If you pay a blackmailer once, you will keep being blackmailed, and so it is no surprise that the government’s capitulation on the sugar tax and food reformulation has encouraged Britain’s food snobs to issue another set of demands. After consulting the renowned policy experts Jamie Oliver and Hugh Fearnley-Whittingstall, the Health Select Committee has today called for a slew of untested policies which they reckon – maybe, perhaps, who knows? – could tackle the imaginary epidemic of childhood obesity.
The Health Select Committee is run by parliament’s nanny-in-chief, the nominally Conservative MP Sarah Wollaston, and operates as an in-house pressure group for the most extreme elements of the ‘public health’ lobby. Its latest set of demands includes a ban on TV commercials for HFSS food (high in fat, sugar or salt) before 9pm, a ban on celebrities and cartoon characters promoting HFSS food, a ban on price discounts in shops for HFSS food, higher taxes on HFSS food, mandatory calorie labelling on all food products (impossible while we remain an EU member) and a ban on HFSS food being displayed at the counter (good news for shoplifters).
The committee says that it was ‘impressed by the progress that has been made in Amsterdam using a whole systems approach.’ Amsterdam is the new poster boy for ‘public health’ campaigners because its child obesity rate fell between 2012 and 2015, possibly as a result of a concerted anti-obesity campaign. The campaign didn’t involve any of the tax-and-ban policies being proposed today – it focused on education and physical activity – but Wollaston’s committee turned a blind eye to this as it fumbled towards its preordained conclusion.
‘We want to see a whole systems approach’, says Wollaston in her press release today. The Local Government Association, which wants to ‘make obesity everybody’s business’, also puts the whole systems approach at the heart of its anti-obesity plans. But what is it? Since nobody has managed to define the whole systems approach without resorting to meaningless jargon, allow me to offer my own definition:
Whole Systems Approach (n): taking a bunch of policies that do not work and piling them on top of another bunch of policies that do not work in the hope that some weird alchemy turns them into more than the sum of their useless parts.
The phrase ‘whole systems approach’ is often combined with the phrase ‘no silver bullet’, as in ‘we are glad that the government has introduced a tax on soft drinks and is systemically degrading the food supply, but there is no silver bullet for obesity. Therefore we need a whole systems approach involving more bans and taxes’. Or, to put it more bluntly: ‘We know the policies that we spent the last few years frantically lobbying for will not have any effect on obesity but give us another chance.’
It is true that there is no single policy that will eliminate obesity, but is it too much to ask that anti-obesity policies have some effect on obesity? The obesity rate is currently 26 per cent. No one expects it to fall to zero as a result of the sugar tax and food reformulation, but shouldn’t they reduce it by a few percentage points? As hard as they fought for these policies, none of the campaigners seem willing to make such a prediction. George Osborne’s response when asked if he would put money on obesity rates falling now that consumers are paying an extra £200 million for their soft drinks was to feebly claim that they will be lower than they otherwise would have been.
In other words, obesity rates could rise and the sugar tax could still be portrayed as a success. There is no falsifiable hypothesis. For all the talk of ‘evidence-based policy’, there is no obligation to produce tangible results. Policy is created in an evidence vacuum, based on the hunches of celebrity chefs, and by the time the policy has failed to produce the one outcome that could justify its existence – reducing the number of people who are obese – the campaigners have moved on to the next big thing.
One of the conceits of the modern ‘public health’ movement is that it is a branch of medicine. The practitioners of ‘preventive medicine’ may have swapped the scalpel for the placard, so the story goes, but their methods are comparable. They publish in peer-reviewed journals. They have PhDs. They are ‘evidence-based’. The only difference is that while a doctor might save thousands of lives in a career, a good ‘public health’ lobbyist could save millions.
Such is the conceit, but there are two major differences between medicine and ‘public health’. The first is consent. A doctor generally requires the consent of the patient. ‘Public health’ campaigners do not seek consent from the public and often act against their express wishes.
