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    The biggest changes come from incremental steps not silver bullets

    In the same week that the new mayor of London began the task of watering down his electoral promises the Government published its long-awaited “Plan for Action” for childhood obesity. The anti-obesity lobby attacked it because it lacked some of their favourite state interventions.

    David Cameron’s biggest flaw as a politician was to promise actions for which he had either little knowledge as to their impact or little inclination to worry about these future problems. Even before he became Conservative Leader he showed this tendency when he promised the Eurosceptics that the Conservatives would pull out of the European People’s Party (EPP) grouping in the European Parliament. This was at a time when his party was exerting great influence in Brussels, through the EPP, when it had none in Westminster.  Of course the European Referendum was another electoral promise, with unknown consequences. On a smaller scale so was the promise of a high-profile action plan for childhood obesity.

    The childhood obesity silver bullets that so many campaigners have been calling for would simply create new hostages to political fortune. At least the sugar levy will raise some money as a hypothecated tax, even with no direct effect on obesity rates.

    The same cannot be said of the “junk food” advertising restrictions called for by obesity experts. A few years hence, once this has been shown to have no effect on obesity rates, what next straw does the regulator grasp for? It would certainly need to include greater regulation of social media.  Every time that the state takes action in this way it is also taking responsibility. It reinforces the message that obesity is the result of commercial practice by the food industry, with little to do with individual behaviour. In short, it is someone else’s fault, and the Government can fix it.

    During my Department of Health days we were rolling out the first ever concerted public health strategy, the Health of the Nation strategy, comprising “key areas”, each of them replete with firm targets. We faced a powerful lobby by the National Asthma Campaign for a new key area to be created, to tackle the rising incidence of asthma. The Campaign had a very strong case, and it was very well made. But some of the existing key areas were already proving problematic in practice, particularly in mental health. Government simply lacked the appropriate knowledge at the time and the necessary policy levers over human behaviour to hit some of the targets.  Adding another key area on air quality and asthma could exacerbate this problem, raising excessive expectations of what the Government could achieve. There would be huge costs involved, but no clear indication of effectiveness. We had to say no. At the time I worked closely with the National Asthma Campaign to build another way forward that would make a real difference, amidst the disappointment around the rejection of their case. We needed to work on the cause rather than thesymptoms. The same is true of the new obesity strategy. It may not offer silver bullets, but it does indicate a determination to tackle the human problem behind the headlines.

    Prime time advertising of “junk foods” is also just symptom of the lifestyles of today’s households. The Government has already gone a long way towards heaping blame on the food industry, and is right to be cautious about going much further in this direction. It is human nature to want to find an external reason for our problems, but it is damaging for politicians to manipulate this natural bias for short term popularity.

    On the other hand it is right for politicians to step in when there are measures that it can take that will make a difference when confronted with complex, strategic challenges: The Climate Change Act is the most obvious example. It imposed a step-change in the regulatory burden on the energy sector that was probably unprecedented in the sixty years since the Clean Air Act of 1956, and willingly imposed new costs on all energy users. But the Act followed decades of incremental measures, responding to the evidence base as it developed, and to new capabilities in energy production. The Childhood Obesity Plan of Action signals that a similar, rational approach will now be taken in tackling the obesity epidemic. Most of the time the biggest changes come about in incremental steps.

    First published on the British Politics and Policy blog.

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    Is this black liquid I continually pour down my throat really good for me? At some point we’ve all wondered this, and we’ve continually consoled ourselves with the occasional news headline celebrating the positive health impacts of coffee.

    The short answer is yes – but – just like grandma always said – only in moderation. I know this isn’t the most sensational introduction, but since this is a health article it’s important to be honest.

    So, before I begin to bore you with any more ‘grandma-isms’ let’s jump into my list of 16 Proven (and honest – as backed up by actual studies) Health Benefits of Coffee.

    If that’s not enough, we’ll also bust 3 super common coffee-health myths together, and explore 5 simple hacks that will make your coffee even healthier!

    #1 Coffee Helps Burn Fat

    After years of being buffeted by an endless stream of gimmicky weight loss ads, you may already be critical of this first topic, but, unlike all those horrifically designed pop-ups, this point maintains its validity.

    However, the key word here is “helps,” and the key factor is “caffeine”, so don’t switch over to an all-frappuccino diet just yet.

    Excess sugar is still bad for you, other nutrients are still essential, but caffeine can help your body burn any excess fat you’ve acquired from your local butcher, and here’s how:

    When it comes to fighting fat, metabolism is like your offensive line – the higher your Metabolic rate, the easier it is for you to eat without gaining weight.

    You know those skinny people who can eat a mountain of food and stay skinny? Chances are, they have a high Metabolic rate.

    Coffee helps you burn fat

    One study has proven that caffeine can increase your metabolic rate by 3-11%, up to three hours after ingestion (1).

    Another study (2) found that caffeine increases oxidative free fatty acid (FFA) disposal by 44%, which is just a fancy way of saying “converted fat to energy.”

    Apart from speeding up your metabolism, caffeine also helps to release (3) FFAs into the bloodstream, making them more available for energy conversion.

    #2 Coffee Gives You a (Temporary) Energy Boost

    I know this point seems rather obvious – after all, it’s the reason most of you drink coffee – but for that very same reason it belongs in this list.

    Do you know why caffeinated coffee has this effect?

    In science-y terms, caffeine induces a brain hypoperfusion (4), which means (just in case you weren’t a neuroscientist) that caffeine speeds up the brain’s energy metabolism while also decreasing blood flow.

    This triggers the release of norepinephrine, a chemical responsible for alertness and arousal (not that kind…).

    Coffee gives you energy

    And just in case you’ve been living under a rock at the bottom of the ocean for your entire life, there is some very recent research showing the positive effects coffee has on energy. As stated above, coffee can dramatically improve your alertness, but also can improve your mental performance (5).

    Additionally, if consumed on a regular basis (6) throughout the day, coffee can help to maintain mental and psychomotor performance.

    But I’m still not done! Some studies even indicate that coffee can improve physical endurance (7) by 12%, but we will get into that a little later (in the list).

    #3 Coffee Reduces the Risk of Parkinson’s Disease

    Apart from giving you energy and helping to burn fat, coffee also has some disease prevention qualities as well (que superhero theme music).

    Coffee can help to decrease your relative risk to a number of serious diseases, one of which is Parkinson’s disease.

    There are quite a few studies that have found coffee can significantly reduce the risk of Parkinson’s. One study (8) reported that a cup of coffee contributes to a substantial 31% decrease in risk.

    coffee and parkinsons disease

    Other studies have found even greater risk reduction when controlling for outside factors like smoking and drinking alcohol. One such study reported a 58% (9) reduced risk in both men and women. Another (10) found, when consuming five or more cups per day, men had a 61% reduced risk and women had 60% reduced risk.

    Although the exact mechanism for coffee’s Parkinson’s demolishing powers is still unclear, one research study reported that it is most likely related to caffeine (11) and not some other nutrient.

    #4 Coffee Protects You Against Alzheimer’s and Dementia

    Spoiler alert: coffee improves cognitive performance. Total shocker, I know, but for all of you non-believers, take a seat and prepare for some knowledge.

    I’ll dive into aspects like general performance, alertness and memory later, and for now I’ll focus on Alzheimer’s disease and dementia (no big deal).

    There have been numerous studies to show that regular coffee consumption is related to decreased risk of Alzheimer’s and dementia.

