Committee Business – in the Northern Ireland Assembly at 3:30 pm on 16th November 2009.
The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer of the motion will have 15 minutes in which to propose and 15 minutes in which to make a winding-up speech. All other Members who are called to speak will have five minutes.
I beg to move
That this Assembly approves the report of the Committee for Health, Social Services and Public Safety on its inquiry into obesity; and calls on the Minister of Health, Social Services and Public Safety, in liaison with Executive colleagues and relevant bodies, to bring forward a timetable for implementing the recommendations contained in the report.
Obesity is a major global public health problem and, in recent decades, there has been a significant rise in the number of overweight and obese people in many countries. In a number of major developed countries, including the United Kingdom and the USA, obesity rates have doubled in the past 25 years, and that relentless increase is predicted to continue for the decade ahead.
In 2005, the most recent health and social well-being survey in Northern Ireland found that 24% of adults are obese. That is almost a quarter of our population, which is very worrying. Even more worrying is data from the Northern Ireland Child Health System 2004-05, which found that 22% of children are either overweight or obese. However, there are some rays of hope. Updated assessments by public health scientists working for the National Obesity Forum suggest that the anticipated surge in the number of severely overweight children is now levelling off. I certainly hope that that is the case.
Obese children grow up to be obese adults, and they end up suffering chronic diseases such as type 2 diabetes, which robs them of vitality, limbs, eyesight and a long life. I would not wish that future for any child. Nevertheless, unless the trend is reversed, by 2050, Northern Ireland will be a mainly obese society, and the cost of that to the Northern Ireland Budget could be enormous. We already pay £500 million a year to cope with the problem. We have a ticking time bomb, which, if it is not tackled, could overwhelm the Health Service in Northern Ireland, as it could elsewhere in the world.
Many people have no idea that obesity poses such a serious risk. However, it is a condition that seriously shortens life by up to nine years and leads to other conditions such as type 2 diabetes, high blood pressure and osteoarthritis. Indeed, one study has shown that 63% of heart attacks in the Western World are caused by obesity. Not only will the problem have an enormous impact on the health of our population, but it threatens to engulf the entire Health Service and will have a serious impact on society and the economy. Members of the obese generation could have a shorter lifespan than their parents, so there is a job to tackle here and now. The question is how.
I will now address a few of the report’s recommendations that may help the Department to tackle obesity. In its research, the Committee was unable to find an example of a strategy that successfully dealt with the problems of obesity. However, in England, a new approach is being taken that focuses on the population as a whole. That approach is called Healthy Weight, Healthy Lives. It represents the first national population-wide strategy, and, though it is too early to assess its success, the Committee found its approach encouraging.
The reason why the Committee found that approach encouraging is that obesity levels have increased steadily over many years, and we believe that it will take a long-term response to reverse that trend. Starting the trend away from obesity will take a shift in the way that the population thinks. It is a shift similar to that which occurred in attitudes to drink-driving and smoking in public places. Those campaigns show that it can be done, and the Committee firmly believes that it must be done.
In Northern Ireland, the Department of Health has moved away from its Fit Futures initiative, which focused on tackling obesity in children and young people, to developing a whole life-course approach, similar to the Healthy Weight, Healthy Lives strategy in England.
I am grateful to the Member for giving way. Does the Member agree that, already, many primary and secondary schools have embarked on very efficient methods of encouraging young people to steer away from the materials that would make them obese in later life?
Much work is being done by schools, but we are still left with the worrying situation of 22% of children being overweight.
In 2012, the London Olympics will be held. We are told that that will be a shining example of how to encourage fitness among young people and encourage a reduced intake of salts, sugar and fats. Yet who are the three main sponsors of the London Olympics? They are McDonald’s, Coca-Cola and Cadbury. That is some example to set children.
In the Committee’s report on the strategic direction that the Department should take in tackling obesity, we recommend that tackling obesity is not just a matter for the Health Service. We recommended strongly that the new life course strategy be developed in partnership with other Departments, particularly the Department of Education, which refers to Mr McCarthy’s point.
Let me expand on that. The Department of Education has a critical and central role. Though the Committee welcomed the action on nutrition that has been taken in schools, it would like PE to be made compulsory. When I was a child, many years ago — some time before the Boer War — PE was compulsory. That is no longer the case, and we need to return to that basic standard to ensure that at least some part of the curriculum is set aside for physical activity.
The Committee also recommends that the funding for the life-course strategy is ring-fenced for at least the first phase of implementation, to ensure that it is not impacted on by other emerging priorities.
Another key issue is the requirement for an immediate audit of the existing obesity-related initiatives. The Committee found that there was a plethora of programmes and initiatives on obesity. To some extent, that is good news because it shows that there is an understanding of the seriousness of the issue by a wide variety of agencies, including district councils, workplaces and charities. However, there is no central source of information on what programmes are available or how successful they have been. Therefore, as well as an audit of initiatives and the dissemination of good practice, the Committee recommends that the Regional Health and Social Care Board develops a range of evidence-based referral options for use by primary care practitioners.
The Committee also asks the Minister to undertake an urgent review of weight management services at all levels for adults and children, including the need for a dedicated obesity clinic and bariatric services for Northern Ireland. Severely obese people often require specialist services, not just in medical terms but with regard to transportation to hospitals, hoists for lifts in and out of bed and special seating. The number of severely obese people is expected to rise by around 5% annually, and bariatric surgery is increasingly used to treat the severely obese. However, there is a lack of funding for bariatric services in Northern Ireland, and it is not commissioned by health boards in the Province. Nevertheless, last year, £1·5 million was made available to allow some 120 people to travel to Great Britain for bariatric surgery. Trusts are looking at how to fund patients to travel to Great Britain, but we are aware that the Department has no plans to provide such surgery in Northern Ireland. That is an area that the Committee believes should be reviewed.
The Committee is also making recommendations on diet, exercise, healthy eating and food labelling. Diet and exercise are not the whole story, but they are major contributors. Poor dietary habits and decreasing physical activity will become ingrained in much of our population, and it will take a strategic, long-term approach to change that. People are eating and drinking products that are high in saturated fat, sugar and salt. The Committee is glad to see that the Food Standards Agency is working with the industry to reduce the intake of salt and saturated fat, but more needs to be done. The Committee would like continuous pressure to be exerted at national and European level to introduce regulatory controls on the levels of salt and saturated fat in manufactured food. We also recommend that the Food Standards Agency and the Minister consider introducing clear and simple labelling based on the traffic light system in which red illustrates that a food has a high fat, sugar and salt content, amber has medium and green has low.
