The next item on our agenda is the debate by individual Members under Standing Order 11.21. I call on Jenny Rathbone to move the motion.

Motion NDM6144 Jenny Rathbone, Rhun ap Iorwerth, Vikki Howells, Angela Burns, Dai Lloyd

To propose that the National Assembly for Wales:

Notes that

a) levels of obesity across Wales continue to rise and obesity is more prevalent amongst poorer communities;

b) changing people’s eating habits is complicated and involves a combination of good food availability, affordability and cookery skills;

c) the Active Travel (Wales) Act 2013 has yet to impact significantly on the amount of exercise people undertake;

d) declining rates of smoking have only been achieved through decades of education and tough government action, and took place against the tobacco industry’s efforts to deny the science and block government action; and

e) a combination of education, legislation and public procurement is required to tackle a growing public health problem.

Motion moved.

Diolch, Lywydd. One quarter of the adult population in Wales is obese, and nearly 60 per cent are overweight: a combination of too much alcohol, too little exercise and too much food laden with fat, sugar and salt. The consequences are serious in terms of diabetes, cardiovascular disease and many cancers. These three conditions are the overwhelming causes of early death and they threaten to undermine and indeed reverse whatever advances are made in medical treatment of life-threatening diseases.

The chief medical officer’s latest annual report highlights that whilst the rich are getting healthier and living longer, the poor are not. The life expectancy gap is already as much as nine to 11 years between different areas of Cardiff alone. This is unfair, avoidable and something we should be no longer prepared to accept or tolerate. We need urgent and decisive action to tackle this health epidemic, which will otherwise bankrupt the NHS. Across the UK, it already costs the NHS £5 billion a year, and that’s projected to double to nearly £10 billion by 2050. And the wider cost to society will reach £50 billion a year.

So, despite the five-a-day campaign, our vegetable consumption is in decline—no better than it was in the 1970s. Less than a third of all adults reported eating five or more portions of fruit and vegetables a day. People are simply not heeding what we’re telling them, and only 1 per cent of food advertising is spent on promoting vegetables.

The Deputy Presiding Officer (Ann Jones) took the Chair.

We’re in the grips of an obesogenic culture and we need to act now. Treating people wo have life-threatening levels of obesity is extremely difficult and complex. We must focus on prevention. And unfortunately and tragically, this is not just an adult disease. Over a quarter of our four and five-year-olds in Wales are overweight or obese, and that compares badly with 22 per cent in England. In the most deprived areas of Wales, that rises to over 28 per cent.

So, despite Appetite for Life, despite the Healthy Eating in Schools (Wales) Measure 2009, Wales still has the worst rate of child obesity in the UK. Awareness raising alone hasn’t worked. Greater action on several fronts is required, across all levels of Government. We cannot go on like this.

So, Public Health Wales, in ‘Making a Difference’, says there are three things we could do: first, we could restrict the marketing of unhealthy food, which is not a devolved matter and therefore not something we probably need to ponder on here; secondly, promote healthy eating in schools; and, thirdly, use taxes to get the message across.

‘Appetite for Life’ was introduced in 2008, and became compulsory in 2013. It got rid of the sale of fizzy drinks and sweets from vending machines, but I’m not convinced that it has produced the life change, and system change, that is required in all our schools. It’s fine as far as it goes, but it does not go far enough. How many school governors are aware that they are responsible for ensuring that the mandatory Healthy Eating in Schools (Wales) Measure 2009 is being observed? How would they go about knowing where the ingredients had come from, and what was in them? I’ve yet to see any training on this provided by my local authority, as a school governor.

At the end of last month, I visited Cornist Park School in Flint. There, they have doubled the number of school meals taken since they adopted the Food for Life charter mark, established by the Soil Association. Children order their meal at registration every day, so they choose what they’re going to eat, and are guaranteed to get it. As catering staff know exactly how many portions they have to cook for, that eliminates virtually all food waste. The menu of six dishes to choose from is supplemented by a salad bar, which is actively promoted by staff. There are carrot and cucumber sticks in little bowls on the table, which pupils can help themselves to. At least 75 per cent of the menu of six options is freshly prepared from unprocessed ingredients. Seasonal products are promoted, and many children report that lunch is the highlight of their day.

The headteacher says that the kitchen is at the heart of her school. Complementing the actual meals, the school uses food education as part of the curriculum, and pupils and their families are involved in improving the school lunch experience. At least once a year, the community is invited for lunch, helping to promote healthy eating at home, as well as at school. All of Flintshire’s 73 schools have adopted the entry-level food for catering mark back in 2002. The catering manager assured me that it is no more expensive than meeting the healthy eating in schools Measure, you just have to be a bit more careful as to where the food comes from, and why wouldn’t we want to do that, when we’re dealing with children?

The cabinet member for education says,

‘We want our parents to have confidence in the service, and this demonstrates to them our commitment to their children’s lunch time experience.’

Why is it that other local authorities have not followed Flintshire’s example? The north Wales consortium of LEAs all thought it was a good idea back in 2012, but none have followed Flintshire’s lead, nor has any other local authority across Wales. Yet, across the UK, 1.6 million meals are served every day in education and healthcare settings that meet the Food for Life criteria, including our very own canteen. Over half our universities have a Food for Life award. Why would we not want the same for all of Wales’s pupils?

