– in the Senedd on 11 January 2017.
We now move on to item 6, which is another Welsh Conservative debate, and I call on Angela Burns to move that motion. Angela Burns.
Motion NDM6196 Paul Davies
To propose that the National Assembly for Wales:
1. Notes that, in light of National Obesity Awareness Week, obesity levels in Wales are increasing.
2. Expresses concern that as many as 59 per cent of adults were classified as overweight or obese, as stated in the recent Welsh Health Survey, and 27.3 per cent of children in Wales are obese or overweight, as recorded in the Child Measurement Programme for Wales: Current Annual Report.
3. Calls on the Welsh Government to address the lack of coherence between its public health initiatives, and cuts to local government funding, which prevent the effective uptake of these programmes.
Thank you, Deputy Presiding Officer. I’m pleased to have the opportunity to bring this debate to the Assembly today, during what is National Obesity Week. Whilst many of us—and I’m one of them, definitely—are worried about the extra pounds they may have put on after a bit of over-indulgence during the festive period, obesity is becoming an ever-increasing problem within the UK as a whole and in Wales in this particular instance.
Obesity levels are rising in Wales. According to the latest public health survey, nearly 59 per cent of adults are classed as ‘overweight’ or ‘obese’, 25 per cent of whom are classed as ‘very obese’ and 27 per cent of children are classed as ‘overweight’ or ‘obese’. Our motion today calls on the Welsh Government to look again at its public health initiatives—the Minister and I have been talking about the public health Bill only this morning and cuts to the local government budget—to help increase uptake in public health programmes.
I will begin by looking at a couple of key facts. One in four adults are labelled as ‘very obese’ and it’s the highest in the UK. The reason why such concerns exist about the carrying around of such excess weight is the link it has to both chronic and severe medical conditions and the resulting reduction in life expectancy by as much as 10 years. It is a preventable condition and the Welsh NHS spends close to £1 million per week treating obesity, with obese individuals most likely to incur health expenditure.
The problem is that whilst initiatives are in place across Wales, inconsistent results are being delivered. Just two out of seven of Wales’s health boards offer level 3 obesity services and none offer the level 4 bariatric services, resulting in the fact that those in most need of support to lose weight are unable to do so, or have to go to England for that help. It is for these reasons we’re calling for more of a cross-portfolio approach from the Welsh Government to tackle this growing challenge.
We’re supported by the British Medical Association, who have called for the principles of the much-vaunted Well-being of Future Generations (Wales) Act 2015 to be built on. The BMA have highlighted that the Act has failed to include indicators that would measure the prevalence of obesity amongst the Welsh population. Deputy Minister, we would be very interested to know of your views on whether or not you think that that could be changed—forgive me, ‘Minister’, not ‘Deputy Minister’.
Nor does the Government reference obesity in its well-being objective, which accompanied the ‘Taking Wales Forward’ programme. Minister, if you were to rectify those two major failings, it could help to focus more attention on the problems we are currently experiencing. I won’t talk too much about the Public Health (Wales) Bill because you and I have explored that in great detail today, but what I would like to do is focus the rest of my contribution on children.
The Education Development Trust have highlighted how schools can play a role in tackling obesity through school-based interventions. It notes the following interventions have had a positive effect: lengthening the existing time of PE lessons, something I must have raised in this Chamber dozens of times—it seems ridiculous that at primary school we are slashing the amount of time that young children are spending outside, in halls, running around; changing the markings on playgrounds to encourage increased movement and increasing the availability of skipping ropes and other sports equipment; walking school buses; highlighting the harm of carbonated drinks and removing unhealthy vending machines; incorporating nutritional elements into lessons, building on the healthy eating Measure—
Will you take an intervention?
Of course, Bethan.
I just wanted to go on the other side of the argument and make sure that even when we’re talking about obesity that we don’t encourage people to go the other way to develop eating disorders. I’ve met many people who have had weight problems, who have been obese, and then they’ve gone to the other extreme. So, just to add that to the debate here today.
And I think that’s a point absolutely well made. I think that what we can do is use schools to ensure that young people, by the time they leave schools, are actually at an appropriate body weight, understand all the nutritional values, and understand the importance of exercise and the joy in exercise, because so many young people actually find exercise utterly, utterly joyless at school, which is why we need dance and movement and all these other things, especially for young women. Because a healthy child, Minister, will turn into a healthy adult.
