Political Print: Poleaxing of PHE is a pernicious act

The arms-length agency was making slow progress in tackling obesity, but axing it with no replacement is an act of national self-harm, argues Nick Hughes.

As the government U-turns continue to stack up, the scrapping of Public Health England (PHE) may not, by strict definition, count among their number. But be in no doubt: abolishing the agency responsible for tackling obesity less than a month after declaring it “one of the greatest long-term health challenges this country faces” amounts – in a presentational sense at least – to a screeching volte face. Lest we forget it was the prime minister himself who fronted the government’s latest anti-obesity drive at the end of July following his own brush with death from covid-19.

If you were being blunt at this point – and I am – then you would say that the mask has finally slipped. The delivery of obesity policy has been kicked around Whitehall to such an extent over the past decade or more that it’s legitimate to wonder whether the gravity with which obesity is spoken about publicly by politicians has ever really been matched by a private conviction to do something about it.

Since 2005, obesity policy and delivery has been sliced and diced into digestible pieces, then dished out and in many cases subsequently snatched back from: the Food Standards Agency (FSA), businesses and their trade bodies (via the Responsibility Deal), the Department of Health and Social Care (DHSC), PHE and various other local institutions and individuals.

Where it ends up now is anybody’s guess – including it appears the government’s. PHE was punished (or scapegoated) for its apparent failure to respond adequately to the threat from covid-19. It will be replaced by a new National Institute for Health Protection (NIHP) whose purpose will be to plan for and respond to pandemics. Obesity prevention is not within its remit.

Word is that health secretary Matt Hancock and his officials will spend the next few months engaging on future options for the non-pandemic related work of PHE. It could be subsumed into DHSC. Or pushed back to the FSA. Or transferred to local authorities or healthcare professionals. We just don’t know.

Given evidence of the link between obesity and a greater risk of hospitalisation and death from covid-19 this is not a good place to be. A short period of inertia could perhaps be forgiven if the UK was well down the road to reducing obesity-related ill health but this is simply not the case. In 2018/19 there were 11,117 hospital admissions with a primary diagnosis of obesity, according to NHS data, an increase of 4% on 2017/18 and up 22% since 2014/15. The government’s own obesity strategy notes that many adults are consuming 200 to 300 extra calories a day and children who are already overweight or living with obesity are consuming up to 500 extra calories a day.

While the new obesity strategy hit the “go” button on certain proposals that had been stuck at the consultation stage, critics argue it fell well short of setting out a detailed roadmap for addressing the structural causes of obesity.

Following last week’s announcement, even active work that was delivering some progress – albeit slowly – appears at risk of being permanently derailed. PHE’s most important role where obesity is concerned has arguably been in overseeing reformulation programmes for sugar, salt and calorie reduction. Sugar targets for 2020 were already in danger of being missed before the coronavirus ran roughshod over PHE’s 2020 workplan, and there now seems little prospect of the work getting back on track.

Footprint understands PHE’s existing obesity work is set to continue at least until the new NIHP is formed. If reformulation programmes subsequently fall into a black hole the loss will not just be that of the food consuming public, but of the businesses (some not all) that have worked hard to improve the nutritional profile of their products and the campaigners that have held theirs and PHE’s feet to the fire.

None of this is to claim that PHE’s work on obesity was beyond reproach. Some businesses privately believe that reformulation targets were never achievable in the allotted timeframe. Campaign group Action on Sugar, conversely, cites a lack of ambition with targets, alongside a lack of transparent monitoring and lack of engagement with industry to ensure compliance among the “known issues” with the current approach.

But at least PHE provided a focal point for obesity prevention with operational autonomy, albeit one that was ultimately at the mercy of ministers.

There is a certain irony in the fact that PHE’s last act on obesity was to launch a new national campaign to encourage millions of adults to “kick start” their health and “work towards a healthier weight” in order to cut covid-19 risk.

As Hancock and his team consider how to fill the void left by its reckless extinction, there will be plenty of stakeholders hoping for another government U-turn on obesity, back to face the way it was a mere month ago.

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