There is an opportunity here for food producers too because Flintshire only has the bronze level of accreditation and, in order to get the silver and gold award, they’d need to be able to source more organic suppliers who can deliver within the price range and with the reliability that LEAs require. So, it’s encouraging to note that Organic Centre Wales has been working with the Flintshire school meals service to deliver a range of activities, including training for school cooks, farm visits, gardening support, and school-yard farm markets. So, the catering mark offers incentives for caterers to use more local produce, which would help to keep supply and demand for Welsh produce within Wales, reaping the benefits of having our own national food procurement service.

Secondly, I want to look at what we could be doing to tax what is bad for us. Finland, France, Hungary and Mexico have all started to do this. In France, a tax on sugar and artificially sweetened beverages—presumably similar to what the UK Government proposes—as well as, in Finland, a tax on sweets, ice cream and soft drinks, have already shown some benefits. But, in Hungary, they’ve gone even further. Since 2011, they have a public health product tax on sugar, sweetened drinks, confectionary, salted snacks, condiments and flavoured alcohol. The beverages are taxed if they contain more than 8 gm of sugar per 100 ml and food is taxed if it contains more than 1 gm of salt or more than 275 calories per 100 gm. Sales of taxable products have fallen by an average of 27 per cent in the first year, and consumers are either choosing a cheaper, healthier product or a healthier alternative. Two years in, the WHO observed change across all income groups and age groups, but a greater change amongst younger people and lower income groups. Three years in, the resumption in healthy food consumption has been sustained and 40 per cent of Hungary’s food manufacturers have reformulated their products in order to avoid the taxation.

Mexico has by far the world’s highest death rate from chronic disease caused by the consumption of sugary drinks—nearly triple that of the runner-up, South Africa. Excessive consumption of Coca Cola and other soft drinks kills twice as many Mexicans as the trade in the other kind of coke that Mexico is infamous for. Mexico, so far from God, but so close to the United States. Unfortunately, the United States is where most of the obesogenic food and drinks industry is based and it is the globalised, Americanisation of our diets that is the principal cause of our woes and certainly in Mexico. In the last 14 years, the consumption of fruit and vegetables dropped by 30 per cent in Mexico, and the consumption of beans dropped by half, which, along with rice and corn, used to be the staple diet. An 8 per cent tax on non-essential junk food and a 10 per cent tax on sugar-sweetened drinks has had an amazing impact in the first three years. There has been a 5 per cent reduction in the purchase of taxed food items, but a 10 per cent reduction amongst lower income households—a greater impact than that of tobacco taxes on tobacco consumption. The impact was concentrated among the poor who bear the biggest cost in terms of obesity and diabetes. As in Hungary, many companies reformulated their products to avoid the tax.

‘The BMJ’ has since said that this has had an amazing impact in terms of the amount of sugar-sweetened drinks that were consumed in the past. The impact of the tax overall on nutritional consumption and on weight gain or loss remains to be studied. But taxes, I think we already can see from these examples, do change what we eat and drink and our own health professionals are calling out for this. The British Medical Association has called for a 20 per cent tax on fizzy drinks and fruit drinks in a bid to combat our obesity crisis.

Wales should be at the forefront in developing innovative policies in this area and should recognise that tackling the burden of diet-related disease will require a series of food-policy interventions, including the proven use of economic measures and price incentives. We cannot wait for the outcome of the Health Wise Wales research, being conducted by Cardiff and Swansea universities into the correlation between health and lifestyle; we have to act now.

Thank you to everyone who is participating in this important debate this afternoon. I’m very pleased to be one of the co-sponsors of this motion.

It’s no overstatement to say that obesity is one of the greatest health challenges of our age. The statistics over the past 15 years have demonstrated a very clear increase in the number of adults and children who are overweight or obese. That affects all age groups, as I say, which means that the tide doesn’t seem to be turning in the same way as evidence suggests that it has turned in relation to smoking and the consumption of alcohol, where younger people are less likely to be adopting lifestyles that are damaging to their health, as compared to young people in previous generations.

What is particularly concerning, I think, is that childhood obesity seems to be worse now than it was even just a few years ago. I am saddened to say that my constituency of Anglesey has the poorest statistics for childhood obesity in Wales, with a little under a third of five-year-olds considered to be overweight or obese. Saying that this is going to cause problems in the future and is storing up problems for the future is clichéd, but it’s entirely true. Therefore, it’s clear to me that the need to tackle this problem requires from us at least the same level of effort, commitment and resource as tackling smoking has been afforded on a global level over a period of decades.

In some ways, the parallels with smoking are very clear. The science behind smoking has been clear for many decades, despite what one former UKIP leader may think. But, of course, it was only in 2007 that the ban on smoking in public places came into force. Big tobacco had such a lot of power to limit, first of all, understanding of the science and then to prevent steps being taken to reduce the use of harmful products. It was only through heavy taxation, banning public advertising and providing consistent messages that we have managed to get smoking rates down. Even having said that, of course, the numbers are still too high.

