Shirley Cramer CBE, Chief Executive, Royal Society for Public Health (RSPH)
Feb 27, 2018
As a country, we are at a public health crossroads. The obesity crisis is a ticking time bomb that is already placing increasing pressure on our stretched health services, and if not addressed as a matter of urgency, may be the straw that breaks the camel’s back for our NHS.
The Chief Executive of NHS England, Simon Stevens, has publicly said that obesity is going to bankrupt the NHS. Preventing obesity will benefit the individual and society so we need to address food habits and the food and drink environment as early as possible. By instilling positive, healthy behaviours in our children and creating a more health promoting environment there is a realistic chance of reversing the current trends.
There has been much written about why we find ourselves in this unhealthy situation and there is a great deal of hard evidence too. We know that children are more inactive than ever before, education on nutrition and cooking is lacking in schools, high-calorie junk food is on every street corner, and multi-national food and drink companies are bombarding children and young people with alluring advertising encouraging them to consume. All of these factors combine to form what we call an ‘obesogenic environment’. In simple terms, this means that the places in which we live, work and play have become increasingly unhealthy or obesity-promoting. The unhealthy choice has become the easy choice and in many cases, it can be the inexpensive and logical choice in busy lives.
There is a debate that often arises when talking about the issue of adult obesity. On one side of the argument, many say that individuals must take responsibility for their own weight and health. No one is forcing anyone to consume and individuals must be accountable for their own actions. On the other side, it is said that the ultimate blame lies with food and drink industry and the environment in which we live. If our environment and society is obesity-promoting, is it any wonder that this is reflected in the population?
However, when considering children and childhood obesity there really is no debate. Children’s choices are made for them by their families and society and we have a collective responsibility for these choices. The environment in which we raise our children has a direct impact on what they consume. If we can create an environment that is conducive to promoting healthy eating, active travel and physical activity, this will be reflected in the health of our children and ease the burden on our struggling health services.
In March 2015, RSPH released a report entitled, ‘Health on the High Street’. The report looked at local high streets as a ‘setting’ for health and wellbeing. It explored both the positive and negative ways in which the businesses that we find on our high streets can have a direct influence on the health of the surrounding local population. We developed a league table of the 10 healthiest and 10 unhealthiest high streets in the UK and unsurprisingly we found that the unhealthiest high streets were all in the most deprived areas.
We also undertook a league table of the London boroughs, ranking 144 different high streets and as with UK towns and cities table, the unhealthiest high streets were in areas with the highest deprivation.
"There is a perpetuating cycle of deprivation and obesity that we must address. Until the cycle is disrupted the coming decades will see these inequalities grow and the poorest children will bear the brunt of deprivation through increasing rates of obesity."
This link would strongly support the idea that our environments and the streets we frequent really do have the potential to help us live well, or be detrimental for our health.
It is a particular failure of public policy that health inequalities continue to grow, that the poorest children can expect the worst environments. In the context of childhood obesity, this means that children from the poorest socio-economic backgrounds are twice as likely to be obese than the wealthiest. This makes the fact that more fast-food outlets are opening in deprived areas even more worrisome. There is a perpetuating cycle of deprivation and obesity that we must be bold enough to address. Until the cycle is disrupted the coming decades will see these inequalities grow and the poorest children will bear the brunt of deprivation through increasing rates of obesity.
The solution involves incorporating health and wellbeing into all policies. We need to make the default option the healthy choice. Town planners, and architects should be assessing the health impact of the public spaces in our towns and cities with specific attention paid to roads, pavements and green spaces used by children and young people. Before infrastructure is built, it should meet minimum requirements of not just not being detrimental for people’s health, but to actually promote health and wellbeing. This approach will require a massive culture shift but it is something that is necessary to create an environment fit for purpose for future generations.
There is no magic bullet – it’s going to take time, money and tough decisions from elected politicians and policy makers, which is why the Government’s childhood obesity strategy has left many of us disappointed. The strategy did not contain nearly enough hard-hitting policy changes, particularly around advertising and promotions of food and drink full of fat, salt and sugar. It seems that many politicians still haven’t grasped the extent of the problem and don’t recognise their own responsibilities. Short sighted, election-cycle politics means that we do not get the critical, comprehensive, long term strategic approach needed to tackle childhood obesity. We are making some progress but it is too slow. A radical culture shift is needed in all areas, and health put at the heart of decisions, if we are to create the environments and streets that can support us to stay healthy and well from childhood right through our lives.
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