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Official Report (Hansard)

Session: 2008/2009

Date: 21 May 2009

COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY

Inquiry into Obesity

21 May 2009

Members present for all or part of the proceedings:

Mrs Michelle O’Neill (Deputy Chairperson) 
Dr Kieran Deeny 
Mr Alex Easton 
Mr Tommy Gallagher 
Mrs Carmel Hanna 
Mr John McCallister 
Ms Claire McGill

Witnesses:

Mr Andrew Dougal ) Northern Ireland Chest Heart and Stroke Association 
Mr Iain Foster ) Diabetes UK Northern Ireland 
Ms Victoria Taylor ) British Heart Foundation

The Deputy Chairperson (Mrs O’Neill):

We will now move on to the next set of witnesses. I welcome Andrew Dougal from the Northern Ireland Chest Heart and Stroke Association (NICHSA), Iain Foster from Diabetes UK Northern Ireland and Victoria Taylor from the British Heart Foundation (BHF). I invite each of you to make a presentation, after which members will ask questions.

Mr Andrew Dougal ( Northern Ireland Chest Heart and Stroke Association):

The obesity epidemic threatens to reduce the advances in health that have been made since the Second World War. For the first time in our history, young people may not live for as long as their parents. More than 60% of Northern Ireland’s population is overweight or obese, which greatly increases their risk of heart disease and stroke.

For more than 60 years, the Northern Ireland Chest Heart and Stroke Association has campaigned for healthy lifestyles to prevent people suffering from those illnesses. We urge the Assembly to ensure that there is more effective cross-departmental efforts and resources to tackle that disaster. In particular, we make a plea for the Department of Education to work in conjunction with the Department of Health, Social Services and Public Safety. In the past, that did not always happen.

The private sector must play its part and work with the voluntary sector and the statutory sector. Statutory regulatory bodies must remember that their role is to protect the consumer rather than the industry. Although the Food Standards Agency concentrated on food safety in its early days, it is now responding to the need for information on nutrition. For many years, the Chest Heart and Stroke Association and other organisations campaigned for the establishment of that agency, and the legislation to do that was enacted eight years ago. The FSA must protect the consumer in the same way that Ofcom protects the consumer rather than the TV industry or the advertising industry.

Over one third of all deaths in Northern Ireland are caused by heart disease and stroke. Stroke is the third biggest killer and the leading cause of disability in Northern Ireland. Of those who have a stroke, one third make a full recovery, one third die, and one third have a substantial disability that results in some level of dependence on others for the rest of their life.

To give the Committee some idea of the costs involved; £102 million is spent on direct health and personal social services; £87 million is spent on informal care in Northern Ireland, particularly by the families of those who are in care institutions; and £65 million is lost in income because of mortality, morbidity and benefit payments. That means that, in total, the cost to Northern Ireland is over £250 million.

The Northern Ireland Chest Heart and Stroke Association believes that 40% of strokes could be avoided through proper preventative measures. That is why we are asking for a primary prevention programme on stroke. We asked for a similar programme on heart disease in the Assembly in 1984, and we finally got one in 1986. In the last 20 years, the number of premature deaths from coronary heart disease in people under the age of 75 has declined by 71%, so it is worthwhile to have a prevention programme. It is time that we had one on stroke.

Thankfully, we have the Northern Ireland stroke strategy, and the Assembly has voted to spend £14 million each year on combating stroke. We want to see that money well spent. We want to see it used in reducing stroke and in treating people much more effectively, particularly with clot-busting drugs that have been available in the United States for 10 or 11 years but are only now becoming available in Northern Ireland.

Figures from January 2008 show that over 150,000 people in Northern Ireland are obese. According to the Foresight report of 2007 — which is a seminal report — it is estimated that if current trends continue, by 2050, nine out of ten adults and two out of three children across the United Kingdom will be overweight or obese.

It is the view of NICHSA that over the last quarter of a century, public representatives have had a binding duty to do all that they can to protect the health of our young people. As far back as 8 June 1984 — 25 years ago — NICHSA held a one-day conference entitled ‘the healthier Ulster diet’, which was chaired by Professor Philip James, who now chairs the World Health Organization’s task force on obesity.

Sound nutrition must not be solely for the middle classes. Health authorities, food producers and retailers must see it as their duty to ensure that everyone is empowered to have a healthier diet. In essence, it is important that we have leadership on this issue. There may be a need for a tsar who could take the issue on.