    One of these studies (12) reported that drinking 3-5 cups a day, from midlife on, can reduce the risk of both Alzheimer’s and dementia by 65%.

    A second (13) study found caffeine to be the primary factor in coffee’s preventive qualities. One of the researchers of the study, Dr. Arendash, was quoted saying:

    The study also noted that coffee was the major source of caffeine for the research participants.

    Other studies have tried to pinpoint exactly what in caffeine is helping to halt the onset of these diseases. A 2014 study (14) found that caffeine blocks various tau receptors (a protein that contributes to brain cell degeneration). Another study found that caffeinated coffee increased GCSF (15) – a substance greatly decreased in Alzheimer’s patients – levels in the bloodstream.

    #5 Coffee Protects Your Liver

    Aside from being your brain’s best friend, coffee also has an interesting relationship with some of your other, equally vital organs.

    Your liver has benefited from a bromance with coffee ever since they first met. After all, coffee is who your liver calls after a night of drinking, as it has been proven that some of the active ingredients in coffee protect your liver from alcoholic cirrhosis (16).

    The results of the Study found that there was an inverse relationship between regular coffee consumption and the risk of alcoholic cirrhosis – i.e. The more coffee your drink, the less is your risk of alcoholic cirrhosis. (this does not mean you can start binge drinking like its going out of fashion, you fool).

    Coffee reduces liver disease

    The relationship between coffee consumption and liver cirrhosis

    Interestingly, another, similar study, showed that coffee can help protect you against nonalcoholic cirrhosis as well (17) – although the causes of N.A cirrhosis are still unknown.

    The inverse relationship between coffee consumption and cirrhosis only increases with greater coffee consumption, and over long periods of time – say 40 years – your chances of getting cirrhosis decreases by 55%. However, (wags finger) remember what I said about moderation, but more on that later.

    Interestingly enough – this appears to be an exclusive relationship between your liver and some magical effect coffee (not caffeine). The above studies proved that drinking Tea did not have the same protective effects on your liver – meaning the benefits have something to do with something unknown that’s unique to coffee!

    #6 Regular Consumption Reduces the Risk of Cancer

    Not that Alzheimer’s, Dementia and liver disease aren’t big deals, but holy shit coffee can help prevent cancer!

    And not just one or two types of cancers, coffee can help to prevent cancers in many of your body’s vital organs.

    According to the CDC, 8% (or approximately 26 million) US adults were diagnosed with some type of cancer in 2014 (18).

    One study (19) has shown that coffee consumption is linked to reduced risk of bladder, breast, leukemia, prostate, and pancreatic cancers, with an impressive “but wait, there’s more” list.

    Now, let’s dive a little deeper and look at some of the numbers (because, yay numbers!):

    Coffee reduces risk of cancer

    Regular caffeine consumption has been shown to reduce these types of cancers

    • Drinking 1-4 cups of coffee a day can reduce your risk of colorectal (20) cancer by 15%, and drinking 4-6 cup a day can reduce your risk by 26%
    • Drinking 2 cups a day has been associated with a 43% reduced risk of liver(21) cancer
    • Daily coffee consumption has been associated with a 20% reduced risk of endometrial (22) (lady parts) cancer, with that risk decreasing by 7% with each cup
    • Consuming five or more cups of coffee a day has been linked to a 40% decrease in the risk of glioma (23) (brain tumor)

    The above are just the most significant findings, but coffee has been linked, although mildly, to decreased risk of many other types of cancer (which you can see here (24) ).

    For the sake of something real journalists call “integrity” I should point out that coffee has also been shown to have a small, yet positive (which isn’t a good thing in this case) relationship with bladder (25) cancer. However, the same study that reported these finding, also reported that this relationship could also be linked to smoking or other dietary habits.

    #7 Regular Consumption Is Linked to Longer Life Expectancy

    Apart from all the badassery I’ve already mentioned, coffee has been associated with longevity, and decreased overall risk of mortality.

    A study (26) conducted by the Harvard School of Public Health found that drinking one cup a day could lower overall mortality risk by 6%, three cups could reduce risk by 8%, and five cups could reduce risk by 15%.

    In addition to general longevity (as if that wasn’t a big deal itself), coffee has been shown to help prevent a myriad of life threatening diseases. Some I’ve already covered, other’s I will cover later in this article; however, since we are talking about life expectancy here is a quick list of them all:

    Coffee fights disease

    Since the CDC has listed diabetes (27) the 7th largest killer in the good’ol US of A, it is also worth mentioning that coffee can help prevent that as well.

    Although most studies agree that habitual (28) coffee consumption can reduce the risk of type 2 diabetes, the exact percentage is still up for debate. One study reports that drinking three cups a day can reduce your risk by 42% (29), and another study reports that drinking four or more cups a day can reduce risk by only 30% (30).

    However, an analysis (31) of other health studies concluded that each additional cup of coffee contributes to a 7% reduced risk of type 2 diabetes.

    #8 Coffee is a HUGE Source of Antioxidants

    Forget wine, forget fruit, forget vegetables; coffee is probably one of the largest sources of antioxidants in your diet. If you don’t drink coffee, you better get on that, because you just won’t find a better source of antioxidants out there.

    And if you’re looking to find a way to get the freshest taste out of your coffee, consider looking into getting a hand coffee grinder.

    Antioxidants in coffee graph

    As you can see, the level of antioxidants and coffee far surpasses any other source

    It’s no secret that antioxidants are good for you. Antioxidants (32) help to limit a chemical called free radicals, which have been associated with cell degeneration as well as a number of deadly diseases. By increasing the amount of antioxidants in your diet you can limit free radicals in the body, and limit your risk to some of these diseases.

    A study of the typical Spanish diet (33) found that, by far, coffee was the largest contributor of antioxidants, making up for a whopping 66% of the antioxidant intake.

    Other studies have found similar results. One such study compared the antioxidant contribution of coffee to other dietary items, like fruits, vegetables, wine, grains and tea. It was found that coffee contributes (34) over 600% more antioxidants than the next nearest contributor, fruits.

    #9 Coffee Lowers the Risk of Heart Disease and Stroke

    Did I mentioned that coffee can also protect your heart? No? Well, coffee can also protect your heart!

    There has been a myth floating around that coffee can increase the risk of coronary heart disease (CHD).

    However, two (35) studies (36) have debunked this myth, showing that there is no causal relationship between coffee consumption and increased risk of CHD. Another study, besides helping to disprove the myth, has also shown that “habitual moderate coffee drinking was associated with a lower risk (37) of CHD in women.”

    Coffee lowers heart disease graphic

    Long term consumption of coffee has also been shown to reduce, although moderately, the risk of stroke (38). Another study pointed out that drinking about five or six cups of coffee a day is associated with the greatest reduction (39) (36%) in stroke risk, and that coffee also contributes to overall reduction of cardiovascular mortality (a less scary way of saying “heart death”).

    However, that same study does point out that drinking more than six cups of coffee a day can result in a loss of these preventative benefits.

    #10 Black Coffee Can Prevent Tooth Cavities

    Coffee wouldn’t be much of a superhero unless it battled some evil enemy with a weird sounding name. And it does!

    Coffee can help to protect your teeth by ruthlessly destroying something called Streptococcus Mutans (AKA – S. Mutans) which sounds, even more, evil).

    S. Mutans bacteria is a major cause of dental cavities when their growth goes unchecked. They are hence, ‘the bad guys’.

    However, one study (40) has shown that coffee can help to strongly inhibit it’s progress. The study showed that daily coffee consumption can contribute to, at the very least, a 40% reduction.