But, in some way, tackling obesity is going to make resolving the problems of smoking, or tackling the issues around smoking, look very easy. Although people understand clearly what the health risks of smoking are, with obesity the situation is a lot more complex and ambiguous in many ways. Identifying one type of food to tackle, in the way in which cigarettes were targeted, is more problematic, not least because companies and organisations behind certain produce are always going to bombard us with messages of, ‘Don’t pick on us; pick on someone else.’ On top of that, a very significant difference is that you can’t smoke cigarettes moderately without them causing damage, but you can consume many of these foods. Those types of food only become harmful when they are over-consumed.

The NHS responds differently to people who want to give up smoking, compared with those who want to lose weight. People can be encouraged to use willpower to stop smoking, but statistics tend to suggest that that isn’t going to be particularly successful. For someone who wants to go a step further, there is assistance available, with nicotine products, support groups and so on and so forth. But, when it comes to someone who is obese and eager to lose weight, then that level of support isn’t available. The usual approach is to provide some dietary advice and to hope that willpower alone will be sufficient, despite the fact that the temptations of unhealthy food surround us everywhere we look. It’s only when the problems get worse will that patient perhaps be referred for more intensive treatment.

Whilst Governments have taken steps to make the choice not to smoke easier for people, and have prevented some environmental factors, when it comes to obesity one gets the feeling that Governments are still making decisions that encourage individuals not to be healthy—they are still planning our cities around the car, rather than using active travel and so on. Sometimes, it isn’t even easy to get hold of information about healthy diets.

Therefore, it’s clear to me, in conclusion, that efforts to tackle obesity will need an even more robust governmental response than was the case with tobacco. All departments of Government must be willing to commit to this in the long term, and to give real impetus to making sure that Wales is in shape and is a nation that is fit and healthy, because I fear that we aren’t fit and healthy at the moment.

As Public Health Wales reminds us in ‘Making a Difference’, their priority policy areas for creating a healthy Wales, over half of Welsh adults and around a quarter of Welsh children are overweight or obese, with particular issues in disadvantaged communities, such as my own in RCT, where the figure stands at 63 per cent of adults. If the numbers of people who are overweight or obese continue to rise at the present rate, by 2050 this will cost the Welsh NHS £465 million per year, with a cost to society and the economy of £2.4 billion.

Linked to this are clear challenges around physical activity levels. Many adults don’t undertake the recommended weekly amounts of physical activity, with only one in three children meeting guidelines. Faced with these stark facts, I am happy to support this motion today, challenging us all to develop solutions that solve what has been described as an obesity epidemic and calling on all of us to use the levers at our disposal.

Welsh Government has taken action. The Change4Life campaign promotes advice on healthy eating, and schools are expected to promote healthy food choices. Policies like free swimming promote access to exercise opportunities, and I was pleased to recently meet with Ramblers Cymru to talk about the Welsh Government-sponsored initiative, Let’s Walk, which celebrates the benefits of just 30 minutes of walking a day in improving health. Other initiatives, like Healthy Child Wales, will bear fruit in coming years.

Interventions around childhood obesity are one of the cornerstones of Cwm Taf health board’s approach. The childhood obesity steering group brings the health board together with partners like Families First, Flying Start and Communities First to develop and improve services. Work completed so far includes the development of guidance for early years settings to ensure they include evidence-based information on nutrition and physical activity, a mapping exercise to determine the need for training, and a research report that considered the effective engagement of families in targeted child and family weight management programmes. Similarly, the Cwm Taf Healthy Schools scheme is another Welsh Government-funded initiative. This bridges health and education to holistically promote good health in school settings, using interventions like cooking in the classroom. I’m sure Members will join me in congratulating Glenboi Primary School in my constituency, which yesterday completed phase 4 of the programme.

Cwm Taf’s approach also includes an antenatal element. The rate of obesity in pregnant women in Cwm Taf stands at around 33 per cent, and with this being a key indicator under the all-Wales maternity strategy, the health board has developed an appropriate response. Commencing in 2015, Bump Start is a specialised antenatal service to help women with a BMI of 35 or over to limit weight gain in pregnancy to healthy levels. Appointments and undertaking routine antenatal visits involve consultations with the public health midwife and a specialist dietician. In its first year of operation, the scheme has received very good feedback. However, there remains the need to do more. Crucially, unhealthy food remains cheap and easy to access, a point made strongly when the British-Irish Parliamentary Assembly, of which I am a member, took specialist evidence on childhood obesity.

I know I am not alone in my disappointment that the UK Government has watered down the proposals that were expected in its action plan for tackling childhood obesity, especially around sugar and on the advertising of unhealthy foods. I am glad that Welsh Government Ministers have jointly written to the Secretary of State for Health pressing the case for tougher action, and have also put on the record again their commitment to using the powers that are devolved.