The Committee also acknowledged that there has been a shift towards larger portions, but academic opinion suggests that there is a link between portion size and weight gain. People seem confused about what a regular portion size is, and we recommend to the Department and the Food Standards Agency that they take a serious look at that issue.
As well as diet and healthy eating, exercise is an essential element to tackling obesity. Therefore the Committee welcomes anything that encourages exercise, particularly the Department of Culture, Arts and Leisure’s draft 10-year strategy for sports and physical recreation. The Committee has concerns about possible delays in implementing the strategy and cannot emphasise strongly enough the need for a strategy to increase physical activity.
At its simplest, obesity can be explained as an imbalance between the amount that we eat and the level of exercise that we take. However, it is not as simple as that. There are many and varied environmental factors, from the accessibility and the marketing of food to transport, planning and other issues, which dissuade from physical exercise. All those issues are referred to as the obesogenic environment. Local government and every Department have a part to play in tackling the obesogenic — I do not like that word — environment, and we urge them to play their part.
There are links between obesity and health inequalities. People on lower incomes tend to buy more fast and processed foods and less healthy food, and, generally, they are less inclined to engage in regular exercise. In other words, research shows that the lifestyle of people on lower incomes is more likely to predispose them to obesity. Research also suggests that women tend to have a higher risk than men of obesity. The Committee strongly believes that the Department should take account of health inequalities and address the issue of greater obesity in areas of social deprivation.
I want to finish on a positive note. Small weight losses produce healthy gains; and research shows that even a modest reduction in weight of 10% can have a significant impact on a patient’s health. We have been told that a 10% weight loss can reduce one’s chances of getting type-2 diabetes and certain forms of cancer by 50%; therefore taking the issue seriously can produce quick gains for the public. We hope that the public will take heed and take heart from the impact that small changes in lifestyle can have on their health.
I thank the many groups that provided written and oral evidence to the Committee on this important issue. We were overwhelmed by the response to the trawl for evidence. In particular, I thank Dr Jane Wilde, the chief executive of the Institute of Public Health in Ireland, who made a major contribution by chairing a research event on 19 May, which was one of the most important parts of the Committee’s evidence-gathering programme.
This is the first Committee report that I have had the pleasure of introducing to the Assembly since I was appointed Chairperson, and, having lived with this document for the past four months, I have the greatest pleasure in commending it to the Assembly and recommending its support by the House.
Go raibh maith agat, a LeasCheann Comhairle. Following the thanks offered by the Committee Chairperson, Jim Wells, I thank the people who helped me in my capacity as a Committee member. I thank the civil servants who provided help: those who attend Committee meetings now and those who attended previously. In fact, I see some of them in the Public Gallery. I also thank the previous Chairperson of the Committee, who is in the Chamber.
The Committee Chairperson mentioned a number of the report’s key points, but they are important enough to repeat. Obesity is a global health problem, and we hear about rising levels of obesity and numbers of overweight people. According to the most recent health and social well-being survey, carried out in 2005, 59% of adults were overweight or obese. That is a fairly high figure.
As far back as 2002, the Department’s Investing for Health strategy estimated that by 2010, which is just around the corner, the cost of obesity to the Northern Ireland economy could exceed £500 million per annum. Whether that happens is a matter of conjecture, but it will soon be 2010, and some Departments, particularly the Department of Health, will be able to assess exactly what obesity is costing the economy. We cannot afford to lose any money foolishly.
What do we do about obesity? The Committee has finished its inquiry. However, it appears that no strategy in any country has been able to deal effectively with the problem. We have had difficulties with our own strategies. The Committee was told that the Fit Futures initiative was, perhaps, not implemented in the way that it should have been and not properly signed off. I understand that the Department is embarking on a whole life-course strategy, which the Committee fully supports.
A number of Departments need to contribute to solving the obesity issue. The Department of Education is key because of its responsibility for physical education. I fully support the idea of young people doing a minimum of two hours’ physical education a week. That has a positive effect on all sorts of issues: mental health, physical health and discipline, which is sometimes overlooked. Strategies from the Department of Culture, Arts and Leisure and the Health Committee also matter.
The Committee raised the issue of eating five portions of fruit and vegetables a day. I admit that I was not sure about portion sizes or how much to eat. I raised that issue during a Committee visit to the Food Standards Agency, which outlined exactly what the portions should be. People might consider a small tomato a portion, but the Food Standards Agency said that it was not so easy to eat five portions. It may be more difficult for people who live in the countryside and do not have access to fresh fruit and vegetables in a shop, if they do not grow their own. Therefore, a number of simple actions should come out of the inquiry, and one is to look at that issue.
Another thing that I learned about during the inquiry was the obesogenic environment and the need to tackle it. That word refers to a situation in which everything is against a person doing the right thing. The Committee discussed what was happening in this Building and what could be done to make it a healthier place. I commend the improvements in the canteen. I am not saying that it was bad previously, but there have been improvements in the amount of fruit of vegetables on offer, and fruit is provided at Committee meetings.
In supporting the motion, I draw the Assembly’s attention to the fact that 60% of adults and one in five schoolchildren in primary 1 — those aged four and five — are overweight or obese. There is increasing evidence to show that the health impact of obesity is similar to that of smoking more than 10 cigarettes a day. Some people with underlying health conditions are more at risk when they are overweight or obese, most notably those with diabetes.
Anti-obesity drugs are costing the Health Service locally £2 million a year. However, the overall cost to the economy has been estimated at £500 million a year, much of which relates to lost working days. I have never heard anyone work out the sums, but I often wonder how much the National Health Service would save down the line for every pound spent on reducing obesity, particularly among children. Health spending on obesity in the United States is about $150 billion a year, and it has also been shown that the health spending on an obese person is $1,400 a year more than the figure for a person of normal weight.