The importance of school-based activities must be emphasised. It is essential that we ensure that healthy eating is part of a whole-school policy. We have been asking for that for 25 years, and we are pleased that the Food Standards Agency, the education and library boards and the Health Promotion Agency are now getting there. There have been major changes. That should be a requirement in every school, not only middle-class schools. Coronary heart disease and stroke is most rampant in the lower socio-economic groups, and that is where we have not been successful. We must focus more and more of our efforts on dealing with that.

The point that Dr Deeny made about guideline daily amounts in the previous evidence session is very valid. I am not innumerate, but I find it difficult to understand them. I find the traffic light system to be very positive, as is using the terms “low”, “medium” and “high” to describe the various contents of food.

Sixteen major companies have deviated from the traffic-light system recommended by the Food Standards Agency before it had the opportunity to launch that campaign. That has caused huge public confusion. Those companies, which I am not going to name today, have done no good for the health of their customers. They have failed to empower their customers. We would like to see all companies sticking to one simple system that people understand.

Stroke is the largest single cause of disability in our community. Preventing stroke can be of huge benefit to the people of Northern Ireland, the Health Service and our economy.

Ms Victoria Taylor (British Heart Foundation):

Good afternoon. Thank you for inviting us to speak to the Committee. As a dietician, obesity is an issue that is close to my heart and one that I spend a lot of time working on. The British Heart Foundation is keen to see improvements in obesity levels, as obesity is, in itself, an independent risk factor for heart disease, but it can also be seen as an accumulator, in that it has an effect on other risk factors including diabetes and hypertension, which is also linked to stroke.

The INTERHEART study estimates that 63% of heart attacks in western Europe were due to central obesity. Another factor that we need to consider is whether people are apple shaped or pear shaped; the apple shape being more inclined to central obesity, which has a greater link to heart disease. People who are apple shaped, or have more central obesity, are twice as likely to have a heart attack as those who are not.

The reasons for action have been set out in the Foresight report, which contains stark and sobering predictions of what will happen by 2050. Based on changes to BMI alone, the report predicts that heart disease will increase by 20% by 2050. That will have not only human costs, but economic costs, through the treatment of those who have heart conditions. We are pleased that death rates from heart disease have fallen since the 1970s. Although the fall is partly due to reductions in risk factors, such as smoking, the decrease is also due to better treatments; people with chronic diseases are living longer with long-term medication.

The question of how to solve the problem is very difficult to answer. We are aware that there is no single solution; a joined-up approach is needed not only between Departments, but between the different sectors. The food industry was mentioned but, as a non-Government organisation, we are keen to work with the Government also. We are also aware of the need to raise problems that we see in food advertising.

The focus of the British Heart Foundation is more on prevention than management. We want individuals to receive good advice, but we recognise the need for a supportive environment. The approach to obesity should be a combination of diet and physical activity, which are the two sides of the energy-balance equation, as well as behaviours.

As a whole, the population is getting bigger, but there are groups of the population who find it more difficult to select and prepare a healthy diet, which is partly based on income. Therefore, as we have already heard, it is vital to make healthy choices the easier choices.

Before I talk about our recommendations to the Assembly, I will point out what the BHF is doing. We are keen to support work that is ongoing, and hopefully our educational resources will help individuals and front line staff to do that work. We are also very proud of our social marketing campaigns. The Food 4 Thought campaign, which looks at what children should do to combat obesity and targets 11- to 14-year olds through schools, has been taken up by schools in Northern Ireland — 128 signed up the most recent campaign. This year, the campaign also takes an innovative look at the consequences of the choices that children make.

The two most pressing policy calls concern advertising to children before the 9.00 pm watershed, rather than just during children’s programmes, and front-of-pack food labelling. We are strongly in favour of the traffic-light system, so we welcome the support expressed for it this afternoon.

A joined-up approach is vital; we need to see all Departments working together. The approach to physical activity and planning policies may involve Departments that would not obviously lend themselves to the obesity problem; however, the problem is not the responsibility of only the Department of Health. We are looking forward to the publication of the service framework for cardiovascular health and well-being. It is also important that we have good monitoring and evaluation of the Fit Futures strategy so that its goals are achieved and we can know whether it has been successful.