Finally, I want to return to another theme that I believe offers a solution to tackle the crisis this motion considers. Members will know that I have previously referred to the nature deficit disorder, whereby children and young people in Wales consider themselves to have a weaker connection to the natural world than their peers in Northern Ireland, Scotland or even London. Initiatives such as Wales’s first nature kindergarten in my constituency, in the Dare Valley Country Park, have a remedial role to play, but we need to bring about a step-change in encouraging our children outdoors. Doing so will enable them to partake of the exercise that can tackle obesity and engender the habits of lifelong activity that will lead to healthier lives.

I’m very pleased to be taking part in this important debate on a very important and serious subject. It’s important that we don’t just talk about it, but try to get to grips and tackle it. Perhaps I’ve mentioned in passing previously that, in another life, I am a doctor, but also, naturally, I’ve been dealing with problems stemming from obesity over the years. And it’s a combination, as we’ve already heard, of healthy eating—even though that’s easier said than done as well, and I agree with that. But it’s very difficult, sometimes, to get hold of healthy food. If you’re trying to go shopping in some areas, especially in our large cities, it’s very difficult to find healthy food in a shop that says that they do sell food. It is very difficult, and we need to get to grips with that. Naturally, there’s an element of trying to define what the size of a portion is. Those portion sizes have increased gradually over the years. Of course, in the middle of all of this, we need to emphasise the importance of breastfeeding, as well, for our babies, to give them a sure start, as far as we can, and to promote breastfeeding to give people that good start in life. There’s research that shows that that does decrease the rate of obesity as well.

I was going to talk as well about it being a combination of what you eat and how fit you are—how much you move around. Diet is perhaps slightly more important than fitness, but we shouldn’t forget the importance of personal fitness as well. You don’t have to go to extremes, such as ensuring that you have the latest kit to go to the gym; it’s just about walking 10,000 steps a day—that’ll do the trick—avoiding the lift and so on, and walking everywhere as far as you can. We’ve heard from Vikki about the Ramblers and so on; it’s promoting walking. We used to do it much more than we do now. Just becoming a little bit fitter with that walking, you will see a decrease of 30 per cent in your blood sugar levels, as I’ve already said in this place, a decrease of 30 per cent in the level of cholesterol in the blood, a decrease of 30 per cent in your blood pressure, and also you do lose weight naturally. So, if we developed tablets that could have those effects, then we would all be calling for them to be prescribed tomorrow. But, of course, that’s natural fitness. That’s what brings those decreases in blood sugar levels, cholesterol levels and blood pressure. We just need to disseminate that information so that people can make alternative choices.

In the time remaining to me, I just want to emphasise, as well as all of this education that’s needed, the importance of legislation in this field. As Rhun has already mentioned, we have been sharing the information on the bad and disastrous effects of smoking for many years, yet the levels of smoking in Wales were still stubbornly high, running at around 32 per cent until the year 2000. What’s happened is that we have legislated to ban smoking in public buildings. That has overturned how people think about smoking. Legislation can sometimes lead the way, and can change the way that society thinks about an issue. As well as all of the education that takes place, we need to legislate in this field as well. We need a tax on sugar, we need to legislate for a minimum unit price for alcohol, and we need to legislate to get rid of some of the things like trans fats from our processed foods. So, there is a role for legislation, as the motion states. Also, these large food and drink companies, as Rhun said, behave like the tobacco companies. They try to undermine all of the messages that mean that we would do something on a minimum unit price for alcohol and on sugar. We’ve seen those problems in other countries, such as Scotland. With this Wales Bill that is on the way, there’s a danger that we’ll lose the right. We do have the right at present to set a minimum unit price for alcohol, but not for too long if the Bill is implemented, as it is expected to be implemented. If we can’t have new legislation in place before the end of the first stage of a new Bill, namely in April 2018, we need to take urgent action. That’s why I welcome this important debate, but also the importance of legislating and taking action. Thank you.

Diolch, Ddirprwy Lywydd. I think the challenges are abundantly clear, as we’ve heard from others, and have been apparent for some time, but no doubt will be coming ever more apparent because of the ageing society that we have, because of the pressure that brings on the health service. We’ve talked for quite some time, haven’t we, in terms of trying to be more preventative as far as the health service is concerned: looking at the wider determinants of health and ill health and trying to get on the front foot rather than being largely reactive. So, I think this debate is part of that dialogue, Dirprwy Lywydd, that’s been ongoing for some time and will inevitably strengthen because of the challenge we face. But I think it’s really important to have good, hopefully strong, local examples in Wales of what can be done in meeting those challenges. I’ve mentioned before, and I’m very pleased to mention again, that in Newport for some time we’ve been holding physical activity summits to bring together key partners: public health, Aneurin Bevan health board, Newport City Council, Newport Live, which is the leisure services trust, Newport City Homes as a housing association that took the transfer of local government housing stock, sport organisations like Newport Gwent Dragons, Newport County AFC, Natural Resources Wales—there’s a long list, Dirprwy Lywydd—and we’ve come together to look at these challenges and to try and make progress locally.

