Nudge or fudge? Public health fears as Lansley retreats from regulation

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Doctors and academics are increasingly concerned that the Coalition is rolling back measures to combat high consumption of junk food, alcohol and cigarettes, and will fail to overhaul Britain's record as one of the fattest, unhealthiest countries in Europe.

The Health Secretary, Andrew Lansley, formerly a director of a marketing company with junk food clients, has declared his intention to press ahead with "nudges" to change behaviour rather than continue the "nannying" approach taken by Labour.

In the latest disappointment to health professionals, he is reconsidering a ban on the display of tobacco products due to take effect next year – which campaigners say would help prevent children from joining the 80,000 killed annually by smoking. The Government has also delayed detailing a proposed ban on "below cost" selling of alcohol designed to tackle cut-price supermarket promotions.

Separately, using freedom of information laws, The Independent has confirmed the dominance of multinational companies on a Whitehall project setting health policy. Eighteen representatives of Mars, Unilever, Diageo and other commercial interests attended the first meeting of the Public Health Responsibility Deal in September – three times the number from health and consumer groups. The group will propose policy on diet, drinking, tobacco, exercise and behaviour change.

Public health academics and campaigners are concerned that the manufacturers' interests may not align with those of the public's health – and that the so-called "nudge" approach will not make much of a difference.

The health professionals highlight inconsistencies in the Coalition approach. Although Mr Lansley said this week he regretted Europe's potential limiting of the Food Standards Agency's traffic light labelling scheme in the UK, it was Tory MEPs who helped sink the scheme in an EU vote in June.

Subsequently, Mr Lansley announced he was taking nutrition policy away from the FSA, which had devised the traffic light scheme and a successful campaign on salt reduction.

Politicians of all parties agree on the importance of tackling Britain's poor record on public health. Diet-related disease is estimated to cost the NHS £6bn a year, alcohol misuse £2.7bn a year and lack of exercise £1.8bn a year. Obesity has trebled in the last 20 years, with nearly a quarter of all adults in England obese. Cheaper alcohol has helped double consumption per head in the past 40 years.

In his white paper, Mr Lansley wrote: "Britain is now the most obese nation in Europe. We have among the worst rates of sexually transmitted infections recorded, a relatively large population of problem drug users and rising levels of harm from alcohol."

But health groups remain unconvinced by the Coalition's record on public health in its first six months. Mr Lansley has ruled out legislation on junk food, and cut the £75m marketing budget for Whitehall's Change 4 Life anti-obesity programme.

Like Labour, the Government has backed away from introducing minimum prices for alcohol, favoured by the Association of Chief Police Officers and the British Medical Association. Instead it supports a ban on "below cost" selling, but this measure was not included in the Police and Social Responsibility Bill published this week. In its place, the Treasury published proposals to raise tax on lagers over 7.5 per cent alcohol, which will affect less than one one per cent of UK alcohol sales.

While reconsidering the display ban on tobacco due to come into force next October, Mr Lansley has suggested putting cigarettes in plain packaging – which the European Commission had already proposed and which Britain cannot impose unilaterally.

Several leading health professionals, including Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health, have condemned the delay to the display ban, saying it followed hard lobbying from tobacco firms.

Christine Mundin, for the British Medical Association, said: "We certainly think the nudge effect can work. Simply telling people what to do very seldom gets the result you want but you need to create the environment in which they can make healthy choices." She added: "You have to work with industry in implementing legislation but not in writing it, because there's a clear conflict of interest. They will always support more education but what we need to see is more action on pricing, taxation and advertising."

Professor Lindsey Davies, president of the Faculty of Public Health, said: "I will be more convinced they have got the balance right when they take up some of the opportunities that are currently presenting themselves. I was really disappointed by the food labelling vote in Europe."

The Department of Health said: "We have learned over the last decade that state interventions alone cannot achieve success. We need a new sense of collective endeavour – a partnership between communities, businesses and individuals that transforms not only the way we deliver public health, but the way we think about it."

Nudge: The new buzzword

Nudge Theory came to Britain in 2008, carried across the Atlantic from the US by an academic named Richard Thaler, who had caught the attention of President Barack Obama. Mr Cameron was attracted to Professor Thaler's ideas because they seemed to mark out a sensible path between two extremes.