The second is efficacy. A new drug or medical procedure requires overwhelming evidence that it works before it can be rolled out to the general population. It also requires strong evidence that it will not cause serious negative side effects. Things are rather different in ‘public health’ where policy is essentially whimsical.
Take Professor Russell Viner who was recently appointed president of the Royal College of Paediatrics and Child Health. Last year, he was given £5 million of taxpayers money to set up an ‘obesity policy research unit’. As a distinguished obesity expert he must be aware of the large empirical literature showing that people who live, work or school near a fast food outlet are no more likely to be obese that those who do not. Moreover, those who live, work or school near lots of fast food outlets are no more likely to be obese than those who live near one or two fast food outlets. Dozens of researchers have looked at this issue and, for the most part, have failed to find any link with either adult or child obesity.
This being the case, you might expect a boffin from a policy research unit to see restrictions on fast food outlets as a complete non-starter, but not Russell. Last month he urged the government to take a ‘leap of faith’ and ban new fast food outlets within 400 metres of schools. Hell, why not? It’s not as if limiting competition will have any negative consequences for consumers or the local economy, is it?
Meanwhile, Jamie Oliver is crusading for a ban on TV commercials for so-called ‘junk food’ before 9pm. There is no reason to think that this will have any effect on childhood obesity. Children do not generally buy their own food, and advertising has little, if any, effect on aggregate demand. The ban on HFSS food advertising during children’s programmes that came into effect in 2007 reduced children’s ‘exposure’ to such commercials by more than a third but does not seem to have translated into better diets or lower body weight.
But who needs evidence when you have intuition? According to Jamie (or whoever runs his Twitter account), ‘it’s got to help, right?’
Yes, we know that advertising restrictions can’t solve childhood obesity alone. BUT it’s got to help, right? This is definitely about an all-around approach. Here’s what JAMIE’S ACTION PLAN looks like: https://t.co/n76qvrclxl
— Jamie Oliver (@jamieoliver) April 18, 2018
Incidentally, JAMIE’S ACTION PLAN goes further than giving food adverts an X-rating. He wants advertising for food that is high in fat, sugar and salt – Ofcom’s definition of what he sloppily calls ‘junk food’ – to be banned in shop windows, on the street and on public transport. He even wants the mention of such products to be banned in television programmes (which will, at least, have the happy consequence of putting an end to his TV career).
Taking a ‘leap of faith’ because you have a hunch that ‘it’s got to help, right?’ is about as far from evidence-based medicine – and evidence-based policy-making – as you can get. Imagine the NHS licensing and prescribing a drug for which there is no evidence of efficacy and which is likely to cause unpleasant side effects on the basis that ‘it’s got to help, right’? Imagine a surgeon telling you to undergo an unnecessary and dangerous operation because he fancies taking a leap of faith.
It would never happen – not deliberately, at least – because there are standards that have to be met in medicine for which there is no equivalent in ‘public health’. In medicine, futile treatments that are likely to harm the patient are wasteful and unethical. First, do no harm.
Make no mistake, ‘public health’ policies do harm. They might not necessarily harm health, but they create all sorts of costs and spawn all sorts of unintended consequences. A watershed advertising ban would cost commercial broadcasters a great deal of money and have a negative impact on programming. If the ban were extended to all media – as Jamie intends – it would have a serious effect on newspapers, sport and the creative arts.
A ban on fast food outlets opening within 400 metres of a school would amount to a near-total ban on new competition in many urban areas. Prices would rise, choice would be restricted and quality would likely diminish. A ban on food discounting would hit shoppers in the pocket, create food waste and make retailers less efficient. Higher taxes on HFSS food would raise the cost of living and be particularly damaging for people on low incomes.
These are real costs for which there is a mountain of empirical evidence. They can’t be ignored just because they won’t damage health in the same way as a dodgy drug or unnecessary amputation. If implemented, Wollaston’s latest set of demands would carry significant costs without the slightest guarantee of benefits. It would not pass muster in science or medicine. It should not pass muster in politics.