Much is already being done at a local level. I am the chairman of the board of governors of two primary schools that run breakfast clubs in order to encourage healthy eating. Children are dropped off at 8.00 am and have breakfast in school, as opposed to them bringing in sweet stuff to eat. The children plant apple trees, carrots, parsnips, beetroot and the like in the school grounds, and they take an amazing interest in a healthier lifestyle. We are on the right track in trying to overcome the problem. It is a matter of changing attitudes towards food for the long term.
It would be wrong for Members to debate the issue without making reference to the need for greater regulation of the food sector. The big food producers of cereal and the like have a vested interest in selling their products. Recently, however, there have been some horror stories about the contents of some breakfast cereals. Researchers have discovered that a 30 g bowl of Kellogg’s cornflakes has more salt than a bag of Walker’s ready salted crisps. The food industry is a big player and has huge amounts of advertising revenue at its disposal, and children are particularly vulnerable to advertising.
Any proper childhood anti-obesity strategy must also tackle the vexed issue of food labelling. Only last week, we heard from the Joseph Rowntree Foundation that the levels of childhood poverty in Northern Ireland were more than double those in the rest of the United Kingdom. Childhood poverty and bad diet often go hand in hand.
Although I welcome the Health Committee’s report, I stress that it is only the beginning. I remind Members that we have started to tackle this problem in Northern Ireland long after every other part of the country.
I support the motion. I pay tribute to Research Services, the previous Clerk to the Committee for Health, Social Services and Public Safety and other staff and the groups who gave evidence to the Committee.
The extent of obesity in our society is very worrying. The Fit Futures strategy focuses on preventive measures among young people, offering a joined-up policy on physical activity. However, it has not been implemented and, therefore, has not yet yielded many positive results. The strategy must be evidence-based. The Chairperson of the Health Committee referred to Dr Jane Wilde, and those who gave evidence at the session that she chaired spoke strongly about the need for evidence. There must be evidence that we are generating positive results, and we must ensure that money spent on health represents effective investment. We can only afford to go with what works.
The strategy must focus not only on promoting healthy lifestyle choices but on those who are not yet obese but are considerably at risk, with a BMI index of between 25 and 29. Research shows that, at that stage, even a small amount of weight loss has health benefits. Weight loss of 10% results in significant changes. What I am really saying is that we should try to prevent people from reaching the obese level, because it is dangerous for their health and costs the Health Service a fortune to send them across the water for bariatric procedures.
The report’s recommendations are about encouraging people to take more responsibility for their own health and putting support in place to promote good nutrition and exercise. Most of us know how hard it can be to say no to a second piece of cake. It is difficult to change such habits, but we need to develop a strategy that deals with the issue in the long term so that to be overweight or obese is not considered the norm. Our new Public Health Agency has the lead responsibility for that strategy.
As has been mentioned, the Food Standards Agency has a big role to play in pushing for a clear and uniform labelling system akin to the traffic light system. The FSA must also work with the food industry to address the overload of salt, fat and sugar in foods.
Physical education in schools is essential if we are to instil early on in children habits that they can incorporate into their lifestyle and carry with them as they get older. That especially applies to young girls, who are sometimes less inclined to take up sports. Most young boys will kick a ball about the place and at least get some exercise that way, but we need to think more creatively about ways to encourage more participation, especially from girls. We should perhaps focus on less competitive sports and other disciplines such as dance, yoga or karate, which reap the health benefits and could bring some fun back into exercising. Primary-school children should also be encouraged to play outside, whether that be in the school yard, the garden or the park. We should perhaps consider skipping, tag and other games that we used to play a long time ago.
The health inequality gap means that the wealthier have recourse to much more enticing brands of healthier food. That makes it difficult for people on a very low income who are struggling to feed a family to do so healthily. They may have to resort to cheaper brands that have a much higher sugar and fat content. The health inequality gap really needs to be addressed, because anything that I ever see on offer or very cheaply priced in the supermarket is rubbish and contains a great deal of fat, sugar and salt. Supermarkets need to be involved, because they have a social responsibility.
Obesity is one of the biggest challenges facing our health system and accounts for the steep increase in type 2 diabetes and heart disease. It also contributes to high blood pressure and some forms of cancer. The list of those diagnosed with those conditions is getting longer. Dr Ryan, when giving evidence to the Committee, said that, when he was training, type 2 diabetes was called maturity onset diabetes, and now he is seeing 18- and 19-year-olds presenting with it. I was heartened to hear recently that, according to research, the rate of childhood obesity may be beginning to slow in England, after the prediction for obesity levels for 2020 was revised.
Rather than pick up the pieces, we must work with the community, retailers, schools, the Food Standards Agency, the Public Health Agency and all health professionals to produce an all-encompassing strategy that deals with the root causes of obesity and with prevention and early intervention.
I also support the motion. Obesity is a societal problem; it is not a disease, but, as we have heard, it leads to very serious diseases. We should not medicalise obesity. It needs to be tackled by society as a whole, so we need to take a holistic approach, as has been said already, that involves communities and their representatives, such as politicians and policymakers. We need cross-government, cross-departmental involvement, and, as the Committee Chairperson said — I agree with him — education in health.
The consequences of obesity have already been mentioned, and those, of course, are medical.
Obesity has major health implications, and it is left to the Health Service, the Department and healthcare workers to pick up the pieces of that societal epidemic. Type 2 diabetes has already been mentioned, and ischaemic heart disease, hypertension, loco-motor and mobility problems can also result from obesity. The serious mental-health issues that affect people with obesity have not been mentioned, but those are important too.
We all know that obesity decreases life expectancy and lessens the quality of life. Members who read the Committee’s report will see that its theme is one of positive thinking and finding a positive way to deal with the issue of obesity. The media is important in sending out positive messages, including advertising. We must instil a positive attitude and mindset in people with weight problems. That works much better than creating a negative attitude and mindset. That never works.
A focus on the negative consequences of obesity and other societal problems, such as alcohol abuse and cigarette smoking, never works. It terrifies people, and their behaviours do not change. We must be positive and focus on the great benefits of more exercise and healthy eating, rather than constantly reminding people that they may die younger. There is a danger of stigmatising obese people. If we were to start to play the blame game and people were made to feel that they were to blame for their weight problem, that would concern me. Were that to happen, people would be less likely to be motivated to do something about their obesity.
The report contains a number of interesting points, and I have picked three. I am glad that the Minister is in the Chamber. Paragraph 82 mentions the Healthwise scheme, through which appropriate physical activity is prescribed for individuals in primary care. That should be made available across Northern Ireland.