Although those goals cannot necessarily be achieved directly by the Northern Ireland Assembly, we would welcome its support for halting the advertising of junk food to children before the 9.00 pm watershed and also for ensuring that there is a single system of front-of-pack food labelling that is clear and that people will understand.

Mr Iain Foster (Diabetes UK Northern Ireland):

I am Iain Foster from Diabetes UK. Six years ago, I was diagnosed with type 2 diabetes. Therefore, I have a personal and a professional interest in the issue.

I understand that the Committee’s inquiry has been ongoing for some time. You have heard a range of evidence. I do not need to rehearse the statistics; the evidence is very clear. Dr Michael Ryan from the Northern Health and Social Care Trust gave fairly comprehensive evidence on the medical side of diabetes. I would challenge one or two of his statistics, although only on minor details; I will not quibble over them.

Essentially, I want the Committee to bear in mind, particularly with regard to obesity and diabetes, the importance of getting beyond the misconception that diabetes is a mild condition. It is not mild; it is a chronic condition that has no cure. Type 1 diabetes will take up to 20 years off a person’s life expectancy. Type 2 diabetes will take up to 10 years off a person’s life expectancy. You can imagine the impact that that has on a person and his or her family, as well as the impact on the Health Service.

At current levels, over £1 million is spent each day in Northern Ireland to treat 65,000 people who have been diagnosed with the condition. Current prevalence models predict that that will rise to over 80,000 people during the next five to 10 years. The Health Service cannot sustain that level of care. Diabetes is a complex condition; patients must see a range of health professionals and take a range of medication. It is intensive and cost heavy. Therefore, it is in the interests of individuals, communities and the Health Service to stop the increase in the number of people who develop diabetes.

With regard to obesity, it is important to remember that there two types of diabetes; type 1 and type 2. Type 1 is genetic and tends to develop in younger people. It has no connection whatsoever to weight issues. At times, even as a diabetes charity, we can be slightly guilty of raising the profile of diabetes in a simple way to get the message across. Yet it is important that we do not have the simplistic model that all diabetes is weight-related, particularly because people who are diagnosed with type 1 diabetes are mainly children. We have a lot of anecdotal evidence of children being bullied and stigmatised because of their diabetes. Type 1 diabetes is not weight-related, and it is important to make the distinction between the two types.

Even type 2 diabetes is not exclusively caused by excess weight or obesity. The causes of type 2 diabetes are still not fully known. Much research is still being done. Weight contributes to around 80% of cases of type 2 diabetes. The other 20% of people who have type 2 diabetes have no weight issues whatsoever. We are aware of people who are heavily obese but have never developed type 2 diabetes. Therefore, it is a complex picture and it is important not to become too simplistic about it.

As regards current treatments of diabetes and obesity, it is clear that society and the Health Service have failed. There is no issue about that. That is not an attack on the Department of Health. The amount of money that it invests in diabetes care is quite clear; however, statistics show that there has been a steady increase in the incidence of diabetes. Logically, therefore, it would seem that the cause of that increase is beyond the remit of the Health Service. There are wider factors that are very much to do with lifestyle that the Health Service currently cannot control. Obesity and the health complications that it causes are a lifestyle issue.

Until now, the Health Service has treated the complications and consequences of obesity using a medical model; it has not viewed obesity as a lifestyle disease. Skills, investment and knowledge relating to people’s lifestyle choices are at a basic level throughout the Health Service. Lifestyle is not a technical, medical issue. Many healthcare professionals feel uncomfortable tackling other people about their lifestyle choices. Many of those issues are outside the Health Service’s control and, to be honest, are probably beyond politicians’ control.

Therefore, I understand that it is a difficult challenge for you as politicians to try to affect that situation. It is a complex situation and no single piece of legislation will achieve the desired result. As it is beyond your control, you will, obviously, not have experience of it and you may feel uncomfortable addressing it.

Unless we start to regard obesity as a lifestyle disease, we will not stop its increase. Levels of obesity will continue to rise, and its consequences will be phenomenal and much worse than other issues that receive far more resources and applied intelligence. Obesity as a lifestyle disease has received little investment or attention. It is important to consider someone’s wider lifestyle and all the factors that feed into it.

We do that by changing people’s attitudes, and that is a challenge in a similar way that dealing with drink-driving, wearing seat belts and smoking in public places were big challenges. However, changing people’s attitudes to lifestyle choices presents an even bigger challenge. Strong legislation played a role in shifting people’s attitudes to smoking and drink-driving, and politicians must face that fact when thinking about obesity.

