Senedd busts a gut

(Pic : oeko-travel.org)

We're all living longer, but that doesn't necessarily mean we're any healthier. We also all know that obesity and lack of regular exercise are two of the most significant public health crises facing Wales.

There's no single root cause and no single solution. The one thing that can be said is that – like many public health issues – it comes down to changing behaviour.

There was a members debate in October on the benefits of walking and cycling (Senedd rallies to get Wales moving). This is a sequel, but with greater emphasis on the public health impacts of sedentary lifestyles.

The motion called for the Assembly to note that:

• Obesity continue to rise and is more prevalent amongst poorer communities.
• Changing eating habits is difficult and down to the availability and affordability of good food as well as general cooking skills.
• The Active Travel Act 2013 is yet to make an impact on levels of walking and cycling.
• Declines in smoking have come about through education and government action. A combination of education, legislation and public procurement changes are needed to address the growing public health problem.

Jenny Rathbone AM (Lab, Cardiff Central) started off with the stark statistic that one quarter of Welsh adults are obese and 60% overweight (clip). The consequences are serious, like diabetes, cardiovascular disease and cancers. Also, the difference in life expectancy between rich and poor is 9-to-11 years, most of which is "completely avoidable".

Less than a third of adults eat five or more portions of fruit and vegetables a day, while just 1% of food advertising promotes vegetables. Despite schemes like Appetite for Life, Wales has amongst the worst child obesity rates in the UK. Three measures Jenny highlighted that could bring about change include: restrictions on marketing (which is non-devolved), promoting healthy eating in schools and using taxes to change behaviour.

Jenny cited a scheme in Flintshire where children order school meals at registration. This eliminates waste by letting caterers know exactly how much to prepare, with seasonal products promoted – no other local authority has followed Flintshire's lead.

Around the world, France has introduced a tax on sugary drinks, Finland and Mexico have put taxes on sweets, sugary drinks and similar things like ice cream. In Hungary, they apply a public health tax to certain products, with consumers subsequently choosing cheaper or healthier alternatives and food manufactures reformulating their products to avoid taxation.

Plaid Cymru health spokesperson, Rhun ap Iorwerth AM (Plaid, Ynys Môn), said it was no overstatement that obesity is one of greatest health challenges of our age, but the tide isn't turning in the same way as smoking and alcohol where young people are now less likely to take them up (clip). Childhood obesity is worse now than it was a few years ago, and Rhun was saddened Anglesey has one of worst levels of childhood obesity, with a third of 5 year olds overweight or obese.

Tackling obesity needs the same commitment and resources as tackling smoking. Heavy taxation and advertising bans cut smoking rates, but tackling obesity makes that look easy. That's because the health impacts of obesity are not automatically understood as there's no single source, and foods only become harmful when over-consumed. There's no level of support to the obese similar to that provided for smokers, while governments still make decisions that contribute to unhealthy lifestyles like car-centric town and city planning.

Vikki Howells AM (Lab, Cynon Valley) highlighted issues in disadvantaged areas. 63% of adults in Rhondda Cynon Taf were either overweight or obese, and obesity is expected to cost the Welsh NHS £465million and the wider economy £2.4billion by 2050 (clip). Also, only 1 in 3 children meet physical activity guidelines (see also - Fat of the Land : More work needed on childhood obesity). Policies like free swimming promote exercise, while Change4Life promotes health eating in schools. Cwm Taf health board are also providing obese pregnant women with specialist ante-natal services to prevent weight gain during and after pregnancy.

Vikki was disappointed the UK Government watered down proposals on sugar and unhealthy food advertising, particularly as unhealthy food remains cheap and accessible. Welsh children also suffer from a "nature deficit disorder" where they have weaker attachment to the outdoors than children elsewhere in the UK; dealing with this can encourage them to take more exercise.

Dai Lloyd AM (Plaid, South Wales West) believed it was important not to just talk about this but get to grips with it (clip). As a doctor he's dealt with problems stemming from obesity, seeing the solution as combination of healthy eating, stricter portion sizes and increasing breast-feeding (see also: Life, Ethics & Independence XI : Breastfeeding) to give babies a good start in life - research shows it decreases obesity.

Nobody has to go to extremes on personal fitness, it's as simple as walking as much as possible; this "natural fitness" can't be replicated by prescription medicines. Dai talked up legislative measures, which have successfully reduced smoking and can change the way society thinks about an issue.

John Griffiths AM (Lab, Newport East) said it's also important to have strong local examples in what can be done to meet the challenges so good practice is spread out (clip). Newport holds "physical activity summits" with key partners. He also praised a local Park Run scheme, where hundreds of people take part every week, with agreement to hold a second meeting. John hoped physical literacy will be driven forward in schools to embed good habits in young people that stay with them for life (see also: Should PE be a compulsory subject?).

Gareth Bennett AM (UKIP, South Wales Central) said levels of walking and cycling haven't shown much improvement since the Active Travel Act, with an actual decline in walking to school (clip). He asked whether the Welsh Government could offer financial incentives to encourage walking to school and outdoor activities? They could also support leisure centres, who through outsourcing may increase prices and entrance fees. He criticised the lack of targets to boost active travel in the Future Generations Act, and questioned how cyclists and walking will be integrated into the South Wales Metro.