    Teeth being attacked by bacteria

    Other studies have found similar results, however, they also found that black coffee(41) produced the most desirable preventative results.

    The study pointed out that additives, like sugar or syrup, essentially cancelled out any of the anti-mutans properties of coffee. Which means your dentist will not be impressed when you come strolling in for your appointment, with a venti caramel macchiato in hand.

    #11 The Caffeine Hit from Coffee Improves your Physical Performance

    It is not just your mental performance that coffee stimulates, but also your physical performance. In much the same way coffee wakes up the brain, coffee can also help jump-start your body.

    There have been many studies (42) to show that coffee can enhance overall physical performance.

    Using measures like time to exhaustion, running/cycling performance, the perception of fatigue and cycling power, researchers have found that drinking one to two cups of coffee can benefit performance:

    ACTIVITY

    RESULT OF CAFFEINE ON PERFORMANCE

    Sprinting – Running To Exhaustion 

    No Effect

    Bench Press -Muscular Endurance

    One Rep Weight Increased by 4.4 lbs. (2kg)

    Marathon – 8km Run

    Blood Lactate Levels Higher After 3 Minutes

    Rugby

    Improved Speed, Power & Passing Accuracy. Lower Percieved Fatigue

    Cycling – Endurance

    Time to Exhaustion Increased

    Cycling – Speed and Power

    Improved Speed and Power

    As mentioned in some of the earlier topics, caffeine provides an energy boost by increasing the release of norepinephrine, also known as adrenaline, into the bloodstream.

    This release increases further when caffeine is ingested before exercise (43), which also further increases metabolism, giving the body an even greater jolt of energy.

    Another study (44) has measured ratings of perceived exertion (RPE) during exercise immediately after ingestion of caffeine and found that caffeine contributes to a 5.6% drop in RPE. The same study also reported that caffeine improved exercise performance by 11.2%.

    #12 Reduces Post-Workout Muscle Pain

    Have you ever ‘charged yourself up’ with a coffee before hitting the weights? If so, good news: the benefits of coffee don’t end in the weight room.

    Not only will coffee make your routine exercise worthy of one of those ultra-intense Gatorade commercials, where everything has a strange green tint, but it will also help with the post-workout pain.

    A number of studies – which like to throw around the word “hypoalgesic” – have shown that coffee can reduce the amount of perceived pain (45) and soreness during, and after exercise – in fact, for up to 3 days after exercise! (46)

    source – muscle pain after exercising is consistently lower after caffeine consumption (black bars)

    The same study also shows that the hit from caffeine may actually help you achieve greater physical fitness by allowing you to achieve a higher number of repetitions during your workout – pump that iron, son!

    Maybe you’re wondering now what is really in your cup of coffee that could help curb muscle soreness?

    Maybe you’d like to know how your coffee can, essentially, numb your pain?

    A group of researchers (47) testing isolated protein fragments (peptides) from coffee on mice found that one peptide had similar effects as morphine – and that explains the lack of pain!

    #13 Coffee Improves Blood Circulation

    Here is another one that you’ve already heard: coffee can help improve blood flow.

    But, you probably didn’t know that, until recently, there wasn’t much scientific proof behind this statement, and that much of the research from before actually argues the opposite.

    Let’s start with the opposing view.

    A couple of studies, one already mentioned (48) , have found that caffeine can actually decrease the blood flow to the brain. One of these studies reported that caffeine reduces (49) cerebral blood flow by an average of 27%. Incidentally, this is also the reason the feelings of alertness (and sometimes, anxiety) associated with coffee.

    Brain blood aside, coffee has recently been shown to increase blood flow throughout the rest of the body.

    Coffee and blood flow image

    Increased bodily blood flow leads to the following indirect health benefits

    One study (50) found that coffee can increase blood pressure in non-habitual coffee drinkers, but noted a lack of increase in habitual coffee drinkers.

    Another (51) study, found that specifically coffee, not just caffeine, contributed to a 30% increase in blood flow over a 75 minute period.

    Although the research isn’t exact yet, there is evidence that coffee can increase blood flow to most areas of the body, except the attic.

    #14 Coffee Boosts your Short and Long Term Memory

    None of this extra energy and improved mental performance wouldn’t be much good if your memory couldn’t keep up.

    Fortunately, the coffee gods aren’t that cruel, so they packed in some memory-augmenting power along with all the other good stuff.

    One study has found that coffee improves memory (52) along with attentiveness and awareness. Other studies have found that caffeine can positively impact short-term (53)recall.

    Not only can coffee enhance short-term memory, but it has also been shown to improve long-term memory as well.

    A study from the Johns Hopkins University found that caffeine aides the neural process that commits (54) memories to long-term storage, known as “consolidation.”

    The researchers even made this short video to help explain the study, for all you non-psychologists out there:

    Despite the findings of this Hopkins study, other researchers have reached different conclusions. One such researcher reported (55) that “the ingestion of caffeine does not seem to affect long-term memory.”

    However, the same researcher did note that coffee does seem to impact certain types of memory and recall, mostly related to alertness and passive learning.

    Regardless of these mixed findings, psychology is complicated, and most of the research on caffeine and memory is fairly new, so it should not be too surprising that initial findings are relatively mixed.

    #15 Coffee Reduces Gout in Men

    Last but not least, coffee can help curb the risk of gout. In case you aren’t familiar, gout is a condition in which defective metabolism of uric acid can cause arthritis. In most cases, gout (56) affects the big toe, but can also cause swelling and pain in other joints of the leg.

    A 2007 study (57) found that coffee, not just caffeine, can significantly decrease the risk of gout in men, by lowering levels of uric acid in the body.

    Graph showing gout and relationship with coffee

    The relationship between coffee consumption and gout

    Drinking six or more cups of coffee a day was associated with a 40% decrease in the risk of gout, but, unfortunately, drinking 5 or fewer cups a day yielded less than a 10% reduction in risk.

    Another study, published in 2010, found similar results for women (58).

    The study showed that coffee can help reduce the risk of gout in women, although the impact was more significant than that in men, with 4 cups a day yielding almost a 60% reduced risk.

    Unfortunately, sugar seems to reverse these benefits.

    A study conducted on the relationship between sugar (59) consumption and the risk of gout found a positive link between increased levels of sugar consumption and cases of gout. So, considering this, it’s best to stick with just a black cup and avoid the sugar (once again).

    Incase you’re looking to buy a new coffee grinder for your office or home then you should check this post for more information

     This article was originally posted on Homegrounds.co

     

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    Last week, the National Obesity Forum caused a furore by claiming that eating fat, including saturated fat, will help cut rates of obesity and type 2 diabetes. Public Health England hit back, calling NOF’s advice “irresponsible”.

    There’s wide agreement that modern diets have led to a rise in illnesses such as coronary heart disease and type 2 diabetes. Like most research, the recent controversy focuses on whether specific nutrients are the cause.

    I’m not qualified to decide whether fat is good for you or will help you lose weight. But as a philosopher, and someone who has studied diet and health-related behaviours, I am curious about the question. What we ask determines what sorts of answer make sense. Does it make sense to focus on nutrients such as fat or carbohydrates, for example, or should we reframe the question?

    There are many ways to think about the dietary changes in Western societies over the past century or so. Of course, we can think in terms of nutrients: more sugar, more refined carbohydrates, more animal fats, more oils. Another change is in terms of agriculture and animal husbandry: new fertilisers and pesticides, new ways to feed and breed animals, new ways to hasten their growth. A third sort of change starts with an organisational revolution: large corporations now dominate our food supplies.