Until now, all efforts to tackle obesity have concentrated on information, advice, and awareness. By and large, that message has been received. People might not know about daily allowances and other technical details, but most have a reasonable idea of what is or is not healthy. Even having a good knowledge, however, does not affect some people’s behaviour positively. Therefore, there must be an additional trigger or lever to change people’s behaviour. I am quite sure that legislation is required. In the past, people have taken a hands-off approach and have been scared of having nanny-state accusations made against them. To shift the wider cultural sense of what is acceptable and signal what direction should be taken requires stronger political leadership from the Health Service and other areas of Government on legislation, the food industry, education and leisure activities. Without that, the trend in obesity will continue, and the Health Service will face the consequences and possibly start to crack under the strain.

I stress that leadership, the recognition of obesity as a lifestyle disease, and legislation are required. Obesity is a complicated issue, because it does not require a single piece of legislation or affect only one section of society; it covers a many elements of modern life. I advise you not to underestimate the challenge. One thing is certain: if we do not attempt to tackle obesity, the future will be very bleak for us all. I could go on, but I am conscious of time.

The Deputy Chairperson:

There is little that you said with which the Committee does not agree. We all recognise that obesity must be tackled across all Departments. To pick up on a couple of key points, Victoria, you said that healthier choices must be the easier choices. That is a simple point, and we can work on it.

Iain made a point about having to regard obesity as a lifestyle disease, and I agree that it must be examined in that context. You also discussed the need to challenge attitudes, and smoking has long been described as the single greatest cause of preventable premature death. Much effort went into bringing about a cultural shift, and smoking is now socially unacceptable.

You told us today, and we heard in previous evidence sessions, that the obesity epidemic is a massive threat to public health. One submission stated that for the first time in our history, parents will outlive their children. You also said that 145,000 people are obese and that the prediction is that nine out of 10 adults and two out of three children will be obese or overweight by 2050. Are you saying that it is time for obesity to be recognised as the number one public-health issue facing society and that it should be tackled accordingly, in much the same way that smoking was dealt with in the past?

Mr I Foster:

Absolutely. Unless obesity is tackled, we will not make progress. Obesity requires the level of leadership and investment that would be given to the number one public-health issue. There are always competing demands for resources, time, energy and so forth, but obesity must be put at the top of the agenda. A significant amount of complications, even beyond the diabetes epidemic, result from obesity, and it places restrictions on people’s quality of life and their life expectancy. People may live longer, but only if they are supported by extremely expensive Health Service resources that would, as a consequence, be denied to other areas of need.

We do not often talk about it, but, in a sense, public spending is a competition. Health is important, but should we spend less on education, on the environment or on other issues? Ultimately, we have to, because society makes choices about where the budget goes. Obesity will increasingly demand more public resources. Smoking and drinking may be damaging to public health, but they are nothing compared with what obesity will do to our population over the next 10 or 20 years. It has to be top of the agenda, and we have to have very strong political leadership.

Mr Dougal:

Let us hope that the politicians will have the moral courage to act swiftly on this issue. It took almost 40 years for resolute action to be taken on smoking. As far back as 1965, the Health Minister, Sir Kenneth Robinson, and Tony Benn banned the advertising of cigarettes on television, but almost 40 years passed before there was a total ban on the advertising and promotion of tobacco products. That indicates weak and irresolute government.

Some 25 years ago, when we in the Northern Ireland Chest Heart and Stroke advocated that nutrition was linked to heart disease, people thought we were not quite sane. Now that link is proven, and people know that there is a connection between nutrition and cardiovascular disease. Government should act now to empower people to make sensible choices. They will not be able to do so unless there is effective, simplified and comprehensible nutritional labelling on the front of the pack — it should not be written in tiny figures on the side panel, making it difficult for some people to read.

It is important that people understand that they should get that opportunity. I know that the single European market has created difficulties. This is an issue at European level; I know that 800 amendments have been tabled to a Bill that is proceeding through the European Parliament. However, that is not to say that moral pressure should not be put on food manufacturers and retailers here to have an effective voluntary system through which they can indicate that they care for their customers’ health and wish to give them choice. If that were to happen, we would like to see Government put their shoulders to the wheel and make sure that something is done. If we cannot do that by statutory means, we should do it through moral obligation.

