Joining Forces to Tackle Obesity, 21-22 January 2002
Transcript : Implications of Obesity for the NHS and the
Economy
Will Hutton
Chairman of the Industrial Society
DR WILLIAM DIETZ: Good morning. It’s a great
pleasure to welcome you to the second day of the National Audit
Office symposium on joining forces to tackle obesity. I’m Bill
Dietz from CDC in Atlanta, Georgia. It’s a great pleasure for me to
introduce this morning’s panel, entitled, "Involving Industry in
the Media and Preventive Strategies Relevant for Type Two Diabetes
Coronary Heart Disease and Cancer Strategies" and to start this
session we have Will Hutton, who is Chairman of the Industrial
Society, a well known journalist and author from both The Guardian
newspapers and chief of The Observer in 1996 and whose most popular
book is "The State We’re In". Will welcome.
WILL HUTTON: Good morning everybody. You’re
supposed to say, "Good morning". I’ve been wondering why I’ve been
asked to do this. What have I got to do with obesity, apart from
representing it myself, as I am a good two stone overweight? When
thinking about what to say I actually considered taking my clothes
off, so let that be a warning to you all. I might still do that,
actually, if you dare.
What I’m not going to do in the next 15 minutes is to repeat the
things that you’ve already heard. Let’s take it as a given that
obesity is very evident, it is shown that it is rising, maybe on
the verge of becoming a really important national issue, on the
cusp of reaching epidemic and crisis proportions. I take that as
read.
I take it as read that it is a class issue. It affects
low-income people more than high-income people. It affects
immigrant communities - particularly Afro-Caribbean women more than
any other section of the population - and I take it as read, that
the National Audit Office has done their numbers and that it
represents a significant cost to the economy - £0.5 billion of
direct costs, £1.5 billion in indirect costs, they say in their
report. I have no reason to challenge that. A lot of days of lost
work as a result of obesity. So we can begin day two of this
conference with that as a consensus.
What I want to do in my little spot is to enlarge, maybe, the
way that you are thinking about this issue. Because, I think
obesity is a reaction to modernity. That some of the trends that
are driving eating patterns are about massive economic and social
forces, some to do with globalisation, some to do with the way that
we have conducted and organised ourselves here in Britain even if
there was not globalisation. We have put those things together and,
sometimes, although the National Audit Office and, I’m sure a
number of you over the last 24 hours have been castigating NHS GPs,
as the NAO say, sometimes don’t take this issue seriously. Maybe,
on occasion, they’re right, those GPs. Maybe, comfort eating and
getting fat is actually the most rational response and the least
bad way out of some of the pressures on individuals.
And we have to think very big about how we address and solve
this issue. I mean, just consider the way we eat. It was only in
the 1950s that half the population ate a cooked breakfast. Six out
of ten men came home for lunch. And the men who walked or cycled
from large factories -- at that time, a factory employing 20,000
men or a mine employing 20,000 men was not uncommon. The National
Union of Mine Workers now has 3,000 people and the largest employer
in London is no factory. It’s the Metropolitan Police. The largest
employer in most northern cities are no longer factories and mines
but the local NHS or local authority and, in these circumstances,
where you can actually walk or cycle home you could do that. And
what’s more, at home, there was a woman who spent up to two hours
preparing the healthy lunch you ate. Female rates in the labour
force are now 78%, exactly equal to those of men. There is
absolutely nil prospect of women spending the hours they used to in
preparing those meals that men used to eat, when eating habits of
families were three ordered meals a day - breakfast, lunch and
supper at metronomic moments in the day.
From 5 to 18, I was brought up in a household where my father
worked and my mother stayed at home. I had breakfast every day at
7.45am. I had lunch every day at 1.00pm. I had supper every evening
at 6.30pm. Metronomic accuracy. It is impossible for any family in
Britain to reproduce that today.
The choice in the 1950s - 5,000 items of food in the average
supermarket. The first decade of the 21st century -
30,000 items of choice. And we have the disposable incomes to
exercise that choice and the food is extremely nice, and we love
eating it. A quarter of our disposable income is spent now in
restaurants, eating out.
An American sociologist called Juliet Score, who has been
investigating the way in which the Americans have increased their
consumption patterns over the last 15 years. As you know, one of
the great features of the American economy is the growth of
consumption. The long American boom of the last 10 years - the
longest boom actually, that America had ever experienced - was
driven by consumption, growing at four to five percent per annum.
But what levels of spending. Why do the Americans consume so much?
And, of course, they don’t just spend money on consumer durables,
they spend money on food. Some of the numbers I saw - 61% of
Americans are either fat or obese. And Juliet Score’s response to
this is that you can’t understand American problems of consumption
in normal economic ways.
