Boris: obesity and the nanny state

26 Jul 2019 Nick Garbutt    Last updated: 26 Jul 2019

Pic: Unsplash

Boris Johnson’s elevation to Prime Minister will have profound – and potentially negative – impacts on public health policy.


As Theresa May came to the end of her time in office she is reported to have had a sharp row with Health Secretary Matt Hancock over the publication of the Green Paper: Advancing our health: prevention in the 2020s

Eventually the document was published but without an accompanying press statement.

It had been commissioned by Mr Hancock’s department but he appears to have backed away from it during the Tory leadership campaign.

Mr Johnson had spoken in support of The Sun newspaper’s Hands off our Grub campaign which aims to end taxes on sugary drinks.  Johnson described such “sin taxes” as the “continuing creep of the nanny state” and added that taxes on unhealthy foods “clobber those who can least afford it” and should be halted unless there is clear evidence that they work.

Mr Hancock was supporting Mr Johnson’s campaign, yet his paper called for such taxes to be extended. This might explain what followed.  He responded by noting Mr Johnson's recent personal weight loss, adding: "Boris himself is a great example of how we can all get fit and svelte without the need for the nanny state by getting on and doing more exercise and cycling to work."

Some will be amused by this extraordinary display of sycophancy, others alarmed – especially given that Mr Hancock was one of the few who remained in post  in Mr Johnson’s brutal Cabinet reshuffle.

It also marks the increasing dominance in the Conservative Party of those who believe that many public health initiatives are infringements of liberty and disrupt free trade.

Jacob Rees Mogg, now leader of the House of Commons put it like this: “It’s un-Conservative to rifle through people’s cupboards to decide what they can eat. Politicians ought not to lead voters’ lives for them.”

Christopher Snowden, research fellow at the influential right wing Institute of Economic Affairs (IEA)wrote in the Spectator last year: ““Treating your citizens like children is, by and large, a domestic policy choice. So far, it has been a choice that British politicians, whatever colour their rosette, have been happy to make.”

The Prime Minister’s intervention in a public health debate and the support for him of his Health Minister changes all that. And there’s a populist element to the debate as well. The IEA have been hammering on for some time about the regressive impact of “sin taxes” which inevitably impact people on lower wages more than the better off.

The Green Paper is therefore under severe threat – so what is it trying to achieve?

Essentially it is about shifting the emphasis from dealing with poor health to building the foundations for good health amongst the population. It states: “We need to view health as an asset to invest in throughout our lives, and not just a problem to fix when it goes wrong. Everybody in this country should have a solid foundation on which to build their health.”

To most of us this will appear to be obvious and entirely uncontroversial.

Central to the report is to shift thinking from our life expectancy to our health span. It states: “Over 20% of years lived are expected to be spent in poor health. On average, men born today can expect to live 16 years in poor health. For women, it’s 19 years.

“There is also a clear social gradient to healthy life expectancy. That is, people in deprived areas tend not only to live shorter lives, but they also spend more of those years in poor health. For example, women living in the 10% most deprived areas can expect to live 18 fewer years in good health than those in the 10% least deprived areas.”

The three most important risk factors it identifies are obesity, smoking and physical activity along with poor mental health. All these are often inter-linked.

So the task for health prevention, the report argues is to increase the period during which we can enjoy good health – today disability free life expectancy is 62 for women and 63 for men.

There is much, much more to this thoughtful paper than introducing “sin taxes” and the authors are at pains to explain: “This green paper is not about nannying, but empowering people to make the decisions that are right for them. It’s about providing everyone with the chance to live happy, healthy lives.”

Yet there are bold proposals on both smoking and obesity. The paper envisages an ultimatum for industry to make smoked tobacco obsolete by 2030, with smokers quitting or moving to reduced risk products like e-cigarettes; ending sales of energy drinks to children under 16; improving the nutritional value of food for infants; promoting breast feeding; extending the sugar tax to milk shakes; reducing salt levels in food and promoting more exercise.

There is also a section on improving sleep – evidence suggests that getting too little is associated with poor physical and mental health.

The report is a clear blue print which contributes to the vital debate about how we can move from treating conditions to preventing people developing them in the first place. This in turn would mean that we cut the period of our lives when we are in ill-health (currently around 20%). The result will not only be that we live more fulfilled lives for longer, but we also save money for the National Health Service.

Much of this we will need to do for ourselves with government providing information and support. Some will require a degree of state intervention in the markets – just as is happening and will continue to happen with the tobacco industry.

For decades this has been common ground for health professionals, policy-makers and political parties. Now it will be a battle ground for those who believe health promotion is not a valid function of the state because it interferes with our ability to choose what we eat, drink and how we lead our lives and with the ability of companies to sell us their products.

Earlier this year Mark Littlewood, director general of the IEA wrote in the Daily Telegraph that the new Tory leader should be a bullish libertarian, standing up for free markets and a smaller state.  He added that the new PM should ensure that “the plethora of censorious and hectoring measures over what British adults choose to eat, drink and smoke must come to an end.”

In his maiden speech to the House of Commons as Prime Minister Mr Johnson pledged to ensure people live longer, happier and healthier lives. It will be interesting to see how he and his devoted Health Secretary propose to pursue this given their recent stance.




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