Mr I Foster:

The evidence is very strong. We need to restate and clarify it, and we need consensus, but the evidence exists. However, we must ask what we are going to do about it.

It is almost like a battle. We have a child in one hand, with its life before it, full of avenues that it may go down, and we are up against a lifetime of habit and the example that parents and society give. We are also facing the food industry, the advertising industry, transport, technological advances and sport, which is now mostly a spectator event. People do not participate in sport; they watch it on television. These days, the most popular leisure activity is probably shopping. Consumerism is one of the huge forces that focus on the individual. To combat all that, we must encourage people to make healthy lifestyle choices. It is an unfair struggle, and it is almost impossible.

If we were to sit back, take a hands-off approach and talk around the edges, we would lose the battle. There must be more focus and more dedicated action to counterbalance all those other forces. Therefore, legislation is necessary.

Ms Taylor:

Given that the Foresight figures are predictions, it is not too late to change things. It should also be remembered that in 2050, nine out of 10 adults will be obese. Those adults are today’s children, so we need to work with them now.

Dr Deeny:

We held a very interesting conference here on obesity on Tuesday. Many top people — professors, researchers and clinicians — from different countries attended. You mentioned one of them, Dr Michael Ryan, who is a paediatrician. There is no doubt that the message is coming through, and we need to get awareness of the issue in the media. The public are not aware that this is an epidemic. The epidemic is not coming; it has started already. The clinicians’ frustration is palpable, and they want something done about it as soon as possible.

You talked about the knock-on effects of obesity, including diabetes, ischaemic heart disease, renovascular disease, stroke, and hypertension. Often, the precursor to those conditions is obesity. The cost of the situation to public health, productivity and the economy will be enormous.

You mentioned a stroke strategy. You are right; it is not before time that that strategy has been introduced. Moreover, heart disease and other illnesses are dealt with much better now. It is great to see that in my professional career. Do we need an obesity strategy? As we all know, it is a societal problem, but the health sector will have to take the lead again.

Some people at Tuesday’s conference believed — and you are right about this, Victoria — that all Departments must be involved in a joined-up way. However, the Department of Health, Social Services and Public Safety will have to drive any strategy and will have to ensure that other Departments participate. DHSSPS will have to pick up the consequences of the illnesses that arise from the obesity epidemic. Do we need a tsar to lead our strategy? Should we give one individual the responsibility to pull together all Departments and the authority to ensure that the issue is placed at the top of the agenda? As we can now see in primary care, the problem is worsening.

The medical journals and at least one newspaper covered a story this week in which some eminent medical researchers said that everybody over the age of 60, regardless of whether they have high blood pressure, should take a pill to reduce their blood pressure. That is not the right way to tackle that issue. Indeed, it is similar to the concept of a polypill. Giving people a polypill is like closing the stable door after the horse has bolted; it does not deal with the situation, but treats the outcomes of obesity, for example, rather than preventing the problem. However, some people are pushing that idea.

I am sure that the multinational drug companies are keen to introduce a polypill. All those companies are trying to create the first pill that controls blood pressure, blood sugar levels and cholesterol. It could earn a company billions of pounds. What is your view on that matter?

Do we need someone to take the lead on the obesity strategy in Northern Ireland? We need to take the issue seriously and, through the media, get the message across to the public, who probably do not realise how serious the obesity problem has become.

Mr Dougal:

The first research from the States into obesity in children was published here in 2001 or 2002. Seven years have elapsed, and we have not advanced that much. A tsar is essential. Professor Roger Boyle, who is the heart tsar in England and who subsequently took the lead on stroke services, has been highly effective. Northern Ireland led the field in the development of stroke services and stroke units. However, after Roger was appointed to lead the stroke strategy, England overtook us. We need a personality and a focus to provide the leadership that has not existed in Northern Ireland. Roger Boyle and others in England have done a great deal to advance the battle against heart disease and stroke.

My chairman, Professor Varma, and I are not keen on the idea of everybody over the age of 55 taking a tablet for blood pressure. Only people with elevated blood pressure should take such medication. I have heard Sir Richard Doll from Oxford talk about the polypill. I think that the idea of having such a pill has many flaws. Last week, an epidemiologist from Liverpool said that reducing the population’s cholesterol measurement by 1 mmol/l will save many lives. However, we still take the view that a population approach could benefit people hugely. People who are diagnosed with diseases need tablets, but the whole population should not be on tablets.