The whole point of this motion is to ensure that the Welsh Government does all it can to make sure that our citizens really understand and that they start their adult life fit, in the right place mentally and physically, because they will then stay trimmer for longer, which will therefore mean better benefits for their own personal health and, of course, an enormous benefit to the NHS and to society as a whole.
Thank you very much. I have selected the two amendments to the motion. If amendment 1 is agreed, amendment 2 will be deselected. I call on the Minister for Social Services and Public Health to move formally amendment 1, tabled in the name of Jane Hutt.
Amendment 1—Jane Hutt
Delete all and replace with:
1. Notes:
a) in light of National Obesity Awareness Week, that there has been little change in the number of adults who are overweight or obese in Wales since 2012—but we want to see these numbers fall;
b) that the latest Welsh Health Survey shows that 59% of adults are classified as overweight or obese and the Child Measurement Programme for Wales: Current Annual Report records 26.2% of children as overweight or obese; and
c) that the Welsh Government continues to invest across all portfolio areas including through NHS Wales, education, sport and local government—to support people in Wales to lead healthy lifestyles.
Formally.
Thank you. I call on Dai Lloyd to move amendment 2, tabled in the name of Rhun ap Iorwerth.
Amendment 2—Rhun ap Iorwerth
After point 2, add as new point and renumber accordingly:
Notes that taxation of unhealthy products and rules over the advertising of such products, are non-devolved matters, and regrets that successive UK governments have failed to utilise these powers to tackle obesity.
Thank you very much, Deputy Presiding Officer. It’s a pleasure to move this amendment that notes that taxation of unhealthy products and rules over the advertising of such products are non-devolved matters, and regrets that successive UK Governments have failed to utilise these powers to tackle obesity. So, that’s what our amendment states. In the amendment we note the preventative agenda in this area by acknowledging National Obesity Awareness Week. Now, of course, we need to tackle that preventative agenda and, as we said in today’s health committee in the context of the public health Bill, there are things that can be done in terms of the nutritional standards of the food that we eat, and also with regard to the availability or accessibility of exercise. Now, it’s possible to tax sugar and sugary drinks, and there’s also room for taxation to realise a minimum alcohol price as well. All of these matters do contribute to obesity. Yes, there’s an education agenda, of course, naturally, but there is room to legislate to push this educational agenda forward.
Of course, the majority of these issues are outwith our powers at the Assembly, and where the powers do lie in Westminster there’s not much will to get to grips with that preventative agenda. Because there are no two ways about it: we need to recognise that the food and drink industry are very powerful in this regard, and can have a very heavy influence. We regret the dilution of the standards emanating from Westminster recently with regard to promoting the preventative work that is going on with this issue of obesity.
Diet is a vital part of this issue. I naturally accept the point that Bethan Jenkins made whilst sitting next to me. Fitness is also a part of this issue. But, we have to be sensible about that as well, and we have to make it easy for people to become fitter. You only need to walk 10,000 steps every day to reach the level of fitness that can have that beneficial influence on your health—10,000 steps. We can all do that—the majority of us—in this place just by using the stairs and not always taking the lifts. I’m not looking at anyone in particular here, but 10,000 steps are all it takes. I do understand what the Deputy Presiding Officer thinks about this every time I raise it, but if fitness were to be a tablet or a pill—. Fitness does mean reducing 30 per cent of your weight, and if you’re fit, your cholesterol level is 30 per cent lower and your blood pressure is also 30 per cent lower. So, if there was a pill that achieved that, then everyone would be calling on us as the GPs to prescribe it, but, unfortunately, fitness isn’t available in pill form, so it’s incumbent upon us to do something about that.
Also, ultimately, there are some people suffering from obesity and we can’t do much in terms of pills or fitness to assist them. There are some people who are very overweight and very obese and we need better provision for those people in terms of bariatric surgery here in Wales. I think the last estimate was that there are only three surgeons who have expertise in this area of specific surgery for the very obese. If you remember that over 50,000 of the residents of Wales have a BMI of over 40, which means that they are what is called ‘morbidly obese’, and there’s also a percentage who have a BMI that is over 50, which means that they are very, very obese, ultimately those people have failed to receive all sorts of advice and treatment, and a surgeon has to do something to get to grips with that issue for those people. The services aren’t available for them. As I’ve said, only three surgeons located in Wales are able to provide that service and the demand for it is significant and increasing.