The need for clear and simple messages was mentioned. Paragraph 114 makes the point that correct food labelling is essential so that people can make the right health choices, and paragraph 120 calls for clarity on what constitutes five portions of fruit and vegetables a day. The report says that the public should be told exactly what that means, and there is currently much confusion on that issue.
The Chairperson referred to education. Some people say that one hour of physical exercise is needed each day, but schools are required by law to have at least two hours of PE a week. Of course, we want an educated population, but we do not want an educated and unhealthy population.
Will the Member agree that, although schools should be encouraged to make time for physical education and they would like to do so, there is little point in that if children pass a variety of fast-food outlets at lunchtime or on the way home from school? That negates everything that the school might have preached during the day.
I take the Member’s comments on board, but that is no reason for not having the required level of physical activity in school. Obesity is a societal problem, and the fact that children do other things outside school does not mean that what schools do when kids are there is not important.
A community approach must be taken. That happens in France under a project called Ensemble, Prévenons l’Obésité des Enfants (EPODE). That is my attempt at speaking French for the day.
Yes, I am afraid that it was. It means that together, we can prevent obesity in children. EPODE, which is referenced in the report, takes a holistic approach. It focuses not on obesity but on physical activity and healthy eating, yet its outcomes have a definite impact on obesity. I urge all Members to support the motion and the Committee’s report.
I, too, thank my Committee colleagues, officials, and respondents to our inquiry; it proved to be a successful road to go down. Obesity causes great concern, not only in the Health Service, but in other areas of government. I support the motion on the obesity report and call on the Health Minister to read it and to act on its recommendations.
The Health Service exists to treat and to care for people; it also has a key role in disease prevention. In the long run, disease prevention saves the public service money; more important, it reduces the prevalence of diseases such as cancer, heart conditions and diabetes, which is particularly prevalent in obese people.
Obesity is a ticking time bomb. The Chairperson also used that terminology. Indeed, the point was made on many occasions in the Committee. During the past 25 years, obesity rates have doubled and continue to rise. In 2005, a health and well-being survey in Northern Ireland found that 59% of adults were either overweight or obese. Worryingly, 22% of children were found to be either overweight or obese. Those figures highlight the problem’s seriousness — the figure for children is particularly alarming.
Obesity is generally preventable through healthy eating and regular exercise. However, I note the submission of the South Eastern Health and Social Care Trust, which suggested that:
“obesity should be understood in a wider context than simply a lifestyle choice concerning nutrition or physical activity. Obesity is often combined with issues of mental health, self esteem, isolation, family support and emotional wellbeing.”
That demonstrates that the cause of obesity is not necessarily straightforward and can be closely linked to mental health; an issue on which I have long lobbied the Minister in the wake of the Bamford review.
Although the motion focuses on the Health Department, all Departments need to take note because they all have a part to play in reducing obesity. For several years, schools have implemented a healthy-eating strategy, and the Department of Culture, Arts and Leisure has developed a 10-year strategy for sport and physical recreation in Northern Ireland.
As other Members said, criticism has been levelled at the Minister and the Department for not completing the Fit Futures implementation plan, which is aimed at children and young people. Despite being in the public domain since 2007, the plan has not been implemented or formally signed off.
Instead, Northern Ireland has adopted the obesity strategy from the United Kingdom mainland, entitled ‘Healthy Weight, Healthy Lives’, which was launched in January 2008. The view of respondents who contributed to the report is that that strategy is not necessarily the correct approach because Fit Futures offers:
“a vision of joined-up policy on physical activity”.
Respondents noted that although they believe that it is a good strategy, little has been done to implement it.
Tackling obesity now could save lives as well as money. In the United Kingdom, the 2007 Foresight report entitled ‘Tackling Obesities: Future Choices’ stated that:
“By 2050, 60% of males and 50% of females could be obese.”
It also states that by 2050 obesity could add £5·5 billion to the annual cost of the NHS, with wider costs to society and business estimated to be £49·9 billion.
There are cost implications not only for our Health Service but for our economy and wider society. The report highlights the comments that were made by the representatives of the Institute of Public Health, who told us that:
“The loss of productivity and the costs of care and treatment of obesity and related conditions have serious effects on the economy and threaten to engulf the health service.”
They went on to say that:
“Obesity is estimated to cause 450 deaths per year, £14·2 million in lost productivity and £90 million cost to health and social care.”
I dare say that if I announced an initiative in the House today that would put £500 million into the Northern Ireland economy every year in these difficult economic times, it would be a stop-press moment. Headlines would be written on the subject, and it would be a cause of significant celebration. However, is it not the case that the Department’s Investing for Health strategy informs us that the outlay for addressing obesity will not only hit that unwelcome target of £500 million but will exceed it? Something must be done. Failure to tackle obesity is simply not an option. I do not want to overuse that statement, but it is apt for the matter in question.
I endorse the maxim that prevention is better than cure. The problem of obesity is a global one. The report contains two major strands aimed at addressing the problem: prevention and weight management. Let us apply ourselves principally to the cost of obesity, which is not an economic one but, rather, the health and well-being of our people. We are talking about serious and complex health issues that have life-threatening implications.
Why do I say prevention? Consider for a moment what is next for severely obese patients when lifestyle and drugs interventions have been unsuccessful: surgery. After that come lifelong medical follow-up treatments. It should set alarm bells ringing in the House that, for those who are obese, there is something of a famine of primary and secondary services. For those who are obese but who have not reached a severe enough level, we need to look to service delivery to see how further weight gain can be reduced.
Let us think financially for a moment. Is it not the reality that some 50,000 of our people meet the eligibility criteria for surgery? Let us take a financial reality check: the cost of surgical treatment and the necessary follow-up per 1,000 patients is between £10 million and £15 million. Multiply that by 50 to get a real sense of the financial implications for our Health Service.
The message must go out from the House today that in terms of health a little bit of weight loss goes a long way in terms of health. As other Members said, a weight loss of as little as 10% can deliver a significant improvement in health.