Consumption and shopping and, in the act of indulging and
excess, is all part of a quest for fundamental satisfactions in the
private domain that don’t exist in the public domain. Her argument,
actually, is that the shrinking of the American public space, the
shrinking of political possibility, the shrinking of the nation’s
unity, has lead to inability to turn on to themselves, hence the
growth of new age faddishness, of explorations of counselling and
all the rest. Hence, spending on food. That sedentary couch potato
with his or her fingers on the zapper moving crazily from channel
to channel and munching their way through an enormous sandwich, at
the same time as drinking a six pack, is somebody who has got, in
her phrase, "Existential problems" and I guess some of you, who’ve
actually engaged in binge drinking or binge eating will know what I
mean or have members of your family who have done it. Well that
isn’t something, which is just an individual failure or the failure
of public health agencies to engage in the problem. This is
modernity. This is the structure of our lives. This is the
structure of travelling long distances to get to work. This is
about compression of time. This is about exactly the same things
that have led to adults spending less time parenting. They have
very less time to parent, they have less time to prepare food for
their kids and for themselves. It is about organising
ourselves.
I would argue that as salients - a pressure on the pattern of
our eating is, actually, for example, the ability of children with
the conservative reforms of the education system in the 1980s,
maximising and opening up the point, the possibility of choice of
school. So that instead of going to the neighbourhood school,
anxious parents would shepherd their children from one part of the
city to another part of the city, in order for them to gain, often
imagined, education advantage. But as those journey times to
school, the distances travelled explode, so the kids are bundled
into a car and all of you can see it, the minute the school
holidays happen the ease with which you can move around London is
phenomenal. Because all of those enormous four-wheel drive cars,
with Emma and Charlotte in the back, moving, sometime 10 miles,
don’t exist anymore. And, of course, that family as they get up,
don’t have time to cook those kids the kind of food they need to
eat. They’ll be eating something saturated with fat in the back of
the car. Of course they’re not walking or cycling to school because
it’s actually a long way away. And I put these things on the table
to enlarge the way that you are analysing and coming up with
responses to this problem.
So, I’m now going to give you some ideas about what to do. But
if I can do one thing with the few minutes that I’ve got, instead
of saying, think modernity, think globalisation, think the way our
lives are lived now and why they are lived now, to get to the ways
people eat, what they eat, the lack of pattern in the way they eat
and the contents of what they eat and actually their response as
individuals to the multiple pressures of contemporary life. I think
if you don’t frame this debate in that way you’re not going to get
answers to the question. I mean, put absolutely bluntly, this is a
political problem. It’s a political problem, as much as a problem
of whether or not there are sufficient notices in GP waiting rooms
about the dangers of eating certain kinds of high fat food. They
aren’t going to have much impact given the context I was
describing.
So, what to do? Well, it’s only if, frankly, obesity starts to
be understood and eating badly is understood to be as dangerous as
smoking and invokes the same kind of response that actually, I
think, we’ll make material difference. And, I have to put a
question to you all. Do you think that obesity is as dangerous as
smoking? You see we’ve managed after 30 years to really stigmatise
smoking and to stigmatise the companies that make tobacco and make
cigarettes.
Actually, if we’re going to make progress in this, we’ve got to
stigmatise food manufacturing companies, we’ve got to stigmatise
supermarkets, we’ve got to stigmatise advertising agencies, we’ve
got to stigmatise television companies. Because, what we want is we
want a completely different approach to the way food is advertised.
We want notices on food - at least as prominent are they are on
packets of cigarettes - about the fat content and the dangers of
eating certain kinds of food. We want food manufacturers and
supermarkets to know that, actually, in the same way that tobacco
manufacturers and tobacco retailers know, that actually what
they’re doing is regarded by the wider culture as potentially
anti-social.
We even need to get into the way that we produce food. The
policy in the EU and the accent it has on food production and
quality food production and the ways that that can be deployed to
actually make certain kinds of unhealthy food, actually,
comparatively cheap is also part of the problem. Now, do you really
think that actually one could put together a political coalition to
attack those enormous vested interests when actually the cost,
despite the NAO numbers, are actually comparatively small? They’re
certainly as great as tobacco was when we discovered that tobacco
had close linking to lung cancer in the 1960s, which provoked the
attack on the tobacco industry.
Well, I think it will and this is why I opened my remarks in the
way I did. I think that, actually, we may be about to be able to
put together such a coalition because I do think that, for many
people, obesity has become a real threat to their well being and we
know this from the enormous growth of the diet industry and the
enormous number of books and articles and television programmes on
slimming.
But, again, you know, a conference like this, I think, needs to
reframe the way the slimming industry actually conceptualises what
it’s doing. You, as an individual, are trying to attempt to slim
and eat well, will not do it, I don’t think, successfully. All of
us - me particularly - has spent time trying to eat better and
failed to do so. And the reason is, is that these pressures I just
described are enormous and not actually culturally engaged, we’re
more politically engaged with, and it seems to me that it’s only
when one actually reframes the national conversation to say that
you’re individual chances of succeeding in eating better and
exercising more will only actually start to happen when,
culturally, we accept this is of fundamental importance, rather
than leaving it to you to make your individual choices. And when
that starts to happen you will start to see the ground swell of
support that will make politicians able to engage in the
legislative interventions they need to make to actually ensure that
the food industry, and everything around it - from farm production
and through to the way it’s advertised - actually and starts to
change.