    These corporations are armed with factories and laboratories, with brands and trademarks and marketing departments. And they have created a new sort of food: the ultra-processed variety.

    Dutch cabbage for sale
    Why don’t we see cabbages advertised by modern food companies?

    Raw ingredients are reduced to pulps and powders and concentrates and extracts. Chemicals are used to emulsify and enhance flavours (some of these familiar, such as salt, others unknown before modern chemistry). New technologies pound and process and bleach and coat, change liquids into pastes or solids, extract the last scraps from animal carcasses, and “fortify” with vitamins lost in earlier stages of processing.

    We see appealing pictures of farms and crops on the packaging, but we’ve no idea how the products inside came from the baffling lists of ingredients.

    Given these enormous changes, how can we discover which aspects of modern diets are damaging to health? I’ve just sketched out three major changes. But each of them involves many factors. So it is enormously difficult to establish which aspects of modern diets have increased rates of some illnesses.

    This isn’t to say that conventional questions about different nutrients are unanswerable. Some answers are becoming clear: lots of sugar isn’t good for us; trans-fats are definitely bad for us. But just focusing on nutrients is a mistake. In particular, there are good reasons to think that modern food processing itself poses health risks.

    Some of these problems overlap with concerns about specific nutrients. Adding salt, sugar or fat (sometimes all three) is a good way to make cheap ingredients palatable. Processing foods tends to remove the many micronutrients found in whole foods, and crops from modern industrial agriculture tend to be poorer in micronutrients anyhow.

    Some problems overlap with concerns about energy intake. Processed foods tend to contain less water and fibre, so they are more calorie-dense and easier to consume in large quantities.

    Alongside convenience, processed foods are carefully engineered for immediate appeal. They are also marketed with every trick in the book (unlike whole foods). All these factors encourage over-consumption. And then we can add suspicions that some aspects of modern food processing – various additives or “processing aids” or chemicals in packaging – pose health risks of their own.

    Don’t focus on specific nutrients

    Focusing on specific nutrients such as fat or cholesterol has often damaged the reputation of whole foods. Many people limit their consumption of eggs, butter or red meat, for example. Processed food companies are in a better position to defend their products, though. Packaging can easily make or insinuate health claims. Margarine might be made who-knows-how with industrial trans-fats, but it can be formulated to be low in cholesterol to reassure us of its health value. The breakfast cereal might be over a quarter sugar, but the packaging emphasises the fibre or vitamin or iron content.

    No one can see or taste nutrients themselves. To focus on them means trusting labels and mistrusting your senses. Confused, we pick up a low-calorie fizzy drink, then choose a low-fat yoghurt that contains all the sugar we just tried to avoid. When healthy eating guidelines focus on nutrients, we become more susceptible to the processed food and drink industry.

    Claims that “fat won’t make you fat” make headlines. I think they hide a more important idea also hinted at in the new report. On top of modern industrial agriculture, industrial food processing represents the biggest change to human diets since people began farming. Major food and drink companies compete with one another. But as Carlos Monteiro, a professor of nutrition and public health at the University of São Paulo, remarks, “they all have the same overall policy” – promoting ultra-processed foods.

    Instead of asking about specific nutrients, we might also ask whether the rise of processed foods has contributed to the rise in diet-related diseases. And perhaps the best health advice is not to obsess about the latest demon nutrient, but to prepare whole foods for ourselves, adapting the old adage: everything in moderation, especially ultra-processed foods.

    This was first published on the Conversation

    Also, to understand the impact of processed meat on the body, please read the latest information.

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    Alcohol produces externalities – costs that are imposed on others without their consent. For example, drinking is associated with crime and violence, road traffic accidents, costs to the healthcare system and lower economic productivity. Externalities are problematic because they are not reflected in market outcomes: consumers typically only consider the costs and benefits of drinking to themselves, and fail to consider the impact their drinking has on others.

    According to standard economic theory, externalities should be corrected through taxes which raise prices to reflect the social harm of a product. For example, if a pint of beer typically imposes £1 of costs on others, then a tax of £1 should be levied on each pint to reflect this cost.

    The UK Government has estimated the externalities caused by drinking to be £21 billion a year in England and Wales. This number is controversial, but the economists behind it acknowledge that if anything it is an underestimate. In any case, the Government has reaffirmed this £21 billion figure repeatedly in parliament. Yet alcohol duty only raises £9 billion a year, suggesting that the price of alcohol does not adequately reflect the harm it does to society.

    Some people might object that it is only a problem minority that causes social harm, and worry that duty is a blunt instrument, which negatively affects moderate drinkers at the same time. This is debatable, but even if such a distinction can be drawn, the burden is minimal. Moderate drinkers may have to pay more for their alcohol due to duty, but this money allows the government to fund services and cut other taxes. Taxes may also discourage moderate consumers from drinking, and cause them to switch to less enjoyable products. However, our estimate of this loss of enjoyment suggests that it accounts for at most 2 per cent of market value, £1.2 billion, and likely considerably less, under current levels of duty. Besides, it is dwarfed by the reduction of crime, healthcare and economic costs as a result of alcohol duty – which total at least £4.4 billion. All things considered, many – perhaps most – moderate drinkers could benefit from higher alcohol duty.

    A key implication of all this is that higher alcohol taxes can be justified solely on the basis of the harm that drinking causes to wider society. The argument does not depend on the benefits to the individual drinker. Yet such considerations provide additional reasons to raise alcohol duty.

    There are a number of reasons to suspect that many people make poor choices around alcohol and could benefit from higher duty that discourages excess drinking. Alcohol is addictive and psychoactive, and as a result many consumers drink while dependent or intoxicated. Many people are not fully informed of the risks of drinking, or believe that they are immune – for example, only half of people in the UK are aware alcohol causes cancer. People suffer weakness of will – where they are unable to follow through on their reflective desire to cut down drinking. More generally, myriad non-rational influences encourage people to drink, including habit, availability and social influence. Raising the price of alcohol does not reverse all these effects, but can go some way to mitigating excessive overconsumption.

    Taken together, these arguments make for a compelling case in favour of raising alcohol duty. On the Government’s own estimates, current levels of tax fail to account for the social cost of drinking. Raising rates of duty would address this harm without unduly affecting moderate drinkers. Moreover, higher duty would reduce the private costs to individuals resulting from excessive consumption. Come Wednesday, we will learn whether the Government has taken heed.

    This post is based on the Institute of Alcohol Studies report ‘Dereliction of Duty: Are UK alcohol taxes too low?’ Download the full report from the IAS website here.

    First published on the British Politics and Policy blog

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    How do they fit into the public health agenda?

    The growing prevalence of non-communicable diseases (NCDs) is triggering substantial policy concern, evident, for example, in the 2011 UN high level meeting on NCDs. Yet, it’s clear that there are very different ways of thinking about this ‘epidemiological transition’. For some, including the current UK government it seems, the rise in such diseases is viewed primarily as a consequence of the choices that individuals make. In contrast, many of those working in public health understand the problem to be largely a consequence of the strategies that corporations pursue. These different views lead to different conclusions about appropriate and effective responses.