Thank you very much. Julie Morgan.
Thank you very much, Deputy Presiding Officer, for calling me to speak in this debate. I think it’s very important that we do keep this issue of obesity on the agenda, and, as well as it being National Obesity Awareness Week, I think lots of people’s thoughts, after the excesses of Christmas, as Angela Burns referred to in her speech introducing the debate, are turning to healthy eating. I do applaud the efforts of people to be more healthy in January. I’m not very successful at it myself, but I think doing a dry January, cutting back on sugary foods or starting a new exercise regime are really important. I think we all need to encourage each other to do that.
But, really, the issue is how we get that message across during the whole of the year, to foster long-term good habits. I do believe that we are raising a generation of more health-conscious children and eaters, because, certainly, this is something that is addressed in primary schools. We do know that unhealthy children become unhealthy adults. So, I think it’s very important that we get the message out to the younger generation.
But, as has already been mentioned, the figure of 26.2 per cent of children in Wales being overweight is very worrying. But I am pleased to see that 64 per cent of children report eating fruit every day. I wish it was a higher figure, but, nevertheless, it is 62 per cent, and 52 per cent eat vegetables every day, whereas, I think, 32 per cent of adults say that they’ve eaten five or more portions of fruit and vegetables the previous day. So, obviously, there is a lot of work to be done, but I do think that the Welsh Government has taken some very positive steps to address this issue.
I want to refer, again, to the active travel Act, because I think this is very important and will have an impact in encouraging people to build walking and cycling into their daily lives. We know that, at the moment, local authorities are currently undertaking preparations to create integrated network maps, and they’re to be submitted to the Welsh Government by September next year. I hope those maps will show areas for local walking and cycling routes that communities themselves believe should be prioritised. So, I hope that we are all able to draw attention to community groups and to this process, and encourage constituents to have input.
Like all of us, I am very concerned about the impact of consuming sugary drinks, and I was very pleased today to see that health experts have called for the Coca-Cola Christmas truck tour to be banned. This has been widely reported in the media. I really feel that this is a very detrimental event—this Coca-Cola Christmas truck. It stops at 44 places around the UK, including Cardiff. This Christmas, it was on Queen Street, and there were queues for free samples, which are handed out and that really just encourages children in particular to drink even more Coca-Cola. According to its own website, every can of regular classic Coke has seven teaspoons of sugar in it. I feel particularly strongly against this particular campaign because, in 2016—
Yes, in a second. In 2016, when it stopped at Asda in Coryton in my constituency, the whole of Cardiff was gridlocked because of the excess of people going to get the free Coca-Cola. I just can’t see that this goes along with good health.
I’m sorry that you feel so humbuggy about the Coca-Cola Christmas truck. Will you join me in congratulating Coca-Cola, however, for the way that they have reduced the sugar content of their drinks and expanded the promotion of the zero-sugar alternatives, which now account for over 50 per cent of their sales in the UK?
I welcome any reduction in sugar in drinks, but I think this particular activity is not welcome. I am also disappointed that the UK Government’s sugar tax seems to have been watered down and that things like sugary milkshakes will be exempt, as these can contain just as much sugar as fizzy drinks. I don’t really think that the proposed levy is as high as it could be.
Lastly, I would just like to mention the Daily Mile initiative, which has been mentioned here in this Chamber before and has been taken up by schools in the UK. Of course, one of the first ones to do this was in Scotland and I wondered if there are any examples in Wales. I couldn’t find any examples, but I hope the Minister will be able to tell us, when she speaks, if there are any examples in Wales. It does seem that this is a great concept and so simple to do, when the children arrive in school, to go and run a mile. Thank you.
I would like to thank the Welsh Conservatives today for bringing forward this debate on obesity, particularly just after Christmas, as Angela has said. Doing something good for ‘Jan-YOU-ary’ is a pledge we can all support during National Obesity Awareness Week. It is a matter of national shame that nearly two thirds of Welsh adults and a third of Welsh children are overweight or obese. But we have to deal with obesity in a sensitive way because people react differently, and we don’t want people to look at the size zero in a magazine and think that that is the way that they have to go. So, it has to be a case of educating people in a sensible way.
