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Putting Children at the Heart of Public Health

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05 Mar 2012
Putting Children at the Heart of Public Health

Introduction

I am delighted to give this - my first major speech as Shadow Public Health Minister - here at IPPR.

The theme of my speech is putting children at the heart of public health policy. Because I believe that we are facing a crisis in children’s health and lifestyles.
Part of the “British Promise” that Ed Milliband has spoken must about the expectation that children will enjoy greater health and well-being than their parents
But, Instead, there is a very real danger that significant numbers of today’s children will live shorter lives than their parents and spend more of their years in poor health.

We know that:
• In the Marmot Review, which most people accept as the definitive document on Public Health, Marmot made his very first policy objective the need to “Give every child the best start in life
• The Government’s own Public Health White Paper “Healthy Lives Healthy People” says “taking better care of our children’s health and development COULD improve educational attainment and reduce the risks of mental illness, unhealthy lifestyles, road deaths and hospital admissions”
• Children are the test of any government’s public health policy. They are not in a position to exercise choice. I will make the argument in this speech that the government should not be afraid of intervening to change the environment to help children’s parents, and the community around them, make the right choices

In my speech i want to set out:
• What are the issues are in relation to children and Public Health?
• What are the underlying causes?
• And what families, communities and government should be doing.

The Great Stink of 1858

But, before I do that, I want to take you back to a public health crisis of another century, the Great Stink of 1858. The Thames had always been an open sewer. But by the nineteenth century, there were not just many more Londoners, but the more affluent had taken to installing water closets instead of privies and cess pits. Consequently sewers, originally intended to take rain water into the Thames, carried raw sewage which was then extracted by the private, and wholly unregulated, water companies to be drunk by their customers.
Only four years earlier London had seen its worst ever out-break of cholera. Over 600 people died, all as a consequence of contaminated water. But the summer of 1858 saw a heat wave and the smell of the Thames became literally unbearable. It was particularly so in Parliament. MPs wandered around the House of Commons with handkerchiefs over their mouths. They tried keeping away from the library and other rooms overlooking the river. They tried draping the windows with curtains soaked in a mixture of chloride and lime. But still the smell was unbearable. They even seriously discussed relocating Parliament up river to Richmond.
The politicians of the day, free-marketers to a man, could have entered into a responsibility deal with the water companies selling contaminated water. They could have tried “nudging” people into not tipping raw sewage down the drains.
They could have said in the words of last year’s government white paper on public health “It is simply not possible to promote healthier lifestyles through Whitehall diktat”
In fact in 18 days flat they drafted, debated and signed into law a bill which would promote the first modern sewage system including constructing the embankments on either side of the Thames.
Faced with a public health emergency, under their nose, government was forced to act.
I contend that the health of Britain’s children is just such an emergency.

The Challenges

I may be the Shadow Public Health Minister now, but I’ve been the MP for Hackney for over twenty years. So, I did not had to read reports in order to see and understand the public health challenges facing the this countries children.

• It should be no surprise that nationally admissions linked to alcohol problems have now reached a record high. The government’s own statistics reveal that hospitals in England admitted 1,173,386 patients for treatment for alcohol-related problems in 2010 to 2011, up 9% on 2009 to 2010 (The first time the figure topped 1 million).And between January 2011—August 2011, nearly 8000 of our children and young people were admitted to NHS hospitals for alcohol-induced illness. And it is worth remembering that evidence seems to point to the facts that in a recession, whilst adult consumption of alcohol levels off, young people drink even more.

• Children in Hackney have some of the highest levels of obesity in the country. We know that most excess weight is gained before a child ever starts school. So when Hackney children, rising 5, enter reception class 13% of them are overweight 14% are actually obese. By age 11, 15% are overweight and a quarter is obese. And the national statistics for childhood obesity are not much better. Rising 5 nearly 10% of our children are already obese and by age 11 nearly 20%. And these children are not going to grow out of it. Overweight children become overweight adults with spiralling levels of diabetes and hypertension and even cancer. 79 per cent of 10-14 year olds who are obese will remains so into adulthood. Once malnutrition and rickets were the diseases of poverty. For too many children in 21st century Britain obesity is.

• No public health programme on earth will stop young people experimenting with sex. In Hackney we are proud that we have brought teenage pregnancy down to its lowest ever rate. And nationally the Labour Government’s 10 year teenage pregnancy strategy resulted in a 25% total reduction in teenage pregnancy But rates of STI’s like Chlamydia are increasing with 15-24 year olds the most affected group. .But there must be concern about the growing sexualisation of young women. Too many girls on estates in areas like Hackney think the route to fame and fortune is to pump their breasts and buttocks with silicone. Last year one Hackney girl, Claudia Aderotimi, died in pursuit of that illusion.