    For those who take the view that the growing NCD burden is a consequence of economic development (via, for example, more sedentary and unhealthy lifestyles), then it’s logical to focus policy responses on trying to inform the choices that individuals make. From this perspective, we can all ‘choose to be healthier’ by doing more exercise, eating healthier foods and avoiding, or limiting, our consumption of health-damaging products such as tobacco and alcohol.  The CEO of Pepsi Co, Indra Nooyi, endorses this viewpoint, arguing that PepsiCo is an ‘ethical’ company because it provides consumers with a choice of products, ranging from healthy to less healthy.

    This emphasis is frequently reinforced in the media through advertising, news stories and television programmes that promote the idea that individuals choose unhealthy lifestyles, and via a focus on individual-level solutions to improve health. From this viewpoint, corporate interests involved in the production and marketing of health damaging products should be ‘part of the debate’, or even ‘part of the solution’ to the emerging health crisis (e.g. via reformulated products, changing labelling and implementing self-regulatory codes).

    Yet, if we turn to tobacco, a sector which has been extensively researched for several decades now, a very different approach is evident. Here, the prevailing view in public health and increasingly in policy, is that the tobacco industry is a primary ‘vector’ of the growing NCD burden. Investigative journalism and research centring on internal tobacco industry documents has made public the extent to which senior managers of tobacco companies have (amongst other things): lied about the addictiveness of nicotine, worked to make their products more addictivetargeted young children as ‘new markets’; and worked to limit tobacco control policies.

    Consequently, the political and public legitimacy of tobacco industry actors has plummeted, triggering some desperate efforts to regain a seat at the policy table. Analysis of a European Union consultation on smokefree legislation has demonstrated that we are now at a stage (at least in the EU) where tobacco industry actors are almost entirely separated from public health policy debates – although the rise of e-cigarettes is beginning to challenge the cohesiveness of the tobacco control movement. In part, this reflects public health efforts to ‘denormalise’ tobacco and routine business practices of the tobacco industry; efforts which have gained particular traction in the UK. The clear differences in perception of the tobacco industry, on the one hand, and the food and alcohol industries on the other, warrant deeper consideration: why are these three industries perceived so differently and is this distinction justified?

    How different are the tobacco, alcohol and processed food industries?

    There are two obvious ways in which it might seem appropriate to distinguish between tobacco, alcohol and food industries. First, we might consider that the harms associated with tobacco products are greater than those associated with alcohol and food. Yet, assessments of the contribution of alcohol and obesity to adverse health outcomes (e.g. adverse pregnancy outcomes) suggests they are often as high as tobacco. Likewise, comparative estimates of the costs of alcohol, tobacco and ultra-processed food often suggest the costs are similar and, in fact, probably higher for food-related problems, such as obesity. So this first rationale seems unconvincing.

    A second reason concerns the behaviour of the industries. It is certainly the case that more is known about the efforts of tobacco companies to misrepresent research and to shape policy in their interest than is known about the efforts of alcohol and food companies. But this is beginning to change. For example, in his book Lethal but Legal Nicholas Freudenberg shows that the practices of these industries in marketing, product design, lobbying, and sowing doubts about evidence of harm are remarkably similar.

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    How different are the processed food and tobacco industries? (Credit: Alan Chan CC BY-SA 2.0)

    These similarities are also evident in research examining alcohol industry efforts to influence policy in the context of minimum unit pricing debates in the UK. Like the tobacco industry, the alcohol industry pursues highly integrated strategies and employs many of the policy-influencing tactics identified within the tobacco industry, including extensive lobbying at all stages of the policy process, the use of thinks tanks and front groups, attempts to shape the scientific content of policy debates, and to influence public perception of their industry and policy proposals. Again, such tactics are evident in work which has compared, for example, how tobacco and soda companies have used corporate social responsibility campaigns to influence the political landscape. In fact, the soda industry goes even further than tobacco in its explicit goals to increase consumption and target children. This suggests that commercial strategies to influence public and policy debates are very similar across industry sector. Hence, the second rationale (different industry behaviour) doesn’t seem valid either.

    Yet, in interviews I have undertaken over the past four years, the view that tobacco represents a radically different case from alcohol and food seems deeply engrained in the way many policy makers, researchers and advocates think. It seems likely that this is at least partly a result of importance attached to individual-level behaviour in neoliberal economies but it may also reflect the success of ‘tobacco exceptionalism’, a core tenant of which is the idea that other industries are different from tobacco and not necessarily worthy of the same, strict rules to protect public health policies from industry interference. This has worked well for tobacco control advocates in the UK so far but may have unintended consequences for other dimensions of public health.

    A new interlinked public health agenda: assessing the role of industry

    If we are serious about tackling the rising burden of NCDs then we need to revisit the popular and persistent distinction between tobacco, alcohol and food industries. From a research perspective, the following five questions seem like a good place to begin better understanding, and perhaps challenging, widely held distinctions between the various industries involved in producing and marketing unhealthy commodities:

    1. What are the interactions between the actors that constitute each of these industries and how close are these connections?
    2. How similar are food and alcohol industry approaches to influencing public, political and policy debates to tobacco? (Since these industries have not had to provide access to their internal documents on the same scale as tobacco, we need to develop innovative methodologies and find new data sources.)
    3. How do members of the public and key policy actors view each industry and their products and why? Does this appear to vary by context or change when presented with different kinds of evidence?
    4. What are the potential policy alternatives that might contribute to achieving healthier future scenarios and how do these differ across alcohol, tobacco and food?
    5. Reflecting this, to what extent can the case study of tobacco control be used to provide lessons for developing and implementing evidence-based policies to promote and protect people’s health beyond tobacco?

    These suggestions are, of course, simply a means of contributing to this emerging debate. What seems essential is that we begin to develop a new research agenda in public health, and policy and politics more broadly, which frees us from our current silo-based view of these interlinked public health problems.

    First published on the British Politics and Policy blog

    These colleagues contributed to the piece: Professor Oliver Razum, Dean of the School of Public Health at Bielefeld University, Germany; Professor Nicholas Freudenberg, City University New York; Dr Lori Dorfman, University of California, Berkeley, Dr Benjamin Hawkins, London School of Hygiene and Tropical Medicine,Dr Shona Hilton and Dr Heide Weishaar, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.

     

     

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    Should the Government Consider a U-turn?

    The public health field is never short of controversies. On 22nd October 2015, Public Health England (PHE) published a report on Sugar Reduction: The Evidence for Action. The report recommends inter alia, an introduction of a sugar tax of between 10% and 20% on high sugar products such as soft drinks (PHE, 2015b). This has sparked endless debates within the academic and public domains. The vociferous debate sustains when subsequently, the government guarantees that there will be no tax imposition on sugary products, whilst insisting that there are other workable alternatives for tackling health issues, particularly obesity, as a result of overconsumption of products with a large amount of sugar.

    Borrowing from the Nudging Theory, tax is seen as a ‘shove’, capable of prevailing the ‘upstream approach’ in public health (policy approach that can affect large populations, such as economic disincentives) through the preventative route (Local Government Association, 2013). This blog post seeks to explore whether the government should reconsider its initial decision not to impose a taxation on sugary products. It will take stock of the evidence that links sugar with obesity, and consider the success of a sugar tax in various countries in addressing the population’s health. It then goes on to explore the power of taxation in changing people’s behaviour and the potential benefit of such a measure on the NHS, before considering whether the tax on sugary products can address the failure of the Public Health Responsibility Dealbetween the government and the food industry.

    Firstly, the evidence linking sugary products and obesity is nearly impossible to ignore. The PHE publication highlights that almost a quarter of all adults, one in ten children aged 4 to 5, and nearly two out of ten children aged 10 to 11 in England are obese, with significant numbers also being overweight. Sugar intakes of all population groups are also above the recommendations. Unsurprisingly, the most disadvantaged sections of society have a higher prevalence of tooth decay and obesity.