So, I’m pleased to say that we’ve now reached the stage where the organisations have all committed a day a month of staff time to take the agenda forward. We’ve built an increasingly strong and active partnership. We’re looking at all sorts of issues, including how the active travel Act is effectively taken forward in Newport. We’ve strengthened the parkrun. I did the parkrun in Tredegar House in Newport a couple of weeks ago, and the energy there is absolutely tremendous; several hundred people at 9 o’clock on a Saturday morning doing the parkrun, enjoying it, socialising afterwards, talking about what else they’re going to do to stay active, fit and healthy. There will now be—it’s not yet established—a city centre parkrun along the riverside in Newport to build on the interest that’s being created.

Throughout all of this, Dirprwy Lywydd, we’re also looking at other aspects such as healthy eating, linking with healthy eating networks in schools, and there will be particular projects as part of this coming together that address those issues in schools. I hope very much that we drive forward physical literacy in our schools, because one thing that I think virtually everybody is agreed on is that if you can establish and embed good habits in our young people as early as possible, it’s very likely that those good habits will stay with them throughout life to their benefit, and to the benefit of the health service and Wales generally. So, I very much hope that that report that Tanni Grey-Thompson did on physical literacy is taken forward in whatever shape or form through the curriculum reforms that we’re about to see, and is absolutely central to life in our schools.

What I would also ask, Dirprwy Lywydd, is that, where progress is being made locally, as it is in Newport, that’s recognised by Welsh Government, it’s looked at very closely, good practice is spread and also that there might be some support. In the past, there was some discussion around possible pilot schemes where local projects were addressing these challenges of getting more physically active and a more healthy local population, and then there might be some support from Welsh Government to strengthen it, structure it and take it forward more effectively. So, I hope that will be the case, but whatever happens, I think we’ve got to the stage in Newport where there’s sufficient buy-in and sufficient energy, ideas and commitment to make sure that we do something important and valuable for our local population.

Thanks to the five Members listed for bringing the debate today. There’s a range of issues under deliberation here, too many to cover in one contribution, so I’ll concentrate on the issues of obesity and physical activity, active travel being part of that.

Levels of participation in active travel have not shown improvement, unfortunately, since the active travel Act was passed, and the independent charity Living Streets says that we are still dealing with a decline in the walk-to-school numbers as more and more parents drive instead of walking sometimes fairly short distances. We do need to do more to promote walking to school. I note that there has been a programme; can we offer some kind of financial inducement to schools for participating in organised walking groups? Also, there’s issue that Vikki raised first of all in her short debate that she did a few weeks back of outdoor activities. That’s another thing that schools can actively promote, which would, I’m sure, have a beneficial effect, but can the Government have any effect on this kind of thing being promoted in schools, particularly primary schools, because we need to start them off early? Can we give more support to local authorities over the funding of leisure centres, given that we now face the spectre of outsourcing, which could lead to an increase in admission fees? I appreciate that these are really local authority matters, but we could perhaps do something as a Government—well, I’m not in the Government—as an Assembly, sorry, to monitor this, at least, and perhaps to give some kind of support to local authorities in their subsidising of leisure centres, given that ultimately we could pay rather more in costs for the Welsh health service if we don’t do this now.

Regarding older people, there is the issue of bowling clubs, which is quite often their only leisure activity. We had a recent case where a popular bowling club in east Cardiff was condemned to closure. Again, it’s an issue where it’s a local authority decision whether or not to subsidise these clubs but we could take some more active role, in the Assembly, in promoting these kinds of activities for older people—similarly, things like Nordic walking clubs, which we’ve had.

Regarding active travel, I think we do have a problem in that we’ve also got now the Well-being of Future Generations (Wales) Act 2015, but there doesn’t seem to be anything linking the two pieces of legislation together. For example, there’s no active travel indicator in the Well-being of Future Generations Act that can hold public services boards or councils to account for their provision of active travel. This also affects the south Wales metro system because concerns have been raised, in the active travel board, about the requirements for active travel and whether they’re going to be provided for when we get the metro. Transport for Wales are setting the scoring for procurement and this could and should include standards to increase active travel to and from stations. I appreciate that we need to deliver the south Wales metro—that is the priority—but is the Welsh Government doing anything to ensure that when we do get the metro it does in fact include some good provision for active travel? Thanks.

I’d like to thank the Members who have brought this debate forward because, obviously, this is a critical issue. Previous speakers have described the situation in Wales, which is obviously a matter of huge concern. It’s clear that eating habits and exercise habits need to be improved—we’ve heard the statistics about that today.

I’m very proud that we do have the Active Travel (Wales) Act 2013 and that it has been passed—a unique Act by this Welsh Government—and I think we absolutely have to make every opportunity to use it to its maximum potential. For example, I know that we are consulting on the local walking and cycling routes that communities themselves feel need to be prioritised. We’ve had a good response in Cardiff, I think we’ve about 200 people giving their input so far, but I think we’ve got to do more. We’ve got to make sure that more people in Cardiff and throughout Wales put out the message that we can develop safe walking and cycling routes, which I think is very important to encourage people to get fit and to leave their cars at home, and we’ve got that legislation there now at the moment. I think we’ve got good examples throughout Wales and we’ve got great organisations like Living Streets and Sustrans, who are working hard on these issues. I know that Sustrans is also considering targeting, in particular, young mums and mums-to-be—and I think Dai Lloyd mentioned this in his contribution—because the evidence does suggest that the biggest impact on whether people adopt walking and cycling habits is whether their parents travelled actively, so the example was there.