We must resist the urge to try to solve the obesity crisis by introducing legislation. A sugar tax is not going to magically stop people from drinking sugary drinks, in the same way that duties on cigarettes haven’t had the desired result that we all wanted and expected. We haven’t reduced the number—much—of people smoking. It just penalises those who can least afford to absorb the costs. A sugar tax, apart from being a regressive tax, will also do little to solve the fact that eating healthily is often more expensive than eating junk food. I mean, how often do people through—. You know, they need to get home quickly and they call in and grab a McDonald’s as opposed to going home and cooking. Allotments are now part of the past, really, where we had wonderful veg and fruit, and everything home-grown, which we now class as organic and that for most people is way out of their pricing, or their budget. So what we can do is ensure that we are better educated about the foods that we eat. Schemes such as Change4Life are a great start, but rather than relying on national ad campaigns we should be delivering these messages to every schoolchild in Wales. Part of the new national curriculum should focus on teaching young people how to eat healthily and how to live a healthy lifestyle. The top-down approach hasn’t worked so far, so let’s go for a bottom-up approach instead. Thank you—diolch yn fawr.
National Obesity Awareness Week is about promoting the ways in which individuals, Government, and businesses can improve public health. The aim is to provide the information and resources that can bring about long-term positive changes. This is desperately needed in Wales also. There is a level of obesity in both children and adults that represents a major public health challenge. Nearly a quarter of people in Wales are currently classed as obese.
Deputy Presiding Officer, according to the child measurement programme for Wales, more than 26 per cent of children in Wales are obese and overweight. What, actually, it is is what we take in and we don’t take out in the body—actually, we don’t burn calories. That is the area that we have to look at very carefully, and we have to start from the children, as my honourable colleagues have already mentioned. The children, when they go to primary schools—I think every school in Wales should have a trampoline. The children should enjoy the game and also burn their calories. Most of the school fields have gone for these developments for housing. For God’s sake stop that nonsense and leave these playing fields for children to go and play in the grounds and make sure the calories are burned, as we did in our childhood.
Basically, there are a lot of other things in life that we have to learn. Only standing for two or three hours a day—don’t do anything—and, my friend, it will actually reduce 4 kg in a year in your body, if you just stand; pity we only stand here for five minutes. But if you add up in a year half an hour standing—ladies in the kitchen, children playing around, all these minor things. All these—[Interruption.] We must, basically—[Interruption.] Obesity is getting serious. We’ve got one doctor in this Chamber. There are very serious diseases that are directly linked to this problem—heart, lung, kidney, liver; you name it—there are serious fatal diseases.
And the children, right from the age of 16—and when you’re young and smart, but, when you’re 40 and above, you become obese. That is not right. It is actually not putting the body into active real life and then giving a contribution to the community. It is costing the British Government virtually—it is costing us, the Welsh Government, £1.4 million a week. The national health service—this is serious money. It is not a laughing point, my friends. It is a serious point: £1.4 million a week. Our NHS is actually under strain to look after these diseases directly linked with obesity. So, we have to do something about it.
The British Heart Foundation says that Wales has the highest prevalence of heart failure in the United Kingdom, with more than 30,000 people diagnosed. What a shame. It is clear we need a programme of preventative initiatives to promote public health in Wales. But the Welsh Government approach to tackling obesity is delivering inconsistent results, with little sign of the level declining. The proposed Public Health (Wales) Bill has already been criticised for not including any provision aimed specifically at tackling obesity. We need a strategy in educating people and this must start in our schools, as I said earlier.
Deputy Presiding Officer, there are other areas, there are many areas in the world—. The Chinese—when you go to China, India and other countries, you go out in the morning and the parks are full of people doing exercises. But look at our parks, our areas. We’ve got beautiful landscapes in Wales, but I’ve yet to see the people going out and doing some exercises. What’s the problem? This is some—[Interruption.] Why are we spending money? It won’t cost us anything. Just come out in your gardens and do some exercise.