Mr McCallister:

You are all very welcome. The discussion has been interesting so far. The difference between the discussion on obesity and that on smoking is that there is no debate about the science or the lobby behind this argument. We need to prevent obesity rather than tackle it once it has happened. I listened to the discussion, and I agree that we need to consider how to plan communities and develop new towns and villages and the schools therein. For example, we must encourage more families to walk to school and to build that into their routine, and we should support the ongoing work in that field.

Education through schools has been mentioned, and a joined-up approach should be taken to training our teachers. Supermarkets and others in the industry will respond more quickly to a market-led exercise when their customers start telling them what they want. We must get back to what we described previously as honest food; the issue is to know where the food is from and what is in it. There is a huge job of work to be done in promoting that agenda, because it is critical to address the inequalities that have been discussed.

I have a background in the food industry, and I have visited some of the businesses concerned and have seen what goes into cheaper products. That is one of the key reasons for our having such health inequalities and a reason that people in certain communities will have their life expectancy reduced by 10 years or more. I agree with what you say, and your input into the inquiry will be invaluable in helping us to take the matter forward. I hope that the Public Health Agency will set about becoming a tsar-type figure and start to address the issues. How do you see that moving forward? Have you had any interaction with the new agency, or are you hoping to do so?

Mr I Foster:

It is early days for the Public Health Agency. We have taken a step forward from where we were previously, but the Health Promotion Agency should be able to learn lessons and learn from mistakes that have been made in the past and take the matter forward. The matter must be given more of a priority, and the agency should have a greater budget. We must also ensure that it has a closer connection with other parts of the Health Service, that is, the other bodies, commissioning groups and regional bodies. If that were to happen, there would be more communication and interplay. Hopefully, that will improve things. However, it is not the final answer, and it will not solve the problem. Additional things need to be done.

The Public Health Agency was conceived and developed in the context of the wider review of public administration (RPA) for the Health Service. It was not constructed to solve the obesity crisis. It may be one useful mechanism to take us forward in that direction, but far more remains to be done across Government. Essentially, the issue is about budget; it is about other Departments signing up to a strategy and perhaps allocating some of their resources to see the benefits that becoming involved in such a strategy would bring and how their self-interest as an Education Department, a transport section or an Environment Department could be served. If they were to become involved, they may be able to tick some of the boxes of their target cultures and decide whether they could allocate money to the Department of Health, Social Services and Public Safety or to a new organisation that could take on some of the issues.

It is a challenge, and a range of practical day-to-day things could be done. Education was mentioned, and I remember doing home economics when I was at school. However, my son has just left the education system, and he has no idea how to cook. His education did not include any of that. His concept of cooking is using a microwave. Perhaps I have failed as a parent in that regard, but, on a practical level, he does not know what honest food is.

There are pros and cons with having a tsar to deal with the matter. Nevertheless, it should be explored.

Ms Taylor:

I am not able to say to what extent we are working with the Public Health Agency at the moment, but as I said, we would welcome working with any of the Government agencies. That is an effective way of working.

To go back to the comment about honest food, it would be great if consumers were demanding that supermarkets supplied them with more healthy options. We want to know how informed the consumers’ choices are, what informs them, and how the marketing of junk food with its high fat, salt and sugar compares with the healthier options. We need to address the extent of the advertising of such food and level the playing field. At the moment, we cannot compete in the same way, and our messages are sometimes drowned out by those about the less-healthy options.

Sport has been discussed, and I was glad that how we plan communities and make families active was mentioned. It is important to remember that overweight or obese children are much less likely to participate in sport and that we must encourage physical activity in our daily lives.

Mr Dougal:

We will be working with the Public Health Agency, and that work must be led by epidemiologists who are heavily involved in research on the matter. Our campaign to prevent heart disease began in 1984, which was a time when many thought that heart disease could not be prevented. That campaign was led by world-renowned epidemiologist Professor Alan Evans. Given that, the work of the new agency on obesity must be informed by epidemiologists’ research.

Mrs Hanna:

The seminar on Tuesday was excellent, and the point was made strongly that a lot of good research exists that must be used — in fact, a lot of time and money is spent on research. I made the point that a person or an organisation must take ownership of the situation or take a lead in dealing with it. I am not dying about the terms “tsar” or “commissioner”. A lot is happening, but that work is not being brought together, and unless somebody is tasked with taking control, nothing will happen.