And this ultimately is about, in that sense, control. I mean,
the industrial society -- now looking at this from an employer’s
point of view and for the employer/employee relationship -- want to
be identifying is that there is enormous demand by better-educated
and more discerning workforces. What we describe in our society as
‘time sovereignty’ and people and this great demand for work life
balance springs from a desire by employees to have more autonomy
and control over their time at the workplace. And actually, in the
political work that we’ve done, we’ve only been able to establish -
it’s significant but not dramatic - but you get 10% - 20% of your
workforce are more content with the more autonomy and time
sovereignty they have. Now, I think, that time sovereignty and work
life balance interact with the agenda of this conference in an
interesting way. It is, of course, by giving people time
sovereignty that they have the opportunity to eat better and
exercise better within the time that they can cull out for
themselves - the biggest one in drivers for time sovereignty. So
here, again, is a way in which this debate can be enlarged.
Exhortations to people to walk to work or to eat better at work and
the other things that I know you’ve been debating at some of your
workshops, will, I think, only take root in an environment in which
employees have, actually, more autonomy and control of how they
conduct themselves in their working lives. And that is, actually, a
much more productive environment. And that actually adds something
to the economic case.
So, I know there is, of course, above all, a public health and
dimension to this. And, I think, if they kick-off the cultural
changes that I think are required to kick-off a recognition by
employers’ of how time sovereignty will help their workers’ be
healthier, as well as more in control, to kick off a culture in
which, actually, one can engage with the massive forces that are
driving the way food is presented to us and the massive forces
which compel us to eat in the way we do, does require our public
health officials and our public health agencies to really start
alerting us to the dangers of obesity. And this is where I hand
over to Imogen - that I guess is what she’s going to talk about.
Thank you very much for bearing with me. Thank you.
DR WILLIAM DEITZ: Would you like to take a few
questions?
WILL HUTTON: I’m afraid I have a meeting at
10.00am so two minutes of questions.
QUESTION FROM FLOOR: May I ask you a question
about stigmatising? In Canada, they don’t tax food in the same way
that we don’t put VAT on food. But the Canadian Federal Government
and seven provinces apply sales taxes to snack foods - sugary and
salty. In a similar way, 19 states in the United States have snack
taxes, either in the sales tax mode or excise taxes on soft drinks
and syrups. It’s a form of taxing something you don’t like, rather
analogous to the smoking tax. Do you think this is a feasible
political possibility in Britain?
WILL HUTTON: I think one of the important ways
that cigarette consumption has been arrested is because of the
extreme expense of cigarettes and, I think, using a tax system in
the way that you’ve described would be a very effective way of
going forward. There is a presumption that food should suffer no
tax and this is where the argument can get really intriguing. Snack
foods have always enjoyed the exemptions that, you know, fresh
fruit and vegetables have enjoyed but, plainly, there is a line to
be drawn in the sand. I actually think it is a really interesting
proposal and I think it’s one of the most original I’ve heard and I
think it’s something that should be explored.
QUESTION FROM FLOOR: Paul Gately from Leeds
Metropolitan University. You asked us a question with regard to,
"Can we draw the same parallels between smoking and obesity?" but I
think one of the problems is, is smoking is very easily
quantifiable whereas obesity isn’t because it is a very complex
disease and so, really, are we fighting a losing battle in
answering your question?
WILL HUTTON: Well, I didn’t quite get the point
of that actually. I mean, it’s almost as if you’re agreeing with
me.
QUESTION FROM FLOOR (OFFLINE RESPONSE) Yes, you
asked us a question about, "Can we say that smoking is as dangerous
to our health as obesity"? But my point is that smoking is very
easy to quantify - it’s a single event that we can quantify quite
easily. Obesity’s not. Obesity is a complex disease based, you
know, due to physical inactivity, poor eating behaviours, and
really, you know, I’m not really sure whether we can answer the
question. I just wanted to get your thoughts on that.
WILL HUTTON: Well, I think at the moment, that
the service side has acknowledged on this is, as you say, too
confusing to allow anyone to make the unambiguous statement that
actually obesity is as dangerous as smoking. I mean, consequence,
it makes it much tougher to put together the coalition that needs
to be put together and to make the regulatory interventions that
need to be made. However, I think, from my reading from the
background I did before I gave my talk today, seem to me that, when
I first came into this subject a couple of years ago, that even in
two years there’s much more evidence that obesity is close linked
to things like coronary heart disease and all those things which
Imogen is going to talk about. I guess that she might field this
when she speaks. I think the furthest I can acknowledge you would
be to show much clearer links between obesity and life expectancy
and bad health than it even did two years ago, so I’m hopeful, but
we’re not there yet.
Any more questions? I shall clear the podium for Imogen. I hear
a woman’s voice. Shout. You’re all so dumbfounded at this
iconoclastic presentation at 8.45am. In that case I shall -- thank
you very much.