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Inaction over child obesity, not Brexit, should be Cameron’s legacy

Tam Fry, patron of the Child Growth Foundation, spokesperson for the National Obesity Forum and expert advisory team member with Action On Sugar, writes for PSE about the government’s delayed child obesity strategy.

Brexit will undoubtedly be David Cameron’s legacy, but if the NHS has to be rescued from collapse any time in the next decade, his six years of complete incompetence in tackling obesity, and childhood obesity in particular, should be equally nailed to his record. 

From the day that he took office in 2010 he knew full well that without a complete break from Labour’s short-term budgets, short-term initiatives – and a ridiculous target to stop 11-year-old’s obesity in the noughties – the NHS might be sunk. 

Derek Wanless, a former banker commissioned by Labour to take a good look at the health service, had spelt out this doomsday scenario in 2004, and by 2007 the Foresight Report reminded government that only a comprehensive long-term strategy would have an impact on the escalating epidemic. The report’s prediction that around half the UK adult population, 50% of boys and 20% of girls would be obese by 2050 should have sent shivers up the spine of both Downing Street and, more importantly, the Department of Health (DH). 

Lack of focus, despite the evidence

Cameron’s response was not to direct the department to take meaningful action, but to appoint a succession of public health ministers whose own legacies will show that they just made things worse. The Responsibility Deal, flawed from the start and belatedly dismissed after years of hope that it might eventually work, is illustrative of how unfocused the DH’s mind was regarding the nation’s children. 

It wasn’t as if Cameron was short on advice on how success could be achieved. In 2011, in readiness for the United Nation/World Health Organization (UN/WHO) summit on non-communicable diseases, the Lancet commissioned a report from an impressive number of the world’s most respected obesity specialists for just such success. Their proposals would have needed considerable start-up funds but, over the years, it was calculated that the investment would have paid off.  The top eight measures – from taxes on unhealthy food and beverages to curbs on their advertising and marketing to children – would be cost saving, and 12 more recommendations were again evaluated as being cost effective. Cameron ignored the advice. 

A more refined and detailed strategy was published in 2014 by the McKinsey Global Institute. It didn’t give tax as high a rating as that proposed to the UN/WHO but its set of 44 interventions were all tested for potential scaled impact and cost effectiveness. It also came out with some interesting numbers given that all the interventions were implemented together. The figures projected that about 20% of overweight and obese individuals would be back in a normal weight range within five to 10 years, with an annual saving to the NHS of nearly £1m: not a complete success, but certainly something to write home about.  

Hope that this plan could become the blueprint for action was heightened when McKinsey people were observed going in and out of the No. 10 policy unit’s back door, thereby triggering some fairly uncompromising words from Jeremy Hunt. He promised that the upcoming strategy, whenever it finally emerged, would contain “draconian” and robust “game-changing” measures as befitted any onslaught on the “great scandal” of childhood obesity. But what came of that? Nothing but a “weak” document, according to The Times, whose health editor had got hold of a copy. 

Revising the strategy 

All is not lost, however, and Theresa May, having put a hold on Cameron’s handiwork, may yet save the NHS. Her prompt action and his failure to squeeze out his ideas “after the referendum” could be a blessing in disguise. Word has it that May’s veto may also have been one of the reasons that the health secretary kept his job in the Cabinet reshuffle. Quite apart from still having to sort out the junior doctors’ dispute, she gave him the summer to toughen up an insipid strategy. 

There is even a theory that Hunt himself assured his new boss that that he could reinstate the game-changing proposals and make it work under her watch. We shall see. The revised plan is currently scheduled for the beginning of September – but politically savvy observers suggest that it could be later, even in the New Year. By the time you read this page you could know if the pundits are right or wrong. 

Time is of the essence 

If it is the New Year it will be calamitous. Though you may consider that a delay of a few weeks or even months is insignificant given the years of inaction, I would take the opposing view. Time is of the essence. 

Simon Stevens, chief executive of NHS England, stated two years ago in his Five Year Forward View for the service that the health of millions of children, the sustainability of the NHS and the economic prosperity of Britain depended on a radical upgrade in prevention and public health, and we are already deep into his timeline.  

More recently, the chief medical officer, Dame Sally Davies, demanded a COBRA-style crisis management for a “national risk”, and COBRA management doesn’t tolerate delay. Any delay should be unacceptable once Westminster returns from its holidays and May should give a toughened makeover her full backing. Will it rescue the NHS? If it doesn’t she should not be held to account.   Cameron should get the blame and his name be linked to an NHS collapse for evermore.

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