Tuesday, 26 January 2016

Should Nanny be in charge of the tuck-shop (and off-licence)?

Guest post by John Mooney, senior lecturer in Public Health at Sunderland University

Aside from inclement weather and beautiful coastlines, there are a number of more worrying close parallels which the North East of England shares with my native Scotland. Most notable among these are an embedded culture of heavy drinking and an ongoing aversion for substantive proportions of both populations to fresh fruit and vegetables, alongside a fondness for fried and fast food.

The unfortunate consequences of these ‘’lifestyle choices” speak for themselves in the league tables for obesity across the life-course and in the statistics for alcohol related liver disease mortality, where only Scotland has higher rates than the North East. Despite good evidence that parts of Scotland, notably Greater Glasgow and West Central Scotland, have a more significant health burden than comparable areas in England (the widely publicised ‘Glasgow Effect’), there is no room for complacency in the North East, as front-line public health teams know only too well (especially since much of Scotland's culinary delights, including Tunnock's teacakes, are readily available in most major grocery retailers).

Is Scotland ready for a Tunnock’s tea-cake tax?

As an embedded researcher in Sunderland City Council where I work one day a week with the public health team, I have the dubious privilege of being immersed in the reality of what this means for those engaged in efforts to improve population health in the region. Specifically, there is the ever present tension arising from the contrast between the current consensus about what types of intervention might work best, alongside the reality and constraints that can frustrate their implementation. Flipping back to North of the border, Scotland’s best example of that practical tension has to be the ongoing legal machinations of the European Courts, dealing with industry raised legal challenges to alcohol minimum unit pricing.

My own previous experience during a career development fellowship at the Scottish Collaboration for Public Health Research and Policy (SCPHRP), gave me a small taste of comparable “practicality constraints” when our review of the international evidence around obesity prevention highlighted that a sugared-drinks tax would be the most promising and cost effective intervention at a national level. The commonly used slang for all fizzy drinks in Scotland (due to the popularity of a certain rustic coloured tipple) of ‘bottles of ginger’ led the Scottish Daily Mail to pronounce on its front page: “Nanny State Researchers propose a Ginger Tax!”. It’s only fair to say that SCPHRP Director, Prof John Frank’s subsequent telephone conversation with the then Treasury Secretary, Danny Alexander was particularly tense!

The all pervasiveness of the term “nanny state” in relation to public health interventions was recently brought home with a colleague’s recollection of her eight year old daughter’s reaction to school tuck shop restrictions: “I don’t want to be living in a <>~^+*!! nanny state”. It was very much in evidence also with the Chief Medical Officer’s festive cheer about there being no safe minimum level of alcohol consumption in relation to cancer risk. No surprises for guessing how that particular advice was received by New Year revellers in Scotland.

While public health “nudge” messages are often ridiculed as nanny state interventions, what is often forgotten in relation to dietary or behavioural advice is that these “nudge messages”, whether around availability, affordability, or portion (glass size/ strength of beverages), have all been incrementally (and imperceptibly) ratcheted up in the other direction over preceding decades. This could equally apply to the added sugar content of processed food and drink or the cultural normalisation of everyday drinking.

This should not however be a council of despair for public health practitioners and policy makers across the board. Smoking was once thoroughly normalised behaviour in all public and workplace environments. The legal challenges to alcohol minimum unit pricing, the most effective intervention at reducing excessive consumption based on solid international evidence, are steadily being chipped away in my native Scotland and perhaps “a ginger tax” for the whole of the UK might not be far away. Especially now Jamie Oliver has taken up the mantle of the sugared drinks tax debate and NHS Chief (Simon Stevens) seems, as of last week, to be fully on board – for NHS premises at least. Although I dread the reaction of my colleague’s politically savvy eight year old when she finds out!


John Mooney FFPH is senior lecturer in Public Health at The University of Sunderland and spends one day per week with the public health team at Sunderland City Council.

He will be presenting at Teesside University’s Health and Social Care Institute lunchtime meeting in a talk entitled: Is Scotland Ready for a Tunnock’s Tea-cake Tax and other public health conundrums? On Wednesday 27 January 12.30 – 2pm in C2.22, Constantine Building, Middlesbrough.

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