On the one hand, the Conservatives accused Labour of creating a top-heavy state that interfered too much in people's lives. They promised to govern with a lighter hand. On the other hand, only the extreme libertarians say that people should be free to wreck their lives if they choose. Most people think the government should encourage people to look after their own interests sensibly.

Professor Thaler wrote a book advocating that the state should construct "choice architecture" which will encourage – or "nudge" – people to give up smoking, drink in moderation, save up for their old age etc, without nannying them. He calls his philosophy "libertarian paternalism".

Public Health Responsibility Deal

Who’s taking part?

Twenty-nine people attended the first meeting of the policy-setting Public Health Responsibility Deal on September 14, 18 from business, six from consumer and health bodies and five from central and local government.

These are some of the private sector participants:

Mars UK From Snickers to Twix to the Mars bar, its most famous creation, Mars is one of the world’s biggest chocolate companies, with turnover of £19 billion a year. It has been criticised for super-sizing products.

Compass Group Compass was the corporation fingered by Jamie Oliver for feeding Turkey Twizzlers to school children. The £1.8 billion UK arm of the global company supplies meals to thousands of schools, hospitals and workplaces in the UK.

Diageo GB The British based drinks multinational specialises in spirits brands such as Johnnie Walker, Tanqueray and Baileys.

Unilever An Anglo-Dutch corporation, Unilever is one of the world’s biggest purveyors of industrial fats courtesy of its Flora and Blue Band margarines and Hellmann's mayonnaise.

Tesco Britain’s biggest retailer has for a long time been a well-connected backroom force in British politics. Campaigners have criticised its promotion of cut-price alcohol and processed food. Despite calling for an end to sales of cheap booze, it sells own-brand lager for 29p a pint.

Full list:

Rt. Hon. Andrew Lansley CBE MP, Secretary of State for Health

Paul Burstow MP, Minister of State for Care Services

Anne Milton MP, Parliamentary Under-Secretary of State for Public Health

Aisling Burnand, Executive Director, Policy & Public Affairs, Cancer Research UK

Andrew Opie, Director of Food & Consumer Policy, British Retail Consortium

Cathryn Higgs, Food Policy Manager, The Co-operative

Dame Carol Black, National Director for Health & Work, DWP

David North, Community & Government Director, Tesco (on behalf of Lucy Neville-Rolfe)

Douglas Smallwood, Chief Executive, Diabetes UK

Erica Zimmer, Head of Public Affairs, Sainsbury’s

Fiona Dawson, Managing Director, Mars UK

Fred Turok, Chair, Fitness Industry Association

George Gordon, Public Affairs Director, Unilever UK & Ireland (on behalf of Amanda Sourry)

Helen McCallum, Director of Policy & Communications, Which?

Ian Sarson, Managing Director, Compass Group

Jeremy Beadles, Chief Executive, Wine and Spirits Trade Association

John Ransford, Chief Executive, Local Government Association

Lindsey Davies, President, Faculty of Public Health

Mary Boughton, Chair of Health, Safety & Risk Mgt, Federation of Small Businesses

Melanie Leech, Director General, Food & Drink Federation

Paul Kelly, Director of Corporate Affairs, ASDA

Paul Lincoln, Chief Executive, National Heart Forum

Richard Taylor, Director of Corporate Affairs, Morrison’s Supermarket plc

Simon Morys, Government Affairs Director, Tesco (on behalf of Lucy Neville-Rolfe)

Susan Jebb, Head of Nutrition & Health Research, MRC Human Nutrition Research

Tim Lefroy, Chief Executive, Advertising Association

Ufi Ibrahim, Chief Executive, British Hospitality Association

Vicki Nobles, Corporate Affairs Director, Diageo GB

Yvonne Doyle, Regional Director of Public Health, South East Coast SHA (on behalf

of Dame Sally Davies)

Apologies

Amanda Sourry, Chairman, Unilever UK & Ireland

Lucy Neville-Rolfe, Director of Corporate and Legal Affairs, Tesco

Dame Sally Davies, Acting Chief Medical Officer for England, DH