I know I’m not the right example myself, but—[Interruption.] I must admit—[Interruption.] We must do what we preach, but the fact is, our children—we’re talking of a generation, believe me. Ladies who are obese, it’s actually not helping for our next generation. Those of child-bearing age get problems; they cannot produce more children. Obesity is one of the direct—[Interruption.] The doctor is there. The doctor is sitting there. You can confirm with the doctor. This actually is declining. There is also—[Interruption.] There are, I said, many problems, directly linked, in health, directly to obesity.
Deputy Presiding Officer, the last point is that we must support—
No. No, I—
All right, thank you.
Thank you very much. I must just say, though, I would like to think that men who are standing in kitchens as well could do some exercise at the kitchen sink. My husband certainly does when he’s doing the washing up. I call the Minister for Social Services and Public Health, Rebecca Evans.
Thank you, Deputy Presiding Officer. Also, thank you for dealing with that point so I didn’t have to. I’d like to thank Members for what I think has, on the whole, been a really interesting and useful debate. ‘Taking Wales Forward’ commits us to developing and delivering four cross-cutting, Government-wide strategies, including our healthy and active strategy. So, this approach will prompt a change in the way that we identify and respond to some of those really stubborn societal issues that are complex and cross-portfolio and which do require a multi-partner approach. Tackling obesity is obviously one such issue.
I think it’s fair to say that we do do a great deal to support people in Wales to make healthy and active choices and to try and maintain a healthy weight, but it is clear that we can’t make the improvements that we want to make on our own. If we are to ensure that the vision of the Well-being of Future Generations (Wales) Act 2015 becomes a reality, we do need a whole-of-society approach to maximise well-being today and to ensure that the behaviours that benefit health tomorrow are well understood and acted on both by Government, our other partners, and, crucially, by individuals themselves.
The Public Health (Wales) Bill will further progress our efforts to embed health and well-being in all policies and programmes. It builds on the work of the future generations Act by providing Ministers with the power to stipulate the circumstances in which public bodies must carry out health impact assessments, supporting them to consider more systematically how their decisions and plans can contribute to improving health and well-being whilst minimising any negative impacts.
Obesity is a complex problem with no easy answer. We know that addressing it requires commitment right across Welsh Government. Many policy areas are already playing their part: planning, education, health, procurement, sport—they and others all have a major contribution to make. It also requires—[Interruption.] Yes, of course.
Thank you for taking the intervention. In Newport, Minister, as I think you’re aware, we have a Fit for Future Generations group bringing together all those sectors you mentioned to try and get a more active local population. Is that the sort of initiative that the well-being bonds might support in due course?
The initiative that you describe in Newport—I haven’t had the opportunity yet to come and visit, but I’d be really keen to do so because I do know that that is a really good example of partners all coming together in order to address physical activity and well-being and health more widely.
In terms of the well-being bond, this project is very much at its infancy in terms of the concept and we are working with officials, again across different Government departments, to pull together the vision for the well-being bond. We’ll certainly be in a position to say more about that in due course.
Tackling obesity, though, does require commitment from ourselves in Wales and beyond, including the UK Government and the food industry itself. A lot of it does rely on people themselves meeting us halfway and taking that personal responsibility. But, to support this, we do need to create the right environment, where choosing healthier foods and drinks is an easy option and where there aren’t barriers to being physically active. We also need to empower individuals through ensuring that they have adequate skills, knowledge and motivation to make the right choices.
Responding particularly to the Plaid Cymru amendment, we’ll continue to lobby the UK Government to take tougher action on the promotion of unhealthy foods to children particularly. We’re closely monitoring the development of the sugar levy for soft drinks and the action being taken forward to reduce sugar through voluntary food industry targets. These have worked, I think it’s fair to say, with regard to a reduction in salt, but if it’s not successful for sugar then we’ll certainly consider calling for a mandatory approach.
Within our competence, we continue to work through settings-based approaches, including through schools, hospitals and workplaces, and we’re taking the legislative approaches through the Active Travel (Wales) Act 2013 and our nutrition standards. We’re also employing social marketing and other campaigns, such as Public Health Wales’s 10 Steps to a Healthy Weight. There are many different community-level approaches being taken forward, and I do believe that these have to maintain some flexibility, enough to recognise the different needs of our different local communities. I’d have insufficient time, really, in the four minutes or so that I have to talk in detail about all of these today, but I have described them in previous statements and debates and I’m more than happy to provide further details in future, but I recognise one thing I haven’t talked about in detail in the Chamber previously is the all-Wales obesity pathway, and that sets out our approach to prevention and treatment, and it was mentioned by a number of speakers today. It does include minimum service requirements that health boards should be working towards, and I just wanted to reassure Members that I’ve personally challenged the health boards through my meetings with the chairs to increase the pace of implementation, particularly at level 3 and level 4 of that pathway and obviously would be keen to update Members in due course as well.