    One may ask: Will taxation on sugary products ever work? Evidence from Mexico suggests that following a 10% tax, there was a 6% reduction in the sales of sugary drinks (Instituto Nacional de Salud Pública, 2015). Following such a success, our European Union counterparts including Denmark and Hungary were quick to follow suit (European Commission, 2014), with overwhelming support from Ireland (Irish Heart Foundation, 2014). It will therefore be difficult for the government to maintain its initial reluctance to imposing a fiscal restriction on the products with a high sugar content considering the magnitude of obesity in this country, and the initiative of European allies on the economic control of sugary products.

    Secondly, the fiscal approach presents us with a powerful opportunity to change people’s behaviour towards their sugar consumption. Scholars talk about the obesogenic environment and its causes, which consists of a tangled web of dietary, lifestyle, environmental, and genetic factors. However, rather than seeing its key role in persuading people to alter their sugar intake, the government reasoned that the tax would raise the cost of living, mediated by the aspiration to increase the productivity and economic growth in the food sector (Petitions – UK Government and Parliament, 2015).

    On the surface, the government’s U-turn on the sugar tax is didactic – it should be left to individual choices to make the best decisions with regard to their health, in an attempt to avoid nanny-statism. Nevertheless, this assumption will only work in an ideal world. Some people need support to lead a healthy lifestyle, particularly those who are the most disadvantaged within the society. In this instance, a sugar tax would nudge (or in fact, shove) people into making healthier choices and thus preventing people from having complex health needs at a later stage, in line with the preventative agenda of the government in the health sector.

    The annual cost of obesity is now greater than the cost of treating health problems arising from smoking (Scarborough et al., 2011). Perhaps tellingly, the estimated annual cost of obesity to the NHS is approximately £5bn, and is growing (Public Health England, 2015a). The introduction of a tax on sugary products will ensure that the pricing structure of the sugar-related products is more reflective of the external and wider costs of the substance to society and the health system as a whole. As such, it may also create a ripple effect on tackling other non-communicable diseases such as those caused by poor nutrition, physical inactivity, and alcohol dependency.

    Thirdly, the tax on sugar will overturn the government’s failure on the Government Public Health Responsibility Deal with the food and drink industry (see Gornall, 2015). The core commitment of the Responsibility Deal is to ‘support and enable people to adopt a healthier diet’. However, the Responsibility Deal seems like a temple built on a faulty foundation; it relies upon the goodwill of the industry to keep their pledges and there are no penalties attached for failure to observe the pledges. Positioning the debate within the mainstream media, the celebrity chef, Jamie Oliver, challenged the Prime Minister to ‘act like a parent’ with food manufacturers, as ‘the industry has to be kept in line’ in tackling the rising obesity problem (House of Commons Select Committee, 2015). Here, there is a window of opportunity whereby the tax will empower the industry to take charge and materialise their promises in tackling the rising obesity epidemic in the UK.

    Let us turn back to our initial question. Should the government consider a U-turn on its initial reluctance to impose tax on sugary products? This blog post has argued the affirmative. Clear correlations between sugar and obesity and success stories within and outside of the European Union should prompt the government to reconsider its initial stand. In addition, assistance from the state remains relevant particularly for those who are at a significant health disadvantage, in the name of the preventative agenda. Imposing a tax on sugary products will also reflect the wider costs of obesity on health and the wider environment. At the same time, it has been argued that the imposition of a tax will put the food industry in the driver’s seat to make genuine efforts in combating obesity in this country.

    The taxation route is not a panacea, nor should it be viewed in isolation from other initiatives. Future theoretical and critical debates will benefit from further studies on the impact of a sugar tax on health in the short-term and long-term, and the acceptance of the population towards the tax imposition. This, then, will reinforce the value of taxation in addressing the obesity epidemic in this country.

    First published on the Policy & Politics blog on 17th February 2016.

     

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    Fizzy drink companies should put child-friendly labels on the front of their products spelling out the sugar content in teaspoons, in a bid to beat tooth decay and child obesity. The Local Government Association (LGA), which represents more than 370 councils – with responsibility for public health – says many youngsters and parents are unaware of the high level of sugar in fizzy drinks.

    The call, which comes ahead of the Government’s forthcoming child obesity strategy, follows research that shows some energy and sports drinks have 20 teaspoons of sugar in a 500 ml can – more than three times the daily allowance for adults – while some popular juices and soft drinks contain between five and 15g of sugar per 100ml. A typical can of fizzy drink has around nine teaspoons of sugar.

    As well as being a key driver behind obesity, sugar is also a major cause of tooth decay, with a recent survey finding that 12 per cent of three-year-olds in England suffered from poor dental hygiene.

    Tooth decay was the most common reason for hospital admissions in children aged five to nine in 2012/13. Damning figures also reveal that in the same year, more than 60,000 children under 19 were admitted to hospital for removal of decayed teeth – half of which were aged nine or under.

    Treating obesity and the effects of oral diseases costs the NHS a combined £8.4 billion a year in England.

    With research showing it takes an average of just 15 seconds for shoppers to decide on an item, the LGA is calling for prominent and clearer labels on the front of fizzy drinks – spelling out the sugar content in teaspoons so that all shoppers can see it instantly.

    Youngsters in the UK are the biggest soft drinkers in Europe – with 40 per cent of 11 to 15-year-olds drinking sugary drinks at least once a day. Poland is the second highest at 27 per cent, and Germany third with 18.5 per cent.

    Under-10s get almost a fifth of their sugar intake from soft drinks and for 11 to 18-year-olds, that figure is nearly a third.

    Better labelling of sugar quantities will raise awareness in children of sugar levels, and ensure people are as informed as possible to help them make healthier choices.

    Unless radical action is taken now to tackle obesity, councils are warning that the next 20 years will see the number of obese adults in the country soar by a staggering 73 per cent to 26 million people.

    Cllr Izzi Seccombe, LGA Community Wellbeing spokesperson said :

    “While we acknowledge that many soft drinks manufacturers are heading in the right direction with sugar reduction, the industry as whole needs to go further, faster and show leadership on the issue.

    In many cases, parents and children are unaware of exactly how much sugar these fizzy drinks contain, which is why we are calling on manufacturers to provide clearer, front-of-product labelling that shows how much sugar soft drinks have in teaspoons.

    On average it takes just 15 seconds for shoppers to decide on an item, so we need to have a labelling system which provides an instant at-a-glance understanding of sugar content.

    Raising awareness of sugar quantities and giving families a more informed choice is crucial if we are to make a breakthrough in the fight against tooth decay and obesity.”

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    The Government should make it a requirement for pub, restaurant and cinema chains to spell out calorie content in food and drink, as part of its upcoming child obesity strategy. Chains with more than 20 outlets need to clearly display calorie counts on menus and at counters to give consumers more informed choice, according to the Local Government Association, which represents more than 370 councils.

    Councils, which have responsibility for public health, say that making people more aware of how many calories they are eating and drinking will help beat the nation’s obesity crisis.

    Some retailers have already introduced calorie counts, but others need to step up, says the LGA.

    The call follows a similar initiative in the US, where rules were brought in making it compulsory for chain restaurants, movie theatres and pizza parlours across the country to show calorie information on their menus. A successful calorie count scheme has been running in New York since 2008 and has the backing of the city’s restaurant industry.