It is impossible to give due regard to a 46-page report that contains some 24 recommendations; therefore let me highlight some of them when commending the entirety of the document. Let us place PE at the core of redressing the situation. PE is integral to our children’s education, and it is important to remember that one in four of our children is overweight or obese. To use an appropriate metaphor, it is time that the Department of Education stepped up to the plate to deliver two hours of compulsory PE a week. Furthermore, to show our determination in that regard, let us utilise the Education and Training Inspectorate to audit the situation.
On a national, and, indeed, European platform, let us punch at our weight in ensuring adequate controls over salt and saturated fat when manufacturing foods. Although many of us have heard the message about five portions of fruit and vegetables a day, are we confident that the exact proportions are easily understood? I think not, so let us clarify the message.
I urge employers to join in promoting the healthy lifestyle message, in promoting healthy eating in the workplace, and in asking themselves how they can promote exercise in the workplace. After all, it is an investment in the future of their staff.
Policymakers must likewise look at the considerable effect that obesity has on our society. Is it not time that we also consider obesity-proofing our policies and include it as a real proofing exercise in all new policies?
The Minister must also go further. It falls to him to go beyond merely registering obese patients to raising his horizons to the national level and move to the introduction of quality and outcomes framework points for positive obesity management.
The life course strategy is key to tackling obesity and although I do not underestimate the almost infinite pressure on finite health resources, to deliver that strategy we must put our money where our mouth is by ring-fencing the resources for that, at least for the initial period of three to five years. Trust me when I say that that will be money well spent.
In conclusion, I highlight the need for professionals in the primary-care sector to have a range of evidence-based referral options provided for them. That is a matter to which the Department and the Regional Health and Social Care Board should apply themselves. They can no longer pay lip service to addressing obesity, because tinkering at the margins will not meet that need. The report goes a long way to being part of the solution to the obesity problem. I place on record my thanks to the Committee staff for all their efforts in producing the report. I support the motion.
I support the motion, but I wish to reflect on another issue as well as obesity. Other Members spoke about the issue of obesity because of the report that is before us today; however, I wish to talk about obesity and lifestyle choices, particularly in respect of their links to diabetes.
I declare an interest as a diabetic, and Mr Deputy Speaker, I know that you, too, are diabetic. One of the problems with obesity is its link to diabetes. The figures for the number of people with diabetes are horrendous. Some 65,000 adults are diagnosed as having diabetes. Since 2008, the number of cases has increased by 7%, and since 2005, it has increased by some 26%. More than 1,000 children in Northern Ireland have diabetes. I know that not all diabetics, certainly not those with type 1 diabetes, have the condition because of their eating habits. However, all type 2 diabetics —
I must emphasise that there is absolutely no link between obesity and type 1 diabetes. However, the percentage link between obesity and type 2 diabetes is as high as 80% or 85% and that is clearly the issue. No health choices can influence whether someone develops type 1 diabetes.
I thank the Member for his intervention. That is exactly the point that I made, and I thank him for confirming that. It is clear that type 2 diabetes is caused by lifestyle choices, stress and anxiety, and by eating and snacking on certain foods.
I am encouraged by most of the comments about the report, which provides some background information on diabetes. Prevention now will mean better health and less cost later, and cost is another important factor. Of the NHS’s annual budget, which is approximately £400,000 million, 10% is spent on treating people with both types of diabetes. Therefore, I am keen that we address the issue of prevention at an earlier stage so that there will be better health and less cost later. I know that that is what the Minister and the Assembly want to do.
The efficiency framework that is in place is not to the satisfaction of those who are involved in diabetes care. In addition, I do not believe that there is enough effective, structured education about diabetes. We must address those issues at an early stage to ensure that diabetes does not become a scourge later on. I know that the Minister is supportive of that principle. My colleague Iris Robinson said that obesity is a time bomb, but so is diabetes. Minister McGimpsey has said previously that he wants to prevent the Health Service from being overwhelmed by diabetes within 20 years. Where is the framework to ensure that that happens? We need to have that in place and address those issues early on.
Last week, the Public Accounts Committee, of which I am a member, had the opportunity to look at that issue in its discussions about the report on ‘The Performance of the Health Service in Northern Ireland’. That report draws attention to practice in Australia, where targets for tackling the prevention of diabetes have been established. I asked why, having acknowledged the importance of targets, our Health Department is not following Australia’s good lead. I believe that it should be.
I also believe that a diabetes screening programme is needed. The Department’s approach is to focus on high-risk groups, but it should be looking beyond that to ensure that the approach is structured and systematic. Although I commend the Committee’s report and support it in its totality, I ask the Minister and, perhaps, the Committee, which endorses and supports it, to address the scourge of diabetes.
In the report, Dr Naresh Chada from the Department of Health, Social Services and Public Safety is quoted as saying that:
“we could have another 10,000 to 15,000 people with diabetes in Northern Ireland by the early to middle part of the next decade.”
Those figures are worrying, and we should focus on them.
I support the motion.
The 2008 annual report from the Chief Medical Officer for Northern Ireland, Dr Michael McBride, states that:
“Levels of obesity in children and adults in Northern Ireland continue to be a major health concern. Recent surveys indicate that around one in four girls and one in six boys in Primary One are overweight or obese, and that almost 60% of all adults measured are either overweight (35%) or obese (24%). They also found that around 30% of young men and women aged 16-24 are either overweight or obese.”
In other words, one in five adults and one in three children has a weight problem.
At the Northern Ireland Health Economics Group’s conference, which was held on 16 October, Mr Rob Phillips from the Department of Health, Social Services and Public Safety (DHSSPS) reported that obesity is estimated to be costing the NHS £4·2 billion each year, and that cost is forecast to more than double by 2050. The cost to the wider economy is estimated to be £16 billion each year, and that is predicted to rise to £50 billion each year by 2050 if left unchecked.
What is being done? First, the Fit Futures initiative, which aims to reduce obesity in children, was established by the ministerial group on public health in 2006 and implemented in 2007. Secondly, a joint public service agreement target was put in place to halt the rise in childhood obesity by 2010. That has since been expanded to include adults. Thirdly, in 2008, DHSSPS set up the obesity prevention steering group, and it is working on an obesity prevention strategic framework, which is due for publication in 2010. Furthermore, in 2009, the Health Committee undertook its inquiry into obesity.