Long distance cycle paths -  welcome though they are - do little
to encourage "everyday" physical activity.
(Pic : Visit Wales)

Julie Morgan AM (Lab, Cardiff North) was proud of the Active Travel Act, but it has to be used at every opportunity (clip). A message needs to go out that people can help develop safe walking and cycling routes that are useful to them. However, health habits need to start young – whether breast-feeding or ante-natal support – and Sustrans are targeting young mothers and mothers-to-be, as there's evidence that if parents walk or cycle, their children will too.

Julie also focused on poverty. For both boys and girls aged 2-15, there's a greater prevalence of obesity in lower-income groups. Nutrient-dense foods are more expensive and lower-income consumers have lower protein, iron, oily fish and vitamin intake.

Lee Waters AM (Lab, Llanelli) endorsed John Griffith's praise for Park Run, being enthused by the support of volunteers – many of whom wouldn't do any exercise if the scheme didn't exist, making the £6,000 investment in getting Park Runs off the ground a "no-brainer" (clip).

The Active Travel Act "shouldn't be a tick-box exercise", but is a huge opportunity to get people who take little or no exercise to do some as part of their everyday routine; leisure centres and gyms are ineffective with such groups. Most car journeys are under 1 mile and these journeys need to be done by foot or by bike.

He said AMs had a cognitive dissonance in saying they want to do something on public health, but being inconsistent in how they apply it. He cited support for free parking in town centres as, despite AMs wanting to increase active travel, the policy encourages car travel. He also had guarded criticism for Carmarthenshire Council for focusing development of long-distance cycling/walking routes for tourists at the expense of utilitarian point-to-point urban routes in Llanelli.

Minister for Public Health & Social Services, Rebecca Evans (Lab, Gower), said that while the Welsh Government were doing more to create the circumstances for people to make healthy choices they can't do it alone (clip).

The Change4Life programme will be complemented by Public Health Wales training health staff to offer brief, helpful advice on lifestyle changes. At a UK level, we need restrictions on advertising of high fat, sugar and salt foods – particularly to children. She supports the UK's sugary drinks levy but would like to see progress, citing the voluntary salt reduction with food producers scheme, which has resulted in salt levels falling by 50% since 2012. Procurement criteria will factor in nutrition – something already being done in the NHS and set to expand across the public sector.

In terms of active travel, there's a commitment to work with schools to develop walk-to-school schemes and fund cycling and walking training. Local authorities are also currently working on their integrated active travel maps under the Act.

Over 80% of the adults are non-smokers for the first time since records began, and this has been achieved through preventing uptake amongst the young and helping people quit. The recently-introduced Public Health Bill includes "strong" measures on smoking, while there's a target to reduce the percentage of the population who smoke population to 16% by 2020.

In summing up, Conservative health spokesperson, Angela Burns AM (Con, Carms. W. & S. Pembs.), said the Minister could do one thing today without a grand strategy (clip): increase the amount of time dedicated to sport in schools (which has consistently declined over the decade) and be more creative in defining "physical activity" – girls may be more body conscious and dislike team sports, for example.

It was also all well and good taking part in Park Runs or going to a gym surrounded by "Lycra-clad bunnies" – but the large group of people who are overweight need to feel less embarrassed and out of place when attempts are made to "bring them in", as their body image may put them off exercise in the first place.

The motion was unanimously approved.

Guts up!

It was always going to be difficult to cover so many points in a limited amount
of time, but cooking lessons were broadly overlooked in the debate.
(Pic : Barry Comprehensive School)

I'm not going to spend too much time on commentary as I've written a lot about this in the past and I intend to look at junk food (with a view towards independence) in January, so I'll be coming back to some of the issues raised yesterday, particularly tax.

The only area in the motion that AMs didn't really address was cooking lessons. There's always a risk that, by trying to create a "literacy" for what are basic life skills, school timetables will be full to bursting - but I'd expect the argument for "food literacy" to rumble on ahead of the new curriculum.

Points made by Lee Waters and Angela Burns are worth picking up on. Firstly, there really is too much emphasis on long-distance walking and cycling routes aimed at tourists than those within and between urban areas (though hopefully the integrated travel maps will help there). Having a nice, scenic bike ride, walk or run along an old railway line is fine, but people need to walk from school, shops and work – not just in their leisure time - or the whole thing's pointless.

It's often the easiest option for local authorities because longer-distance routes are often much easier to engineer; for example, they won't interfere with road traffic as much and don't require large number of drop kerbs or other safety features. So you might end up with a high quality route between, for argument's sake, Pontypridd and Cardiff - but as soon as you get to Cardiff and stray too far from the Taff Trail things get more difficult to engineer and this in turn will put casual cyclists and walkers off, maintaining the cycle of car dependence.

Secondly, Angela Burns was right to say that as the majority of the adult population are now overweight or obese, the hectoring we've seen with smoking probably isn't going to work. The approach need to be subtle and needs to match what individuals want or would feel comfortable with. For example, women-only gyms staffed by women personal trainers, a wider variety of sports offered in schools (as said) and harder-nosed measures like banning secondary school pupils from leaving premises at lunchtime (whilst simultaneously offering nutritonally balanced options for them; ideally with their input).