    Council leaders want the Government to take bold and brave decisions to tackle child obesity, as part of its strategy. Latest figures show the need to take urgent action, with three and a half million children obese – one in five 10 and 11-year-olds and one in 10 four and five-year-olds. Obesity in children can lead to major health conditions later in life, such as diabetes, cancer and heart disease.

    Cllr Izzi Seccombe, the LGA’s Community Wellbeing spokesperson, said:

    “Pub, restaurant and cinema chains need to be displaying calorie counts so consumers and parents have a more informed choice and a better understanding of how healthy a particular snack, meal or drink is. Food and drink with high calorie content is clearly a factor behind obesity, and the subsequent health problems it can cause. We want the Government to require major retailers to make their customers fully aware of how many calories they are eating or drinking.

    Clear and prominent signs indicating the number of calories in a product should be mandatory. We need to take bold action in changing our environment if we are to beat obesity, and that includes when we’re sitting at a table in a restaurant reading a menu or ordering at the counter.”

    45 companies have signed up to the Public Health Responsibility Deal

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    • New research from Give Up Loving Pop reveals the dangerously high levels of sugar in ‘breakfast drinks’.
    • 18 out of 20 breakfast drinks surveyed contain very high levels of sugar (>13.5g/portion or >11.25g/100ml) contributing to tooth decay, type 2 diabetes, cardiovascular disease and obesity.
    • Products such as Fuel 10k’s Chocolate Breakfast Milk Drink are slipping under the radar despite containing only three grams of sugar less than a standard can of Coca-Cola.
    • The ‘breakfast in a bottle’ concept- which includes products such as Fuel 10k, Weetabix On The Go and Up&Go- is challenging the existing breakfast market, and has rapidly grown from nothing to £13m in three years.
    • Breakfast is fast becoming an inconvenience in the UK; last year, Brits consumed breakfast on the go an estimated 205 million times, up 13% on the previous year, and more food-to-go solutions are expected.

    Gulp logo

    New research from the Give Up Loving Pop (Gulp) campaign has revealed the extremely high levels of sugar in ‘breakfast drinks’; a new, fast-growing product category of drinks that have recently arrived in the UK.

    Following the Scientific Advisory Committee on Nutrition’s report on Carbohydrates and Health this summer, which suggested slashing our sugar intake by half, and vocal concerns about sugar from food campaigner, Jamie Oliver, breakfast drinks represent a new example of ‘stealthy sugars’.

    Whilst the public are aware of the high sugar content of many popular soft drinks, and with the government facing calls to introduce a tax to reduce their consumption, research from the Give Up Loving Pop campaign reveals a new generation of breakfast drinks whose high sugar content is flying under the radar.

    Stroll down the breakfast aisle in your local supermarket and you may not realise that breakfast drinks such as ‘Weetabix On The Go: Chocolate’ contain as much as 25g of sugar per serving (6 teaspoons). Similar offenders include the Up&Go Strawberry breakfast drink packed with 18.5g of sugar per serving (5 teaspoons). Demand for ‘breakfast in a bottle’ is growing rapidly creating a market worth £13million in less than three years.

    With the UK’s growing obesity problem seeing no signs of slowing, public health campaigners are worried that the rise of breakfast drinks will draw the public away from healthier breakfast options and toward the consumption of breakfast drinks, that the research reveals, are often little better than Coca-Cola.

    Robin Ireland, Director of the Give Up Loving Pop campaign, comments:

    “Breakfast should be the most important meal of the day, but with these ‘breakfast in a bottle’ drinks we’re seeing yet another avenue for sugar to infiltrate our daily diets. Our research reveals that the food and drink industry is still finding new and innovative ways to stealthily pack sugar into every meal of the day.”

    “It’s becoming increasingly difficult to anticipate where sugar will turn up next in food and drinks.”

    “With the nation struggling with bulging waistlines, the last thing we need are more stealthy sugars in our food and drinks. Recent scientific recommendations suggest that we should limit our consumption to 25-35g of sugar per day at most. We stand little chance of meeting these recommendations when people are likely to be drinking breakfast drinks not knowing that they sometimes contain as much as 32g of sugar per serving, just 3g of sugar less than a can of Coca-Cola!”

    “You would assume that breakfast in a bottle would be the healthy option in the morning; but with some of these breakfast drinks you are almost drinking as much sugar as a can of coke.”

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    Public Health England’s report ‘Sugar Reduction: the Evidence for Action‘ has, rather unexpectedly been released.

    The report sets out a range of tough policies that need to be taken to reduce the consumption of sugary foods and drinks that are fuelling the obesity crisis.

    The report makes eight key recommendations:

    1. Reduce and rebalance the number and type of price promotions in all retail outlets including supermarkets and convenience stores and the out-of-home sector (including restaurants, cafes and takeaways).
    2. Significantly reduce opportunities to market and advertise high-sugar food and drink products to children and adults across all media including digital platforms and through sponsorship.
    3. The setting of a clear definition for high-sugar foods to aid with actions 1 and 2. Currently the only regulatory framework for doing this is via the Ofcom nutrient profiling model which would benefit from being reviewed and strengthened.
    4. Introduction of a broad, structured and transparently monitored programme of gradual sugar reduction in everyday food and drink products combined with reductions in portion size.
    5. Introduction of a price increase of a minimum of 10% to 20% on high-sugar products through the use of a tax or levy such as on full-sugar soft drinks, based on the emerging evidence of the impact of such measures in other countries.
    6. Adopt, implement and monitor the government buying standards for food and catering services across the public sector, including national and local government and the NHS to ensure the provision and sale of healthier food and drinks in hospitals, leisure centres etc.
    7. Ensure that accredited training in diet and health is routinely delivered to all of those who have opportunities to influence food choices in the catering, fitness and leisure sectors and others within local authorities.
    8. Continue to raise awareness of concerns around sugar levels in the diet to the public as well as health professionals, employers, the food industry etc encourage action to reduce intakes and provide practical steps to help people lower their own and their families sugar intake.

    Robin Ireland, Director of Food Active has welcomed the report which broadly supports what public health campaigners have been calling for:

    “This report is warmly welcomed by the Food Active team and sees several of our campaigning priorities outlined as direct recommendations to government. I’m pleased that our advocacy efforts over the past 12 months through Food Active and the Give Up Loving Pop campaign are supported by Public Health England’s report.”

    “The recommendations within the report could put a major dent in the UK’s growing obesity problem; as long as they are implemented.”

    “With this report now out in the public domain it is vital that the Government steps-up and takes these recommendations into account when producing the forthcoming Childhood Obesity Strategy. Although, slightly worryingly, we have been informed that the publication of this has been delayed until the New Year.”

    “We have the evidence, we now need the action.”

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    Clare Bambra and Ted Schrecker

     A 2010 editorial in the Journal of the American Medical Association warned: “If left unchecked, overweight and obesity have the potential to rival smoking as a public health problem, potentially reversing the net benefit that declining smoking rates have had on the US population over the last 50 years”.  Obesity increases the risk of developing cardiovascular disease (CVD), certain types of cancer, Type 2 diabetes, and orthopaedic problems. At the end of the 1970s it was estimated that 15% of US adults were obese.  By 2012, this had more than doubled, to 35%.  Among adolescents the increase is even more striking – from 5% at the end of the 1970s to 20% in 2012.  In the UK, it is estimated that obesity nearly tripled between 1980 and 2002, from 6% amongst men and 8% amongst women to 23% and 25% respectively.  Amongst children in England, obesity has increased from 11% among boys and 12% among girls in 1995 to around 20% today.