Although all of that work is welcome, there is a lack of evidence on the effectiveness of such interventions in reducing obesity levels. The recent Change4Life media campaign cost £75 million, and previous media campaigns have been costly and largely ineffective. The concept of communicating risk about unhealthy lifestyle behaviours has not led to significant modification. Our population is getting bigger: the ‘Northern Ireland Health and Social Wellbeing Survey 2005/06’ found an overall increase of 26% in adult obesity in Northern Ireland since 1997.
According to a report released in July 2009 by the Trust for America’s Health and the Robert Wood Johnson Foundation, such policies are failing in America. The report states that adult obesity rates increased in 23 states and did not decrease in a single state in the past year and that the percentage of obese or overweight children is at or above 30% in 30 states. The report calls for obesity prevention and control to become a high priority in healthcare reform, which I very much support.
The increase in the weight problem is such that current resources are overstretched and cannot adequately address the need for professional intervention. For example, the Northern Ireland Audit Office recently published a report stating that over 62,000 people in Northern Ireland, of which I am one, have type 2 diabetes. Some 20,000 people are unaware that they have the condition, and it is predicted that 81,000 people will have it by 2015. Type 2 diabetes is a condition that is reaching epidemic proportions.
Diabetes is one of the most costly and burdensome chronic diseases of our time; treatment of diabetes takes £1 in every £7 spent on healthcare in Northern Ireland. In 2005-06, £43·7 million was spent on diabetes treatment, excluding primary or community care, personal or social care and outpatient services. It is estimated that 10% of the NHS annual budget goes on treating diabetes. The increase in its prevalence is largely explained by the rising trend in obesity.
Obese patients are seen at a diabetic clinic where the focus is on blood sugar control, blood pressure and cholesterol levels, with weight being a secondary consideration. Often, conventional models of weight reduction are not sufficiently effective to impact on life expectancy or healthcare costs, as they rely on brief, opportunistic interventions. Such a service is not adequate or appropriate.
Obesity is strongly associated with raised blood pressure and cholesterol. Twenty-one percent of heart disease cases can be attributed to excess weight or obesity, and heart disease is the leading cause of death in patients with type 2 diabetes. Given that weight has an impact on patients’ life expectancy that is similar to that of smoking, high blood pressure or high cholesterol, why do we not have the necessary resources and skills to help them to manage their weight?
Leading healthcare professionals are calling for lifestyle management to become part of healthcare provision. Weight loss is one of the few interventions that may result in increased life expectancy for many patients. Research has constantly shown that effective weight reduction can, over three years, prevent 58% of overweight individuals from developing diabetes.
In the UK, 26% of total prescribing costs are attributed to complications experienced by overweight or obese patients. There is plenty more that I could say on the subject; however, I support the motion.
I welcome the Committee’s report on its inquiry into obesity. Members have devoted considerable time and effort to compiling the report and to ensuring that the issue of obesity remains at the forefront of public interest. The report contains 24 recommendations, and, I am pleased to say, my Department has either addressed, or is considering, all the issues that it raises.
Obesity is a complex issue, the scale of which should never be underestimated. Often, it has been referred to as a time bomb and, in 1997, the World Health Organization described obesity as a global epidemic. In Northern Ireland we are facing significant problems: obesity rates have tripled over the past 20 years, and it is estimated that obesity causes 450 deaths each year.
Being obese reduces life expectancy and can lead to considerable health problems; significantly, the risk of developing the biggest killer diseases, coronary heart disease and cancer. Obesity also increases the risk of developing type 2 diabetes and can lead to depression and lack of self-esteem.
Obesity levels are rising at an alarming rate, particularly among children. Recent surveys indicate that around one in four girls and one in six boys in primary 1 are overweight or obese and that almost 60% of adults measured are overweight or obese. That is clearly a matter that we must address if we are to protect people from the serious health problems that are associated with obesity and ensure that our Health Service does not have to face the additional burden that that will place on services.
Such high rates of obesity bring with them a considerable cost to our society, which, in today’s difficult economic climate, is becoming increasingly unaffordable. In 2003 and 2004, following a House of Common’s Health Committee inquiry, a Foresight report estimated the cost of obesity as £3·7 billion a year.
In Northern Ireland, obesity results in the loss of 260,000 working days each year and costs the economy around £500 million. However, it is not just about the cost to our society; it is about the cost to people’s health and the impact that obesity has on their lives and that of their families. That is why it makes sense to invest in preventing obesity and in helping people to change their lifestyles for the better.
Much progress has been made in tackling childhood obesity, and it is encouraging that, already, there appears to be some levelling off in the rise of obesity among P1 children. As a result of the Fit Futures task force, we now have programmes such as the healthy breaks initiative. As well as working to ensure that there is healthier school food for children, further progress has been made in making sure that food labelling is clearer, that there are tougher restrictions on the advertising of food that is high in fat and sugar, and that physical activity levels in schools improve.
Following the Foresight report, there has been increasing interest in obesity and an acknowledgement that we should be focusing on the whole population and not just on children. In February 2008, my Department established the obesity prevention steering group. Initially, that group was established to drive forward the Fit Futures programme, and, latterly, it began work on the development of an obesity prevention strategic framework that targets the whole population.
I note and agree with the report’s view that obesity is not just a health issue. From the outset of the debate, Members have accepted that the issue is not specific to my Department; it is cross-departmental and cross-governmental.
Work on developing the strategic framework continues based on the life-course approach and tackling what is now described as the obesogenic environment. That means that we will be looking at ways to improve lifestyle and the physical health of the entire population. Following full public consultation, the framework should be launched in June next year.
As we all know, it is one thing to develop a strategy, but how the strategy is implemented is crucial. I believe that we are now in a position to make a major difference, thanks to the creation of the Public Health Agency. I established the agency specifically to ensure that strategies and policies were delivered and implemented at ground level. The key strength of the Public Health Agency is that it is uniquely placed to co-ordinate and deliver health improvements to the Northern Ireland public at both the regional and, through effective partnership working, the local level. The local partnerships will also include councils, because I am convinced that we should harness the skills and knowledge of local people in delivering initiatives to the local population.
I have already referred to the costs of obesity to our society. I am particularly concerned about the cost to the Health Service on the part of individuals who have made unhealthy lifestyle choices. Everyone in Northern Ireland has a responsibility in respect of lifestyle issues such as alcohol and smoking. In the end, individuals make decisions on their own lifestyle. It is essential that they make the right choices and that the Government provide the information and help that they need to do that.
