.

For every child born in 2019, 23% will be overweight or obese by the time they start school; 61% will be overweight or obese by the time they are 211. In the last eight years, the number of diabetes related amputations has risen by 25% resulting in 9000 amputations last year2. And we know the situation is generally worse if you are in a lower socioeconomic group. From this alone we can tell that we have serious health problems in the UK – never mind all the other potential indicators we could look at. Clearly, we need to do more on prevention, and so it is great to see the Prevention Green Paper just published aiming to address this issue.

There’s no doubt that initiatives and actions set out in the Green Paper are positive – we especially welcome the commitment to ban the sale of energy drinks to under 16s, the launch of a new health index and the Childhood Obesity Trailblazer projects (see descriptions above).

Yet though the Paper says we will need “bold action” to reduce the number of years people are living in ill health and reduce health inequalities, it sadly lacks truly bold, big and new proposals. The language in the paper also worryingly leans towards the personal responsibility approach. As just one example, the paper says: “In the 2020s, people will not be passive recipients of care. They will be co-creators of their own health. The challenge is to equip them with the skills, knowledge and confidence they need to help themselves.” Skills and knowledge put the responsibility on the individual and while important are not enough when the environment and people’s situations pose significant barriers to living a healthy life.

When it comes to healthy eating and obesity, the government needs to take responsibility and put policies in place that facilitate people to be able to have a healthy diet rather than making citizens responsible for a food system that they can’t control. Our very first report set out that individuals are ‘force fed’ unhealthy diets by an unhealthy food system3. The situation hasn’t changed. Evidence shows that unhealthy options are widely available, attractive and affordable; and people’s choices are restricted and manipulated. Food and drink advertising disproportionately promote unhealthy foods, and we strongly urge the Government to take bold action on banning promotions of foods and drinks high in fat, salt and sugar (HFSS) and introducing a 9pm watershed on TV advertising of these HFSS products.

But they also should take this a step further and actively promote healthy foods – there’s not nearly enough of this in the Paper. Chapter 3 of the Obesity Plan, released within the Paper, still places an emphasis on reformulation and harm reduction around unhealthy foods rather than making healthy foods more accessible. The paper acknowledges the need to make healthier choices easier but offers little in the ways of solutions to make this happen. We will wait to see the consultation response on mandatory calorie labelling in the out-of-home sector but again this put the responsibility on the consumer and does not change the availability of unhealthy food — with one in four places to buy food being fast food outlets this is a huge oversight2.

Likewise, the Green Paper acknowledges that there is a social gradient to healthy life expectancy but generally lacks solutions on how to tackle this inequality. Prevention, “personalised” or not, will be more equitable if it doesn’t require time, money, effort and good access to information to make it happen. Obesity is 2.2 times more likely in children aged 5 in the most deprived communities compared to the least2. The discrepancies in cost between heathy and unhealthy food are stark (with healthy calories being three times as expensive as unhealthy calories2) and affect what people living in poverty can afford. The poorest 10% of UK households would need to spend 74% of their disposable income on food to meet the Eatwell Guide cost2. Addressing low income and also considering all the raft of food provisioning which the state does for children (school food, free school meals etc) and the elderly provide important policy levers.

It is fantastic to see that the Prevention Green Paper outline that infant feeding will finally be included within Chapter 3 of the Obesity Plan. Breastfed babies have been shown to have lower rates of obesity and a number of other conditions4,5 so supporting mothers to breastfeed should be a key priority for prevention. But again, we need to think bigger and bolder – a survey is not going to cut it. There are known barriers to breastfeeding that the government could act on now, as set out in the Children’s Future Food Inquiry6. To name just a few: legal protection for breast feeding mothers at work including having facilities and paid time to express milk; greater support from hospitals and NHS services to support women to continue breastfeeding, especially after the initial few weeks at home; and reducing the promotion of breast-milk substitutes.

We also need to look outside the box for how we can support families to buy, prepare and eat a healthy diet in this critical time period. The Healthy Start Scheme exists but needs a major overhaul to really support pregnant women and families on a low income to eat well and the promised government consultation on this is now long overdue. But what else can we do? It is very exciting to see social prescribing included in the Paper – this idea could be applied to support healthy eating, which would have cross-cutting prevention impacts. GPs and others could prescribe cooking classes or community garden programmes. Or if we’re really serious about this, how about fruit and vegetable prescriptions? We know that driving up fruit and vegetable consumption could save 30,000 deaths per year, and if set up in a clever way these prescriptions could also provide a boost in business to UK fruit and veg growers and our local economies. Our Eating Better for Less report7 explores how these concepts are being used in the US and we could learn from that experience in the UK.

Prevention is key, there’s no doubt about that. But given the scale of the problem, we’re going to need the government to do much more, much faster with strategic plans that look to change the systems in place to give people the best possible support to be healthy.

 

  1. The Food Foundation. Trajectory for children born in 2019. 2019.
  2. The Food Foundation. The Broken Plate.; 2019.
  3. The Food Foundation. Force-Fed: Does the Food System Constrict Healthy Choices for Typical British Families?; 2015.
  4. PAHO/WHO. Breastfeeding and Non-Communicable Diseases (NCDs). https://www.paho.org/hq/index.php?option=com_content&view=article&id=9977:2014-breastfeeding-and-non-communicable-diseases-ncds&Itemid=40721&lang=en. Accessed July 25, 2019.
  5. WHO. Exclusive breastfeeding to reduce the risk of childhood overweight and obesity. WHO. 2019.
  6. The Food Foundation. Children’s Future Food Inquiry.; 2019.
  7. The Food Foundation. Eating Better For Less: Incentivising Fruit and Vegetable Consumption with Price Discounts at the Point of Sale.; 2017.