England’s chief medical officer has called on the government to consider imposing taxes on foods high in sugar and salt, as it has done with sugary drinks, and accused the food industry of failing to help deliver healthier diets.
In her annual report, Dame Sally Davies said tougher action was needed. Obesity and diseases such as type 2 diabetes were taking a huge toll of health and the economy, she said, and a voluntary agreement with the industry to lower sugar and salt content had not worked.
“The food industry has not done enough,” she said. “They were asked by Public Health England to reduce sugar by 20%. We have recently heard that they have not achieved their present target and we know there is too much sugar and salt in our diet.”
Sugar delivers empty calories with no nutritional value and is a big contributor to obesity. One in four children are overweight or obese when they start primary school, rising to one in three children at the age of 11. Salt raises blood pressure, contributing to heart disease, heart attacks and strokes.
From 2003 to 2011, the UK was a world leader on salt reduction thanks to the tough approach of the Food Standards Agency, Davies said. However, the FSA was merged into Public Health England, and the former health secretary Andrew Lansley set up a voluntary “responsibility deal” with the industry.
“The government moved salt into the responsibility deal. Industry have not delivered. We have a system where people are benefiting from selling unhealthy foods and they are not paying for the harm that it is doing,” Davies said.
Figures released by PHE this week showed that just half of the salt reduction targets set for 2017 had been met. Davies said people were consuming on average 8.1g of salt a day. “We need to bring that down to 7g a day. That will save lives and it is wrong that we are not doing it.” In the longer term, she said, salt levels should come down to 6g a day, in line with World Health Organisation guidance.
She wants a ban on added sugar in baby milk and baby foods, and is calling for the sugar levy to include milk drinks that contain added sugar. Her report also recommends incentives to increase fruit and vegetable consumption, such as price subsidies.
Davies, whose report looks forward to 2040, is calling for a “repositioning” of the role of health in society, to ensure it is recognised as “the nation’s primary asset”, with healthy behaviours normalised and healthy choices becoming the easy choice.
The report points to the economic arguments for prioritising health: people in good health stay in the workforce and do not cost the NHS money. Half of the nation’s chronic disease burden and 40% of cancers are attributable to poor diet, smoking, physical inactivity, alcohol and air pollution, the report says. There are nearly 4 million people with diabetes, mostly obesity-related type 2, which costs the NHS about £9bn a year.
Davies called for a “health index”, to stand alongside GDP and reflect the social determinants of health – which is worst among the poorest and least-educated communities – as well as risk factors such as diet and smoking, and the outcomes from NHS treatment.
Graham MacGregor, a professor of cardiovascular medicine at Queen Mary University of London and the chair of Action on Sugar and Action on Salt, said he strongly supported the call for mandated targets for salt, sugar and calories, “particularly given the very weak approach of PHE in enforcing the current voluntary programmes”.
He said: “Unhealthy food – that is, foods that are high in salt, sugar and calories – is now the major cause of death and disability in the UK. We are calling on the government and the food industry to take immediate action and prevent all these unnecessary deaths and suffering.”
Robert Lechler, president of the Academy of Medical Sciences, said a comprehensive approach was needed. “This means finding smarter ways to reduce unhealthy behaviour while at the same time changing culture to enable the NHS to lead the fourth industrial revolution by responsibly using patient data to improve healthcare.
“We need to see better digital literacy amongst the NHS workforce, accompanied by a cultural shift in the way patient data is used to support health and care. We know from recently speaking to patients, however, that they want technology to support doctors, not replace them.”
Ben Reynolds, the deputy chief executive of the food and farming charity Sustain, said: “As the alliance that led the campaign for the soft drinks industry levy, we’re pleased to see the chief medical officer coming out in support of the future inclusion of sugary milk drinks in this.
“It is really interesting to see the CMO’s support to look more widely at food prices, and how these can be used to encourage more fruit and veg and rebalance with the price of less healthy produce. Good food should be more affordable, accessible and attractive. Only then will we see a shift in consumption away from unhealthy and unsustainable products, which leave taxpayers to pick up the costs through an overstretched NHS and environmental damage.”