Obesity has a clear link with another issue that I am determined to tackle: health inequalities. Those are associated with a wide range of social determinants, including poverty, unemployment, poor education and poor housing. The same determinants impact on individuals’ opportunities and choices on healthy eating and physical activity. Tackling health inequalities is an issue that I have tasked the Public Health Agency with addressing urgently.
Although the main focus of the report is on prevention, it also highlights the important issue of obesity management and treatment. Weight-management programmes may be delivered in a variety of settings. Examples elsewhere illustrate the important role that can be played by a range of public services, including the leisure services provided by local councils and, in the health sector, primary and community care services.
We must recognise that the management of obesity can be challenging. Bariatric surgery may be considered for patients for whom a dietary approach has been unsuccessful. The management of bariatric patients is complex and involves not just surgery, but extensive support from a range of professionals before and after surgery. In particular, dietary management after surgery requires specialised support to avoid complications. There is strong clinical evidence to suggest that patient outcomes, including risk of death and post-operative complications are best treated in specialist units that perform a large number of procedures each year.
Before the Minister moves away from the subject of bariatric services, I note that there is a school of thought that says that a sufficient number of people from Northern Ireland are having such treatment to warrant consideration of locating a clinic dedicated to such services at one of the acute hospitals in the Province. We send 120 patients across the water each year at a cost of £1·5 million. Surely, we are getting to the stage where it would be better to provide that service in Northern Ireland.
As I said, we have a budget of £1·5 million to deal with the number of people who come forward for such services; currently, that is 150 suitable patients per annum. That level of activity means that it would not be cost effective to establish a dedicated clinic for such surgery here. The advice that I receive is that, because the procedure is very complex and there is a risk of death and post-operative complications, patients are best treated in specialist units that perform large numbers of procedures each year. Access is travel.
Against that, the Chairperson advanced the argument that we provide that service locally. At the minute, we are not at the point of being able to develop a dedicated stand-alone service in Northern Ireland.
Primary care in Northern Ireland continues to make a positive contribution to identifying and supporting patients with obesity through an enhanced service that has been delivered by GP practices. Since 2006, I have invested £3·2 million in primary care to assist patients specifically in managing their weight through the provision of advice and guidance and referral to appropriate opportunities for sport and leisure. That is exactly what happens in the Grove Wellbeing Centre in Belfast, which brings together high-quality health, social care, leisure, lifestyle and lifelong learning services to its customers.
The report specifically talks about resources. Last year, my Department allocated £1·6 million to prevention. Additional long-term investment is needed in that area, and I intend to discuss that matter with the Executive.
Obesity is a key public health issue that we always have addressed, and will continue to address, as a matter of urgency. I welcome the Committee’s interest in the matter, and we will respond to each recommendation in more detail in due course. I recognise the long-term cost to our society that will ensue if we do not halt the rise in obesity. As I said, we are having some initial success with P1 children. In fact, when I took up my ministerial post, one of the first things that I said to the House was that my advice suggested that, if we do not take steps to address it, the Health Service in Northern Ireland will be overwhelmed by type 2 diabetes within 20 years. I listened carefully to that advice and followed up on it, not only through the Fit Futures policy, which I inherited, but through the obesity prevention steering group, which is overseeing the implementation, and through a new overarching 10-year obesity prevention strategic framework.
Furthermore, I am specifically addressing obesity issues across the whole population. We have included diabetes as a key anchor of the new cardiovascular framework. To date, I have included the development and implementation of the Healthy Breaks initiative, which, combined with food-in-schools policy, will ensure healthier school food for children. I have also established the Public Health Agency, which I believe will be the main driver to address issues such as health inequalities. Members mentioned Dr Jane Wilde of the Institute of Public Health, who plays an important role. The Public Health Agency in Northern Ireland will play a crucial role in the future.
Prevention is better than cure. We must work through GPs and primary care, and invest in primary care, to address those issues with patients. Other UK health Departments are reviewing what our Department is doing for obesity under our long-term condition management enhanced service with a view to introducing similar measures. We are far from complacent. How to get the message to local communities is always the issue. We should use local people to help local people. That is the key issue for the Public Health Agency. It must also address health inequalities. People who live in disadvantaged communities or in poverty are more likely to face such challenges than people who live in more affluent areas. The Public Health Agency and the Department are driving progress on those issues.
Sadly, the Public Health Agency, which was established on 1 April, immediately faced the huge challenge of swine flu. Therefore, Members are not seeing its activity properly as yet. However, it is working away, and that activity will become more apparent in the future.
The Department will carefully consider the recommendations in the Committee’s report, many of which we are taking forward already. We will consider all ideas and proposals, and all suggestions are more than welcome.
Go raibh maith agat, a LeasCheann Comhairle. I thank Members for taking part in the debate and I thank the Minister for his response. Obesity is a major issue, and the Committee has undertaken a very valuable piece of work. We expect that our report will influence the Department’s thinking and policy development, and I welcome the Minister’s comments on that.
Obesity is pivotal not just because it is a major health issue that is central to the quality of life of our population but because of the major financial implications that many Members have highlighted. Last week, Members had an extensive debate on finance and efficiencies in the Health Service. The potential cost of obesity to the Health Service dwarfs the efficiencies that were discussed during that debate, and we have heard today that, as predicted by the Investing for Health strategy back in 2002, unless trends are reversed, obesity will cost the Health Service £500 million a year. Much of that potential expenditure can be saved if we can reverse the trend.
(Mr Speaker in the Chair)
Obesity must be tackled. We have no choice, if we are to have an affordable Health Service and if our population is to have good quality of life. We need to invest now in order to save later. Many Members spoke about how obesity is tackled, including the development of the new life course strategy, the lack of implementation on the Fit Futures initiative, and the need for a partnership approach with other Departments, particularly with the Department of Education, given its role in providing physical education in schools. We are aware that physical education is part of the curriculum, but the number of hours a child spends in physical education each week is not compulsory. That is a key measure that the Department of Education can take forward.
Other Departments also have a role. The Department for Regional Development has a role to play in promoting the Sustrans Safe Routes to School scheme, so that children will have safer routes by which to walk to school. Members referred to the Department of Culture, Arts and Leisure’s sport and physical recreation strategy, a 10-year strategy that is sitting somewhere in the Department. That strategy needs to be published and actioned.