    In our new book Neoliberal Epidemics: How Politics Makes Us Sick (published this month by Palgrave Macmillan) we argue that obesity in high–income countries is partly the result of political and economic choices made since the 1980s. Since the early 1980s, neoliberalism or “market fundamentalism” has dominated politics and economics across much of the globe. In the UK, this is most associated with Thatcherism. Obesity is a neoliberal epidemic – one of four, along with austerity, stress, and inequality. They are neoliberal because they are associated with or exacerbated by the rise of neoliberal politics. They are epidemics because they are on such an international scale and have been transmitted so quickly across time and space that if they were a biological contagion they would be seen as of epidemic proportions.

    Other high-income countries have also experienced increases in obesity. Obesity has no single cause; the many influences include changes in the food environment (including advertising, marketing, accessibility and affordability); the growth of sedentary work occupations and leisure time activity, such as television viewing; changing transport patterns, notably the rise of driving rather than walking; and changes in the built environment. However, countries that have gone farthest down the neoliberal road, the UK and the US in particular, have experienced greater increases in obesity – suggesting that neoliberalism has magnified and accelerated trends that are present to some extent throughout the high-income world.

    Overweight and obesity are now also rising rapidly in many middle- and some low-income countries, with prevalence in Mexican adults comparable to levels in the United States.  We argue that obesity is a neoliberal epidemic for several reasons.  These include: (1)  economic and social policies that have meant fewer people  can afford a healthy and balanced diet; (2) increasing time poverty, as when the demands of work (often on unpredictable schedules), transportation, and (especially for women) child care within ‘flexible’  labour markets are combined, there is not much time or energy left for eating a healthy diet; (3) the role of aggressive corporate marketing of unhealthy, energy-dense foods, notably as multi-national supermarkets, manufacturers of ultra-processed food and fast food chains expand into developing economies with the lowering of barriers to foreign investment. A fourth connection is political structures, more specifically, higher levels of economic insecurity (a neoliberal epidemic in itself) – associated with neoliberal policies like the rollback of welfare state protections and opening up labour markets to the “creative destruction” that Joseph Schumpeter extolled as a defining virtue of capitalism – are causally linked with a higher prevalence of obesity through both biological (stress-related) and psychosocial (‘comfort eating’) mechanisms, in addition to the more direct effects on time and food budgets.

    Public health researchers who agree on little else recognize that reducing overweight and obesity is a formidable challenge. We have no easy solutions, but show that neoliberalism has exacerbated the obesity crisis. If different political choices had been made, fewer of us would be fat. Obesity is an example of how politics makes us sick.

    Links: Schrecker, T. and Bambra, C. (2015) Neoliberal Epidemics: How Politics Makes Us Sick, Palgrave Macmillan, available at: http://www.palgrave.com/page/detail/how-politics-makes-us-sick-ted-schrecker/?K=9781137463098

    About the authors

    In June 2013, Ted Schrecker moved from Canada to take up a position as Professor of Global Health Policy, Centre for Public Policy and Health, Durham University (UK). Since 2002, most of his research has focused on the implications of globalization for health; he also has long-standing interest in issues at the interface of science, ethics, law and public policy. A political scientist by background, Ted worked as a legislative researcher and consultant for many years before coming to the academic world, and co-edits the Journal of Public Health. Among his publications, he is editor of the Ashgate Research Companion to the Globalization of Health (2012) and co-editor of a four-volume collection of key sources in Global Health for the Sage Library of Health and Social Welfare (2011). Ted can be followed on Twitter @ProfGlobHealth.

    Clare Bambra PhD is Professor of Public Health Geography and Director of the Centre for Health and Inequalities Research, Durham University (UK). Her research focuses on the health effects of labour markets, health and welfare systems, as well as the role of public policies to reduce health inequalities. She has published extensively in the field of health inequalities including a book on Work, Worklessness and the Political Economy of Health (Oxford University Press, 2011). She contributed to the Marmot Reviews of Health Inequalities in England (2010) and Europe (2013); the US National Research Council Report on US Health in International Perspective (2013); a UK Parliamentary Labour Party Inquiry into international health systems (2013), as well as the Public Health England commissioned report on the health equity in the North of England: Due North (2014). She is a member of the British Labour Party and can be followed on Twitter @ProfBambra.

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    Start Well, Live Better is the Faculty of Public Health’s manifesto for improving the public’s health during the next parliament. A child born today is very much more likely to live to be 100 than at any time in the past so we see our manifesto as a charter for the health and the future of those who can’t yet vote.

    Whoever forms the next government, we want them to take up our demands: to give every child a good start in life; to introduce good laws to prevent bad health and save lives; to help people live healthier lives and to take national action to prevent global problems.

    The good laws we call for are standardised cigarette packs, a minimum unit price for alcohol, a sugar tax, controls on the marketing of high sugar, high fat, high salt foods to children and a national 20mph speed limit in built-up areas. We believe that national government action is necessary to enable health to improve and it should not have to wait until everything else has been tried.

    Local government is shackled in its efforts to tackle the obesity epidemic and control alcohol-related violence and ill health, because governments have failed to implement good laws to help the sector. There is long history of local action preceding national legislation for the public’s health in this country. The first Public Health Act of 1848 came in only a year after the first wave of cholera but it was still six years after Chadwick’s sanitary report. It would then be 27 years before the second Public Health Act gave real and coherent powers to require clean water and sanitation, reduce shoddy housing and require the appointment of a medical officer and sanitary inspector. Many councils, notably Liverpool, Leicester and the London boroughs, were on the case 30 years before that 1875 Public Health Act and had implemented local nuisance control laws of their own. More recently, Liverpool’s threat to implement a public smoking ban in 2004, and Greater Manchester’s high-profile proposal to introduce a minimum unit price on alcohol in 2010 gave stimulus to national policy debate. On the smoking ban, some might say the government was shaken or shamed into action. The prime minister supported Manchester on the minimum unit price but failed to follow up. Many types of council are now looking at local minimum unit price policies.

    Traditionally national politicians seem to exhaust all other possibilities before having recourse to law making. The 20-year waits for seatbelt legislation and for the public smoking ban hide a catalogue of premature death and disability which should have been a cause of national shame. The illusory defence of individual freedoms and individual responsibilities has deflected blame from politicians who have failed to protect and improve the public’s health.

    Politicians, to their credit, have finally moved to standardise cigarette packs. Buoyed by this, a minimum unit price for alcohol should follow in the first 100 days of the next parliament. A tax on sugar-sweetened drinks would reduce the number of obese adults by 180,000. Controls on the marketing of processed food to children would arrest the continuing rise of obesity in year 11 children and adults. These changes would give councils a fighting chance in obesity prevention and reduction through active transport policies and healthy town planning and through weight management services. For any local authority, there will be more child death audits involving road accidents than there are other children’s safeguarding issues; 20mph residential zones can be done by local authorities, so why aren’t they?

    We need a national standard through law. Cicero put it best: “The health of the people is the highest law.” We quote it freely and it appears in our manifesto. His words engraved are on a plaque above a health centre built by Southwark LBC in 1937 under the last Poor Law, and should be ingrained in every policy and every action taken by councils.

    The Faculty of Public Health believes councils are fighting with one hand tied behind their backs on public health. Protecting the public’s health should be a partnership; good national laws should complement the local action councils are taking to secure a better future for all our citizens.

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