A public health green paper destined for the trash?

Nick Hughes analyses whether the latest proposals to reduce childhood obesity will ever be enacted given they are part of a green paper published on the quiet before Boris Johnson became PM.

It’s a tried and tested tactic in politics to choose July or August to publish a document you hope will garner little attention. To do so at a time of political transition is an even surer sign that the paper is destined for pulp. Yet there are reasons to take more than a passing interest in the government’s green paper on public health that was slipped out quietly in the dying days of the May government; two days before Boris Johnson was invited by the Queen to form a new administration.

Firstly, the Advancing Our Health: Prevention in the 2020s document serves the dual purpose of also setting out chapter three of the government’s childhood obesity plan. Tucked away in the middle are a series of commitments to tackle rates of obesity, which have thus far remained stubbornly immune to the actions laid down in chapters one and two.

The headline-grabber is a proposal to extend the sugar levy to milk-based drinks if the next round of sugar-reduction results shows the industry has not been making sufficient progress.

The problem with this proposal is that it appears entirely at odds with the new government’s approach to public health. During his campaign to become prime minister, Johnson promised to freeze “sin taxes” and reassess their effectiveness. Looking at the make-up of his cabinet, it appears likely that any kind of fiscal intervention aimed at improving health will be quickly removed from the government’s agenda.

The counter argument is that the man who signed off on the green paper, health secretary Matt Hancock, is back in post, making it harder for the government to pass off the proposals as the policies of the old regime.

The first significant test of whether the paper retains any relevance will be on the promise to end the sale of energy drinks to children under the age of 16, a proposal that received overwhelming public support during a consultation. The policy was mentioned by Jo Churchill, under-secretary at the Department of Health and Social Care, on 5 August in a written response to a ministerial question on the steps being taken to ensure the halving of childhood obesity by 2030. This suggests, for now at least, it remains official government policy.

The paper also sets out the next steps for salt reformulation, a programme that has so far spanned five administrations dating back to 2006. Public Health England (PHE) now plans to publish revised salt-reduction targets in 2020 – one year later than promised – for the industry to achieve by mid-2023.

Responses to further consultations on mandatory calorie labelling in the out-of-home sector, a ban on promotions of foods and drinks high in fat, sugar and salt (HFSS), and a 9pm watershed on TV advertising of HFSS products are also promised “as soon as possible”. But, with a new PM in post and Johnson and his team consumed by Brexit, what the government considers “possible” in the current climate is anyone’s guess.

Arguably more in keeping with Johnson’s liberal philosophy is the wider paper’s big idea to prevent future ill health, captured in an unequivocal opening statement that “the 2020s will be the decade of proactive, predictive and personalised prevention”.

The theory is that rather than spending millions on ineffective health campaigns, data generated by genomics and artificial intelligence will allow people to tailor their diets to meet their specific metabolic need.

With Johnson recently appointing a proponent of a big data approach to public health as his new senior health adviser, we should expect the potential for “predictive prevention” to become a familiar clarion call in future ministerial speeches and documents.

As for the fate of the other policies – like everything concerning British politics at the moment – there are many more questions than answers.

 

 

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