There is a role for the Department of the Environment through local government and the availability of leisure services. Again, the key issue is to ensure that people can afford the services offered. OFMDFM also has a key role to play in tackling health inequalities and poverty. Members will agree that those living in poverty are affected by any health problems disproportionately and seem to be predisposed to obesity. Many Members referred to those issues, and there will be consensus that a strategy to tackle obesity is required quickly and must be cross-departmental.
Another theme that has emerged in the debate today is the requirement for an immediate audit of existing obesity-related initiatives, such as the dissemination of local good practice and a central database of projects with standardised evaluation tools. Dr Deeny mentioned the Healthwise scheme, which is a 12-week exercise programme in which people are referred to their leisure centre. That is a fantastic example, but the problem is that it is not consistent and it is not available across the board. Those examples of good practice need to be implemented in all areas. They need to be consistent and measurable, because we need to know whether people are achieving something through them. The Committee hopes to see an audit of initiatives and the dissemination of that good practice across the board.
The other clear theme was weight management, the need for dedicated obesity clinics, and the possible provision of bariatric services. Many Members referred to bariatric surgery, which is not being delivered locally. People requiring it must travel to receive it. Those who live in the North should be able to benefit from this life-saving, life-changing treatment. They need to be able to access that surgery in local hospitals. Everyone agrees that local care, and more particularly, follow-up care, is best delivered locally. Bariatric surgery should be no exception. The Chairperson of the Committee referred to the number of people referred to England for that surgery, which costs the Health Service £1·5 million a year. Given that we are expected to see a 5% year-on-year increase in the level of obesity, and subsequently the number of people who may need to access that service, we need to plan for the future.
The Committee is also making a series of recommendations around diet and exercise, which some Members referred to. Diet and exercise are not the whole story. They are major contributors, but we need to look at the “whole life” approach. There needs to be a major shift in thinking and a major change in how society and communities behave.
People must take more personal ownership of, and individual responsibility for, their health. We must analyse the root causes of ill health. I urge the Minister to bring forward the review of the Investing for Health strategy as a matter of urgency. There is strong evidence to indicate that people living in food poverty almost always have a diet that predisposes them to the risk of obesity, and we must take that seriously.
I will now refer to Members’ contributions. Claire McGill pointed out that no country has a strategy that we can look to as an example of best practice. Therefore, the Assembly has an opportunity to lead the way in bringing forward a strategy that other places can look to as best practice. She also referred to the good example that is set by the Assembly’s canteen facilities.
Samuel Gardiner mentioned the rising levels of obesity and the cost of anti-obesity drugs to the Health Service every year. He referred to local good practice and outlined the need for a more consistent, whole-population approach. Mr Gardiner also said that people can be confused easily about the levels of salt, sugar and fat in their diets and about what is good for them and what is not. Clear, transparent, consistent front-of-package labelling is needed. A traffic-light system would be perfect, because it would enable busy people to see easily what food is healthy when they are doing their shopping. If a label has more green boxes than those of any other colour, people will know that that food is healthy.
Carmel Hanna pointed out the need to ensure that money is spent effectively and to focus on people who are in danger of becoming obese, as well as those who are obese already. We must tackle the problem of obesity at its root cause. She also talked about the role of sports, and she said that young girls are less inclined to take up sport, particularly competitive sport. Sport NI told the Committee that such activity is not all about competitive sport and that we must encourage recreational sport. Mrs Hanna also referred to the role that the food industry and retailers play in deciding on portion sizes, labelling, and so on.
Dr Deeny said that people are not always aware of obesity’s associated health risks, such as type 2 diabetes, high blood pressure and an increased risk of some cancers. Action Cancer told the Committee that obesity can lead to an increased risk of uterine, cervical and ovarian cancer. The statistics about that are worrying, but people do not generally associate those illnesses with obesity. Dr Deeny went on to talk about avoiding getting into a blame game or attaching a stigma to obesity. We must be very conscious of the need to avoid that.
Iris Robinson gave some startling statistics that I must repeat. Some 25% of children are either obese or on their way to being obese, and 60% of adults are obese or overweight. Obesity is a global problem that we must tackle now. Mrs Robinson also outlined the need for all Departments to get involved, and she said that they all have a role to play.
Alex Easton said that failure to tackle obesity is not an option, and he referred to the weight-management services. The Committee is calling for a review of those services so that people are supported in their endeavours to lose weight. Mr Easton also mentioned the role that employers can play in promoting healthy lifestyles at work. We have a long way to go to tackle the problem, but this debate is a good step forward. The Committee is committed to working with the Minister so that the matter can be progressed.
Jim Shannon said that he is a diabetic, and he made the link between obesity and type 2 diabetes. He said that the number of people who are presenting with type 2 diabetes is increasing rapidly, and he referred to the need for a service framework to tackle diabetes properly.
Adrian McQuillan talked about how the Chief Medical Officer’s report highlighted the danger of obesity and the lack of evidence to support the work of various programmes. Therefore, more evidence must be gathered to guide the way forward.
I thank the Minister for welcoming the report and for his commitment to working with the Committee in taking forward the 24 recommendations. I welcome his comments that it makes sense to invest in services. I also welcome the fact that some progress has been made. However, we must work together to make more progress in tackling this epidemic.
I agree with the Minister’s reference to the positive role that the Public Health Agency plays. That agency has hit the ground running in dealing with swine flu, but it has a key role to play in tackling obesity, and it is best placed to deliver co-ordinated services and a co-ordinated approach.
The Minister also talked about health inequalities. We cannot get away from those. There are social determinants of ill health, and we must tackle the fact that people who live in socially deprived areas have poorer health than those who live in other areas.
In conclusion, no one in the House disagreed with the fact that obesity is a global public health issue. There is no getting away from the fact that obesity costs the Health Service a colossal amount of money. We must invest now so that we will save in the future. I echo the Minister’s words that prevention is better than cure. Go raibh maith agat.
Question put and agreed to.
That this Assembly approves the report of the Committee for Health, Social Services and Public Safety on its inquiry into obesity; and calls on the Minister of Health, Social Services and Public Safety, in liaison with Executive colleagues and relevant bodies, to bring forward a timetable for implementing the recommendations contained in the report.