• The rate of smoking related deaths in Hackney is one third higher than the average for London. And eight out of ten adults, who have ever smoked regularly, began smoking before the age of 19. On some streets in Hackney it is easier to buy alcohol and fags (and place a bet) than buy fresh fruit. Nationally Labour made real progress on smoking. But it is still the single biggest preventable cause of early death and illness and claims over 80,000 lives a year.

• Hackney has one of the highest levels of severe mental health conditions and depression in London. And emergency mental health hospital admission is rising sharply. And increasingly mental health is an issue for young people. Nationally 3 children in every classroom has a diagnosable mental health disorder and I in 12 are self-harming.. And we know that 50% of life-time mental illness starts before the age of 14.

So it can be no surprise that tomorrow, around 33 sets of frantic British parents will rush to hospitals to collect their children, who have been taken there with alcohol-related illness. And it will be the same the next day, and the next.
This week, scores of children, just starting out in life, will be told that they have diabetes. By 2025 it is estimated that over four million people will have diabetes.
This week many of our children and young people will face up to having a sexually transmitted disease, and everything that comes with that.
And a recent UNICEF study contended that British children - due to a lack of family interaction and the trappings of consumerism – were the "the unhappiest in the industrialized world".

Causation

Part of the public health problems facing our young people is that we live in a very different world in the 21st century from the last half of the twentieth century
When I was a child growing up in a working class community there were still plenty of no-car households and hardly any two-car households. So children routinely walked to their primary school. Now millions of children, even in areas like Hackney, are driven everywhere.
I wasn’t a particularly sporty child. But in the summer holidays I often would play out all day, up and down the streets, from breakfast to teatime. Now responsible parents worry about letting their children roam around outside and young people spend hours playing video games and in front of a computer. No wonder childhood obesity is spiralling.
My family always ate together and I never remember us eating out. Now some children eat take-aways and fast food almost on a daily basis and for many families sitting together to eat at the table is the exception rather than the rule.
There is an issue about availability of both food and alcohol and the proliferation of fast-food outlets.
When I was a child the only place you could get alcohol was an off-licence or a pub. In Hackney you can go into any corner shop and see alcohol for less than the equivalent amount of Coca Cola. Teenagers routinely “pre-load” on cheap supermarket alcohol before heading for a night out.
But there is also an issue of rampant consumerism. Britain had become a hyper-consumerist society in which status has much to do with what you possess and consume. Young people in deprived communities are often desperate to grasp at a consumer society that is within reach of their richer peers.
When you criticise consumerism you are often accused of being anti-aspiration. When it comes to the issue of children’s health I think this is wrong. Everyone aspires for health and well-being for their children. No-one aspires for their children to be obese.
An inability to delay gratification - whether with money, food, alcohol or sex – looks set to become the emblem of this generation, reinforced by advertising and media. By the age of ten, the average British child recognises nearly 400 brand names.
Let me just say a few words about last summer’s riots. .I believe that some of the issues that underlay those riots may also underlie some of our worst public health problems. On the night of the riots I was on the streets talking to the police, residents, shopkeepers and young people. It was a strange experience to be out on the streets of Hackney as areas like the Pembury estate became engulfed in flames, with years of incremental progress burning grotesquely for an international audience.
What we saw last summer was criminality. But it was also an eruption of alienation disillusionment and rampant materialism It is no co-incidence that up and down the country the rioters targeted: sportswear shops, mobile phone shops and betting shops. And it is no co-incidence that life expectancy in Tottenham is some of the lowest in London, ten years less than Kensington.
The ‘Get Rich or Die Trying’ culture is seeping into British public health. The public avidly consumes cookery shows, but wants quick and easy take-aways and ready-meals. Children want the instant gratification that can come from stroking a key in front of a computer, instead of the deferred gratification of learning an outdoor activity. Sex is a commodity and young girls increasingly commodified.
British culture, lifestyles and communities are all being consumed by the flames of consumerism. Meanwhile, many of our greatest public health problems have escalated
Carrying on with the ‘chips and Playstation 3 culture’ is not an option. It’s not about the nanny state – it’s about social justice.


THE GOVERNMENT’S SOLUTIONS
It has pursued ‘chaos theories’ not ‘nudge theory’

The government has posed a completely false polarity between “Whitehall diktat and nannying” and empowering people.
Of course we have to empower people and local communities. But history teaches us that successful public health policy requires at its heart willingness by government to act. It is infinitely harder to achieve agreed change, if business believes that government will never be prepared to regulate.
So it has been with a growing sense of anger and frustration that we have seen this government prioritise big business, ahead of British families, putting crony capitalism at the heart of the government’s public health strategy.
It was a sign of things to come, when in opposition, Andrew Lansley set up a Public Health Commission chaired by Dave Lewis the chairman of Unilever the food multinational that brought you Pot Noodle.

Responsibility Deals
The government has set great store by its “responsibility deals” with big business as an instrument of policy.
But everyone who has looked at them has been sceptical.
The House of Lords Science and Technology Select Committee said “We have major doubts about the effectiveness of voluntary agreements with commercial organisations, in particular where there are potential conflicts of interest”
After all, you cannot expect big business, which makes billions every year by marketing sugary, fatty and unhealthy foods to willingly limit its own profiteering.