We obviously can’t win the battle against obesity simply by promoting active travel, although I think there are great opportunities there. Changing eating habits is very hard, but I do believe it starts right at the beginning and I was pleased that Dai Lloyd mentioned breastfeeding—I expressed my concern that that was not in the chief medical officer of health’s report last week. But I know that the Welsh Government is concerned about promoting breastfeeding, but I just think that is something we’ve got to have another great push on. It is very important, as Vikki Howells mentioned—the importance of antenatal support and working with mothers. But it is very difficult to change eating habits, particularly with adults. However many public health campaigns we run, food still equals comfort for many people and also, I think one of the most important points is that poverty impacts on eating habits, and I think that’s something that I want to say a bit about now.

The Child Poverty Action Group has just published a book called ‘Improving Children’s Life Chances’, which shows that, for both girls and boys aged two to 15, there’s a greater prevalence of overweight and obesity in the 40 per cent of children from lower income groups. And we know that. We know, through the work on health inequalities, that it is the poorer families who are more likely to be overweight.

Research shows that foods that are nutrient-dense per calorie are more expensive. Data from the national diet and nutrition survey 2008-12 show that the lowest income group generally consumes less protein, less iron, fewer fruits and vegetables, less vitamin C, less calcium and less oily fish. And one of the reasons for that is that lean meat, fresh fruit, vegetables and fish are difficult and are expensive forms of calories. I think we all know that that food is more expensive. So, it makes sense that, when incomes are higher, you can afford better-quality food, which is why the effects of austerity and benefit cuts are so pernicious—because they do affect what people are able to eat.

So, I think it’s very important that we do look at this in the overall context of people’s lives and I do believe that poverty has a big impact on what we are able to do. Some of those levers of poverty are not within our power in this Assembly, but I do believe that we have levers here that we can use and should use. People have mentioned a lot of those levers today, but I think it starts with the first food that you have—or we hope you’ll have—which is breast milk. It’s crucially important what happens in school in terms of healthy eating and there have been lots of suggestions here today, and the exercise issue that we know we can promote through the active travel Act. I do believe we have many levers here in this Assembly to tackle this very important issue.

I only want to make a brief few remarks in response to some of the speeches here this afternoon. I’d like to wholeheartedly endorse what John Griffiths said about the potential of the parkrun. I recently took part in the new Llanelli coast parkrun, which was a terrific experience. Every time I’ve taken part in the parkrun, as somebody who is not a natural runner, I’m always warmly enthused by the support of the volunteers who really encourage you along. For most of the people taking part in the parkrun, were it not for that activity, they’d be doing nothing at 9 o’clock on a Saturday morning. For the £6,000 of investment needed to get them up and running, I think they are a no-brainer from a public health investment point of view, and I’m pleased to see them flourishing across the country.

I wanted to talk in particular about the element of the motion around the untapped potential of the active travel Act, which I think is perhaps a little harsh, given that the Act has only recently become enacted, but I think it’s right to point out that we really can’t just see this as a tick-box exercise and nor can we approach it in a half-cocked manner. This is a huge opportunity to try and get people who currently take little or no physical activity to take some. There’s plentiful evidence to show that for those people who are physically inactive, the way to get them to take some physical activity is as part of their everyday routine, and simply expecting them to go to leisure centres or gyms is likely to be ineffective. So, this is a huge chance to reach a section of the population we most need to reach out to.

I think we do suffer sometimes in this Chamber from what’s known as ‘cognitive dissonance’ when we say one thing, but we do another. We talk, in public health terms, enthusiastically about the value of active travel and physical activity, and yet, when we talk about an economic strategy, for example, or we talk about transport matters, we put this to one side, and we seem to think that physical activity is the responsibility of the health profession. When we do other activities, we don’t think about how those tasks can be used to deliver the rising levels of physical activity we need to see. So, for example, to return to a theme that I’ve talked about recently—the encouragement of free car parking in town centres. We should be encouraging town centres and towns that are cycle and walking friendly, and using scarce public investment to build in networks to encourage people to take those short everyday journeys. Some 20 per cent of car journeys are under a mile. A lot of those could be replaces by walking and cycling trips.

In my town of Llanelli, for example, there was a proposal for an urban cycling network to connect people up with those everyday destinations they want to go to. But, unfortunately, the county council—pre-active travel days, but those schemes are now on the books—are focusing their investment on longer-distance routes and tourism routes, and not on those everyday routes. It’s essential, instead of hardwiring in policies that are going to encourage sedentary lifestyles, such as free car parking, we really need to be seizing every opportunity to build in physical activity to all of our plans.