The Committee has just taken evidence from the Food Standards Agency. I asked its representatives about the legislation, because it certainly modifies behaviour. Iain Foster mentioned — and I was aware of this — that even when we know what we should be eating, we do not eat it. That is true, and we must all put our hands up and admit to eating a chocolate bar when we know that we should not. However, there remains a deprivation gap for people who do not have enough money to make choices. Some of us can buy nice fruit or other food in Marks and Spencer, but others do not have those choices. There is also the fact that schools no longer teach home economics, and it is quicker and cheaper to buy carry-out burgers.

Given that not enough is happening, we must adopt a carrot-and-stick approach that is more about the stick. Legislation must be used. Do all the witnesses agree that obesity is the number one priority and that it is almost like a time bomb? People often do not change their behaviour until they get a frightener — as people here say — and fall ill or are forced to change. The many statistics that are available indicate that obesity contributes to other illnesses, including heart disease, stroke and diabetes.

People are dying younger. Unless we address obesity, we will be reminded of the awful idea that some parents will outlive their children. We do not want to overly frighten people, but warnings must be balanced.

A great deal of support is necessary. We must lead, and the Committee and the Public Health Agency must take that lead. The agency was represented at the seminar on Tuesday, where it was accepted that dealing with obesity involved more than just the Department of Health, Social Services and Public Safety. It was acknowledged that the pieces must be picked up by the DHSSPS and that it is probable that someone from that Department will take the lead. However, I believe that the responsibility should rest with the Public Health Agency.

A lot is happening, and some of that work was brought together at the seminar on Tuesday. The Committee has taken a lot of evidence, but it is now time for what may be called a brainstorm to move the process on. Some of what is done about tackling obesity must be based on what the Committee heard from the Food Standards Agency. Pressure must be put on food producers and manufacturers to do the right thing. That may not be possible immediately, but there should be a timescale for weaning us off fat and salt. Moral pressure must also be exerted, but it takes more than that to change people. At the same time, complications in European legislation must be teased out. I am merely thinking aloud about what must be done and what support and advice is needed to make progress on the situation.

To return to my question, I would like to know whether we all agree that obesity, which feeds into all our other priorities such as diabetes, stroke, heart disease and cancer, is the number one priority. There can be no better time than now to take action, given that the Committee is in the middle of its inquiry. However, support and input from other people will also be required.

Mr I Foster:

In itself, the inquiry will create a lot of societal challenges. For example, what will happen to the inquiry’s findings? How will they be pursued? Will the ensuing report just be added to all the other documents that have been produced on the subject? I know that you are concerned about the number of commissions in Northern Ireland; we have had enough commissions and quangos, and we do not want any more. We need to see action, and that will depend on how the Government use the limited finance and influence that they have to the maximum benefit. They must be a bit more creative and not approach the matter in the same bureaucratic and inward-looking way that they have approached other matters in the past.

Andrew Dougal and I sit on the Department’s obesity prevention steering group, and although it is still early days for it, neither of us is overly excited or optimistic about it making one dot of a difference to most people’s lives. The challenge, therefore, is to determine how aspirations can be translated into actions by investing in programmes that might produce societal changes. However, we must be realistic and not set one- or two-year targets; we are talking about a 10- or 20-year process. As we have seen in the past, when the Government talk about a 10- or 20-year process, it can be code for saying that they do not need to worry about the matter at hand. The real test will be the shift in how the Government respond.

Mr Dougal:

We must act speedily. Research has been available for seven or eight years, we have the obesity prevention steering group, and the World Health Organisation has produced a report on the matter, as has the Department of Health in England. Let us get on and do things.

We must also remember that although we have had success in preventing heart disease and stroke, that was achieved in the higher socio-economic groups. Therefore, although I agree with the total-population approach, there may be a need to focus on the more deprived groups in society to ensure that those people are empowered to change their lifestyles. Many of those people feel that their lives are so awful that there is no point in changing their lifestyles. Therefore, we must get the message across that if those people quit smoking and change their diets, there can be benefits for them, such as avoiding coronary heart disease, strokes, cancers and diabetes. Those are the important points to make, and we must home in on those people and empower general practitioners and those who work in primary care to provide the support in the community that is necessary to allow those people to believe that the health that they enjoy and their lives can be improved greatly.

The Deputy Chairperson:

Thank you for coming along. Your evidence has been informative, and you made a number of points that we hope to look at more closely and incorporate into our response.

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