Why Dame Sally Davies’ suggestions won’t satiate our public health crisis
Amongst the political drama of Brexit, a barely functioning government, resurgence in climate change activism and a dozen other issues that I can’t list, a new government report about how to curtail childhood obesity will likely not have made your radar. In these turbulent times of great change, a public health report may seem banal.
However, fitting in with this zeitgeist, the report from outgoing chief medical officer Dame Sally Davies has made some seemingly radical suggestions for policy. This report has arrived riding off the sugar tax and increasing concerns about childhood obesity and health, explaining why the proposed suggestions are wider-reaching than one might expect.
The report’s recommendations touch many spheres. Some policies build on existing legislation, like extending the sugar tax and fixing confused VAT loopholes to more effectively target unhealthy foods. Other policies target fast food companies by phasing out marketing for unhealthy products, introducing smoking-inspired plain packaging laws, and changing regulations to make it more difficult to start a fast-food outlet. More radical plans include implementing car-free weekends to encourage physical activity and providing free water refills to encourage more people to drink water.
The most controversial proposal has been the banning of snacking and drinks (excluding water) on local public transport, which has led headlines in most of the coverage, and it’s easy to see why. A concern I saw was for people who have medical conditions, and whilst the report does recommended exceptions for such people, it’s easy to imagine how misunderstandings could arise, especiall if they have the burden of proof. And it isn’t clear how such a ban would be enforced. I doubt the government is preparing a snitch force to patrol every tram, bus and tube line for crisp packets.
More importantly though, it’s fundamentally a misguided policy. Having just moved to London, I’m still grappling with a daily routine that includes hour long commutes and weaving a healthy and filling diet into this. In our workaholic society where your typical Londoner will be working more than 8 hours, snacking within hour long commutes is reasonable as you stave off hunger before you arrive at home to eat dinner. Targeting this snacking is completely counterproductive.
It’s unclear why snacking has been perceived as unhealthy in this report, when you can snack on healthy foods and portions. It seems that this suggestion was made without consideration of the experience of working people, a theme that becomes more prevalent the more you look at the report.
The BBC article describing it as a “model [of] good behaviour to children” is very revealing – it’s a vain token gesture, attempting to build an image of health completely divorced of context. Judging people for eating large snacks or portions on a bus without knowing anything about their routine, lifestyle, or their own biology won’t create a healthy society. People have different dietary requirements which shouldn’t be dismissed or ignored.
The banning of eating on public transport is noteworthy not just because of the logistical absurdity, but because it doesn’t address the root problem: poverty. It isn’t a secret that income inequality has been one of the defining themes of our contemporary politics. Throughout my life, I’ve seen a recession define political discourse with stagnating wages in the face of increased living costs, unemployment, and austerity. Inevitably, this affects our diets and eating habits. Every year food banks break the most ignominious of records as more people need emergency packages.
The report has a section dedicated to the link between poverty and obesity, acknowledging how poorer families are disproportionately affected and how this gap has widened in the last ten years. It states that intervention to tackle childhood obesity is a great opportunity to improve the lives of children from the poorest areas. Therefore, the lack of suggestions about addressing poverty with policy suggestions is even more conspicuous.
Fresh, healthy food is expensive and making a fresh meal is time-consuming. The unfortunate reality for families struggling to make money is that they can’t necessarily provide three healthy meals. A 2013 report showed how during times of financial pressure, caloric intake was reduced, and nutritional quality of meals was reduced due to sacrificing fresh fruit and vegetables for processed foods. Poverty negatively impacts diet through several different pathways.
Firstly, there’s the direct fact that families are more reliant on buying unhealthy food. Parents living without food security will want their meals to be as filling as possible in case meals have to become more erratic, even if it risks malnourishment and long term health problems. Developing from this are pernicious long term effects that promote poor diets.
Poor diet and health from poor diets affects the education of children and potentially locks them out of educational opportunities that can improve their financial security. Behavioural pathways mean that a culture develops where people don’t know nor care about cooking healthy meals, meaning the loss of the art of cooking typically passed down in families. And people considered fat or unhealthy will be discriminated in employment, perpetuating the cycle. These are some of the interconnected factors conspire to exacerbate food poverty and public health.
That isn’t to say that working class people are, by their nature, unhealthy. Rather, social systems exist that make it harder for people with low incomes to live healthy lives by enforcing numerous different pressures. Though the problem of public health is a web of different factors, it’s important to recognise that the root is poverty. Poverty is the heart of the issue, using the different factors discussed as veins and arteries to influence health. Any reforms to improve health must address this.
When you consider poverty, this report lacks the radical zeal found when imagining changes to our infrastructure, public transport, and restraining fast food manufacturers. Regular car-free weekends could be a great way to begin disincentivising car use but is unreasonable when given the inadequacies of our public transport system. Restricting the developmet of fast-food outlets could help disincentivise fast food consumption, but it doesn’t address why an overworked population that often struggles for cooking time have become overly reliant on fast food.
Ironically, considering the coverage this story has received, these proposals are arguably nowhere near radical enough as the report’s flair for creative policies stays firmly within a defined box that seeks to compartmentalise the issue towards food. Thus, its proposals are separated from wider political, economic and social trends. These limitations are a reminder that the scientific problems we face today can require massive social and political change, and we shouldn’t be afraid of exploring these intersections.
Matthew Dale is studying for an MSc in Science Communication at Imperial College London