I note recently that Cardiff council has published an ambitious cycling strategy for the city, which we really must get behind and enthusiastically endorse. I know they’ve been having difficulty within the city region, for example. The city deal, which is still littered with very orthodox and old-fashioned thinking, where local authorities up and down the Valleys see an opportunity for funding and dust off road schemes that they’ve had on the shelves for 30 and 40 years in some cases. Cardiff, to be fair to them, are showing real leadership in building on the gains we’ve seen in the last 10 years in the city of increased levels of cycling, and they’ve put together an ambitious plan. But I know they’ve had difficulty within the city region in getting support for that. I’m pleased, in the case of the Swansea bay city region, that Terry Matthews’s vision hasn’t been about roads and enterprise parks—it’s been about digital connectivity. I think that’s the thinking that we must embrace.

The active travel Act, as has been mentioned, presents us with an enormous potential prize within our grasp. But it can’t simply be seen as a duty that we have to discharge. It’s something that we must embrace enthusiastically. We must push—all of us in our leadership roles within our communities—to get people to feed in the potential routes they’d like to see as part of the integrated network maps, to get those everyday journeys put into the plans so that they are the first to be delivered. It’s a huge prize, and obesity will only be tackled by actions like these. So, we really need to abandon this cognitive dissonance, and scan every opportunity to build in increases in physical activity in all of our programmes. Diolch.

Thank you very much. I call on the Minister for Social Services and Public Health, Rebecca Evans.

I’m very grateful to Jenny Rathbone, Rhun ap Iorwerth, Vikki Howells, Angela Burns and Dai Lloyd for choosing to focus on important public health issues in the individual Members’ debate they’ve tabled this afternoon, the spirit of which is consistent with our commitment to support people to be healthy and active. I really welcome all of the thoughtful contributions that have been made. Whilst we’re certainly doing a great deal to create the right circumstances and conditions for people to make healthy and active choices, we must also recognise that Government can’t do it alone. If we are to make the vision of the well-being of future generations Act a reality, we need a whole-of-society approach to maximise physical and mental well-being today, and to ensure that behaviours that benefit health tomorrow are understood and acted upon.

This is a challenging agenda. Levels of obesity in adults have risen slowly since the first Welsh health survey began in 2003, and although levels in children are now stable, they are still unacceptably high. We know levels increase with deprivation, so there’s a compelling case to act in order to address health inequalities. We want to support the public to make healthier choices. Public Health Wales recently launched its 10 Steps to a Healthy Weight campaign to support this, and this does include a focus on breastfeeding. This complements our Change4Life programme and our other campaign work. Our Healthy Child Wales programme focuses on the early years, based on the evidence that maintaining a healthy weight in the early years has a long-term impact on levels of obesity and health in adulthood.

Interactions with the health service are often opportune moments when individuals are receptive to lifestyle advice. Public Health Wales is developing its systems-based approach to this, which includes making every contact count. The aim is to equip staff with the skills needed to deliver brief advice to encourage small changes to improve health and well-being at every opportunity. But this agenda is complex. Improved education and skills, easier access to healthier food and public procurement policies all have a role to play. We also need more restriction on the advertising and promotion of high-fat, salt and sugar foods, particularly to children. Some of this work needs to be done at a UK level. We have long called for the Secretary of State for Health to deliver stronger action, such as tougher action on sugar and on the advertising of unhealthy foods to children, and we do support the UK Government’s announcement of a sugar levy on sugar-sweetened drinks, but we do need to see some progress.

The food industry itself has a role to play. UK-wide voluntary salt reduction targets, considered to be a global example of best practice, have led to a reduction of salt levels in foods by up to 50 per cent since 2012, and this is certainly welcomed, but we do need the industry to do more.

Influencing public procurement on this agenda is vital. The Welsh Government has already acted to create a national procurement service for Wales that is developing central procurement mechanisms for all public sector organisations. We are actively engaging with them to set procurement criteria that factor in nutritional specifications. NHS procurement already employs a dietician to do this. This will be a significant step in ensuring that all food and drink provided in our public sector is healthier. This will build on the nutritional standards that we’ve introduced in some of our public settings, such as schools and hospitals. We’re also developing similar approaches for other settings, such as early years and care homes, because we know how crucial good nutrition is for young children and older people.

People themselves need to have the skills and knowledge that underpin healthier lifestyle choices, and schools have a key role to play in this. Our programme for government makes clear our commitment to work with schools to raise awareness of the importance of healthy lifestyle choices. We have a good platform to build from with our Welsh network of healthy schools schemes, and we’ll maximise opportunities to strengthen work in schools further through the development of the new curriculum.

Today’s motion highlights the potential of the active travel Act to raise physical activity levels across the population, including for children. The active journeys programme, which works in schools to promote active travel amongst pupils, makes resources and support available to schools across Wales. This will be complemented by our Walk to School Wales project, which will develop a toolkit to support schools to review and improve active travel options in their areas. The Welsh Government provides funding for walking and cycling training, which is mostly delivered in schools, and these programmes will be reviewed in the coming year with a view to reinforcing the promotion of active travel.