I hope, really, that what I’ve been able to set out has reassured Members that obesity and tackling it is very much a key focus for this Government, and we are putting in place the necessary infrastructure for a much more systematic and effective way of working right across Government departments and portfolios in order to tackle it.
Thank you very much. I call on Suzy Davies to reply to the debate. Suzy.
Thank you, Dirprwy Lywydd, and thank you, everyone, for taking part in the debate today. I, too, like Oscar, am not exactly standing here in a position of strength, but I do want to contribute and sum up today’s debate. We had an individual Member debate just before the Christmas recess, if you all remember, and the scene was set for this debate then. Jenny Rathbone opened that debate with three ways of tackling what I think we all accept by now is a growing problem, with long-term effects, of a condition that society tends to represent through the medium of fashion, through body image, through fad diets—the sorts of things that Caroline Jones was mentioning. And if the magazines we buy and the programmes we watch and the adverts we see don’t begin to change that narrative then genuinely I think you as a Government and we as an Assembly are going to have an uphill struggle trying to get sporadic nudge-based awareness-raising campaigns to have any impact at all. And, at the same time, people of all ages remain vulnerable to the dark side of those glossy magazines and social media and the Sky Living programmes that we all know about, so that we end up with the sort of things—or, shall we say, threats—that Bethan Jenkins mentioned earlier on in the debate, in her intervention to Angela.
It’s why I’m no fan at all, I’m afraid, of using public disapprobation of food and eating as a tool of population behaviour change as we’ve done, perhaps, with smoking and as we’re now starting to do with alcohol. It really does need a completely different approach. None of the ideas we’ve heard of today can be overlooked. They’ve all been really, really good ideas; we’ve heard a lot of them before, but we have to take a sort of reality check, I think, in what these things can look like in real life. We need some genuine, quite firm, political will here as well as public education in order to get through, or make sure that really good ideas don’t suffer from anchors of things that don’t work, and I’ll just give you some ideas of what I’m talking about.
So, for example, I think we’ve all, in turn, over the last five years or so, applauded the idea of the reintroduction of home economics, and Angela mentioned today more space for PE on the school curriculum, but is there the political will to create space on that curriculum, or even to create a longer school day to make sure that that is included? The various healthy school initiatives—I really liked, actually, the evidence you gave in the previous debate, Jenny, about the Flintshire experience and what’s going on up there, but, you know, I tend to think that, however well informed a teenager is, however early we say that eating apples is good, as we do in primary schools to some good effect, you give your standard teenager the opportunity to go out at lunchtime and grab a McDonald’s and that’s what they’re going to do. So, is there the political will to say, ‘Actually, nobody should be leaving school at lunchtime’? I’m not necessarily advocating that, but these are questions I think we have to address to make this stuff happen.
Sugar tax: how high do you go? I am very sad in having tracked the cost of a Mars bar, from when decimalisation was introduced, from 3p to 65p over a lifetime. The size of the Mars bar has shrunk considerably. I am still buying them. I know that they’re bad for me. How expensive do you have to make them to make people stop buying them? And that question matters in poorer communities where access to a variety of shops is really difficult.
On exercise, Dai, as a shorty, I probably take far more steps over a given length than, say, Nathan Gill here. [Laughter.] And, do you know, you are absolutely right about walking: it’s free, but time-poor sluggish individuals—I’m not even talking about me on this occasion—are put off walking by simple things like the weather and, in terms of younger people, by safety. People have been in this Assembly for long enough to know that I’ve talked about safety. [Interruption.] I’m going to mention cycling in a second, but I’m running out of time, okay? So, finally, what I wanted to say about active travel, and for cycling as well, is: please make ‘safety first’ the key ingredient, because if it’s not, it ain’t going to work.
Thank you very much. The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Thank you. Therefore, we’ll defer voting under this item until voting time.