And the Children’s Food campaign has said “The food pledges in the Responsibility Deal are minor and allow industry to appear to be helping to improve public health without having to do very much. The current pledges are underwhelming amounting to little more than a continuation of schemes that were being developed anyway by the Food Standards Agency”

Of course we have to work with business, but responsibility deals are not the path-breaking initiative that will produce a step change in the health of Britain’s children.

Nudge

Andrew Lansley has said he wants to nudge people to good health rather than nanny them. He and the prime minister are enthusiasts for the work of the nudge theorists as opposed to regulation. But the House of Lords Science and Technology looked into nudging and concluded “Non-regulatory or regulatory measures used in isolation are often not likely to be effective and that usually the most effective means of changing behaviour at a population level is to use a range of policy tools, both regulatory and non-regulatory. Given that many factors may influence behaviour, this conclusion is perhaps unsurprising”.
And one of the key proponents of nudging Richard Thaler has said that he would have opposed a smoking ban and would have opposed the Clean Air Act – probably the piece of 20th century legislation that has saved more lives in Britain than any other.
Nudge theory is interesting and should be part of the public health policy armoury. But it cannot be a substitute for regulation.
And what we have seen from this government on public health has been closer to the chaos theory than the nudge theory. We still await a number of long promised, policy documents on issues like alcohol. Local authorities still do not know exactly how much public health funding they are going to get. There is still no clarity on who will be commissioning a range of public health services.
In London in particular with it’s the proposals for public health in the NHS bill going trough parliament could be a car crash. Fragmentation threatens work on public health issues like HIV yea
And big business is the ones nudging British children and families towards an oncoming public health crisis. Any positive nudging from this government is overwhelmed by the entire advertising industry's focus on nudging consumers.

So What Do We Do?
It is a year since I took up this post. And I have had the opportunity to travel all over the country talking to patients and health stake-holders.

Alcohol
I am very familiar with issues around alcohol abuse from my own constituency. But in the past year I have been able to travel all over the country and meet a range of experts.
The one message that everybody has pressed home to me is the need for a proper strategy on alcohol abuse and action on PRICE.
Price is not a magic bullet, but you cannot have a serious strategy without it. So I am willing to give the government’s proposals a fair hearing. But we will need to see the detail and study the practical effects.
We should equip young people with the skills they need to resist peer pressure to go out drinking. There are concrete lessons to be learnt from overseas, where tried and tested programmes aim to reduce alcohol and substance abuse through classroom-based education. These types of programmes have had excellent success rates.

Obesity
• The role of parents cannot be stressed enough. Parents are key partners in the drive to halt childhood obesity. The Early Bird Cohort study, led by Professor Terry Wilkins, seems to show that many parents are oblivious of their children’s weight. Hence the regular stories in the tabloid press of outraged parents who have been told their child is too heavy for their age.
• I was impressed last year to visit Manor field Primary school in Tower Hamlets where the voluntary sector organisation MEND run a child obesity program which involves parents. Amongst other things they have to attend classes tackling the social and psychological factors behind over-eating with their children
• Better food labelling (traffic lights) (House of Lords Committee)” We invite the Government to explain why their policy on food labelling and marketing of unhealthy products to children is not in accordance with the available evidence about changing behaviour. Given the evidence, we recommend that the Government take steps to implement a traffic light system of nutritional labelling on all food packaging. We further recommend that the Government reconsider current regulation of advertising and marketing of food products to children, taking a more realistic view of the range of programmes that children watch.”

• Children should be protected from junk food advertising. Not just with a 9.00pm watershed for television but online, through mobile phones, packaging and in-store.
• Maintaining school food standards is vital and the exemptions for academies and free schools should be removed.
• And retaining cooking skills in schools is important. You’re less likely to eat junk if you can cook real food.
Sexual Health
• The government needs to resist nonsense about teaching GIRLS abstinence
• All children and young people should be able to access high quality, comprehensive relationships and sex education. A good relationships and sex education programme should include information on contraception and STIs and also focus on improving relationship skills and knowledge such as communication and negotiation skills

Ed Miliband was right when he argued that we need a country and an economy based on the values of most British people. Something for something. I want to be part of a Labour government that empowers, rewards and incentivise practises and behaviours with long-term public health benefits for our children

We need a national movement that will drive the change we need, and a government that will empower and reward that change.

I think we need to incentivise and reward, in order to rewrite the rules that govern our country, and shape our culture.

Conclusion

Health and the fair distribution of health tell us how we are doing as a society. The wellbeing of our children is a key issue.

The simple answer is: we must do better.

That’s why public health is a top priority for Labour.

That’s why I hope IPPR, and everyone here today, will help shape our thinking on these issues in the months and years ahead.


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