Second Opinion: Are policymakers able to control the obesity epidemic?

When the first National Nutrition Survey was carried out, Ireland had almost no overweight or obese children. In fact, many were too thin. Between 1946 and 1948 doctors measured the heights and weights of 14,835 primary-school children looking for signs of defective nutrition, including rickets and underweight. The study found that height and weight varied depending on social class.

Children whose fathers were unskilled or unemployed were, on average, two inches shorter and up to five pounds lighter than middle-class children. Between 15 and 21 per cent of boys and girls, mostly from poor families, were underweight, and fewer than 1 per cent of children were overweight. Today the reverse is true.

Last month, the Royal College of Physicians of Ireland (RCPI) published a new paper on obesity, The Race We Don't Want to Win: Tackling Ireland's Obesity Epidemic, which notes that one in four children is now overweight or obese. The RCPI wants school vending machines to stock only healthy options. I couldn't agree more. When interviewed on RTÉ Radio, Minister for Education and Skills Jan O'Sullivan said she did not intend to issue a directive to schools on the content of vending machines: "Banning things can be difficult and it doesn't necessarily stop practices." In fact, bans work. Has she forgotten the ban on smoking in public places, one of the most successful public health measures ever implemented?

Vending machines

An email to the

Department of Education and Skills

asking about its policy on school vending machines elicited the following response: “We want parents, and not the State, to tell schools how they should operate.” The new parents and students’ charter currently being developed “will ensure that parents and students can tell schools whether they want vending machines to be in the school, and what products should be in those machines”.

Has the department forgotten the O’Keeffe v Ireland case? The European Court of Human Rights found that “a State cannot absolve itself from its obligations to minors in schools by delegating those duties to private bodies and individuals”. What if the same approach had been taken by the government when it wanted to control smoking in public places? Where children’s health is concerned, the Government must act and either ban school vending machines altogether or insist they stock only healthy options.

Politicians such as O'Sullivan can control the obesity epidemic through effective public policy. The question is whether they are sufficiently well informed to know what policies are effective. A report by the European Association for the Study of Obesity (EASO), Obesity Perception and Policy: Multi-Country Review and Survey of Policymakers 2014, shows that almost all of the 333 policymakers interviewed understood the extent of the obesity epidemic but were badly informed about what would make a difference. Almost everything they thought works doesn't.

Policymakers saw individuals and families as having the main responsibility for reducing obesity. They don’t. Policymakers saw the food and drinks industries as having a powerful influence but did not see the “gap between perceived responsibility and the requirements placed on [industries]”. Calories on menus and front-of-pack, traffic-light, food labelling systems, recommended by the RCPI and nutrition experts, are still not mandatory.

Many countries, including Ireland, waste taxpayers’ money on education and awareness-raising campaigns about obesity. Campaigns do not work. Fiscal interventions, such as fat and sugar taxes, were seen by policymakers as ineffective, yet they are among the most successful of all public policy interventions. Ireland’s policymakers were not interviewed as part of the survey of 11 countries, which included England, France and the US, but there is no reason to believe they are any different.

Proposals

Policymakers need to be well informed about the drivers of obesity, and about what works. The RCPI has proposed a number of actions that will work and should be implemented. Controlling school vending machines is one of them. Introducing a 20 per cent tax on sugar-sweetened drinks, including juices and sports drinks, in the 2015 budget is another.

It is now nearly 10 years since Obesity the Policy Challenges: The Report of the National Taskforce on Obesity 2005 was published, and overweight and obesity rates are still increasing. The response of the Department of Education and Skills to my inquiry about school vending machines does not inspire hope that effective policies will be implemented any time soon.

Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland council drjackyjones@gmail.com

The National Nutrition Survey, volumes I-VII, is available in hard copy only and can be read in the Central Statistics Office in Cork. It is a fascinating insight into Irish eating habits in the postwar years.