The Act further puts in place the framework to support active travel as a key element of building physical activity into our daily lives. It does so by mandating the planning of coherent walking and cycling networks in our communities and improving them every year. This year, we saw the first key stage of the Act with the approval of the existing route-maps of all local authorities in Wales, and local authorities are now working on the preparation of their integrated network maps. We’re working with local authorities to ensure that these genuinely reflect the needs of local communities and connect the places that they need to travel between. This requires input from a broad range of perspectives. Last week, I was very pleased to speak to an audience of planning, transport, environment and health professionals who are all keen to strengthen the links between their sectors and professions to move the active travel and wider health and well-being agendas forward. Working together, we will see the active travel Act impact on the number of people making active travel journeys.

I am pleased that we can now report for the first time since records began that over 80 per cent of our adult population are non-smokers. This has been achieved by using the comprehensive approach outlined in our tobacco control action plan. This involves working with young people to prevent the uptake of smoking, working with smokers to help them quit and an increase in smoke-free environments. Legislation is part of this wider picture, including UK-wide work to introduce standardised packaging of tobacco products, and, in Wales, the newly established tobacco control strategic board will oversee continued action.

I was pleased to recently have introduced the Public Health (Wales) Bill to the Assembly. The Bill has a particular focus on addressing health inequalities and creating conditions that promote the good health of children. The aspects of the Bill that relate to smoking are particularly strong in this regard, and I have no doubt that it will help us meet our target of reducing smoking to 16 per cent by 2020. The importance of creating the opportunities and the environment in which people can make healthier lifestyle choices is clear from the contributions that we have heard in the debate today. I hope that I have reassured you that we are taking a wide range of approaches across Government to do this. But, as I said, it is not something that we can do alone, and we look forward to working with a wide range of partners to accelerate progress in this area.

Thank you very much. I call on Angela Burns to reply to the debate.

Thank you very much, Deputy Presiding Officer. I would like to thank everyone who took part in this debate. I am sorry, I am not going to go through all your individual contributions because I don’t have a huge amount of time, but there are just a couple of points that I really wanted to make. This is, if you like, a game of two halves, so let’s look at the children first.

I am very glad that some Members mentioned the importance of getting them young. Minister, I would say to you that one of the key things that you could do today, now, within your power, without having to do huge great big strategies, would be to increase the amount of time we give to sport in school—not just increasing the amount of time that a child can undertake sport, but also to be far more creative about what physical activity means. To be frank, very few girls like team sports. Very few boys will like certain other things. There is a huge gender imbalance. Teenage girls are very conscious of their bodies, and I think that we could be very creative about looking at how we could bring on board dance, movement, running, single sports—encouraging all sorts of things rather than just saying, ‘If you’re going to do sport, you’ve got to do this kind of sport or that kind of sport.’ I think that it’s really vital that we address it. It’s also very vital that we address the amount of time that we give to sport. Let’s be really clear: in our schools, the amount of time that we give to sport has been decreasing over the last decade, and that goes in the face of everything we’ve spent the last hour talking about here.

Of course, the other thing is, if we have healthy young people, they will grow to be much healthier young adults and older adults, because they will be used to the whole concept of going out, doing things, riding bikes and so on. The amazingly wonderful initiatives that a lot of you have talked about today are great, but do you know what? I couldn’t do a parkrun. I would probably last about three yards and fall over—bump, and I’d be gone. So, fit people—Lee—off you can go, and that’s brilliant. But there’s a whole class of us out there—. In fact, let’s be clear, 59 per cent of us out there are overweight or obese. So, what do we do for the 59 per cent, and how do we change the way that we talk about it? How do we stop it from being pejorative? How do we go out there and say to those people, ‘Hey, you don’t have to lose weight by going to a gym, surrounded by Lycra-clad bunnies, while you’re sitting there, wobbling away, trying to be fit’? That’s why large people—particularly women, but men as well—don’t want to do this kind of stuff, because it’s embarrassing. In fact, if you look at obesity in the UK, there’s a lot of psychology involved in this. There’s a huge psychological report on this, and it talks very clearly about the fact that we need to look at the exercise environment. It needs to be addressed, so that there isn’t an exacerbation of social physique anxiety, and so that fat people, large people, don’t actually feel incredibly embarrassed about trying anything, so they don’t try it. I think we need to look at that. We need to be much cleverer about how we target people. We have got a lot of very overweight adolescents. How do we get to them? What do we do about them? They don’t want to go to a gym, and they probably won’t go to a park. But, if we can train our health professionals in cognitive behaviours, they might be able to find keys that help unlock certain areas of our population and bring them back into the fold.

So, in my view, the easiest things that we can do—. There’s a lot of other stuff that we talked about—taxes, sugar, this, that and the other—but they’re all big picture. Small picture: get our primary schoolchildren and our secondary schoolchildren doing a bit more activity—activity that they enjoy; activity that makes them want to carry on doing it. Give them better food. Since when has a cheese wheel been a food form, let alone good food? The people who are already overweight or obese: be kinder towards them in terms of how we bring them in and get them to do the activity they need, so they don’t feel ashamed, embarrassed and some sort of small dreg of society. A lot of overweight people just have that feeling, because of the national conversation, that they’ve become a problem. We need to help them and be kind about it.

Thank you very much. The proposal is to agree the motion. Does any Member object? [Objection.] Therefore, we defer voting under this item until voting time.

Voting deferred until voting time.