|
Campaign for Health Service Democracy
Sheila Porter-Williams,
Green Haven,
Halfway Lane,
Dunchurch,
Rugby,
Warwickshire,
CV22 6RD
Telephone 01788 811438
24 May 2004
Choosing Health? Project Team,
Department of Health,
Room 528/9 Richmond House,
79 Whitehall,
London,
SW1A 0NS.
Dear Sir/Madam,
The aim to promote healthy lifestyles must be right.
Before responding to the questions addressed to individuals and communities on
how to achieve this aim, we have one reservation which the Government and the
medical profession must take very seriously.
Ministers and doctors have suggested that the national
health service might refuse treatment to people who are ill as a result of their
own fault, such as because of an unhealthy lifestyle. We have evidence that
some doctors actually refuse treatment to people because they are over-weight,
smokers, alcoholics, drug abusers, or mentally infirm. This rationing of
medical treatment according to moral judgment is totally improper. People whose
illnesses appear to result from unhealthy lifestyles have reached their present
conditions for many reasons, including lack of knowledge, accidents, misleading
advertising, social pressures, unhealthy and dangerous working conditions,
compulsion during military service, hopelessness, addiction, and genetic factors
that cause conditions which superficially seem to be self-inflicted. While we
should work hard to reduce the impact of such factors for the future, we should
resist any temptation to punish people for their ill health, however it may have
been caused. If an unrelated medical condition results in clinical objections
to the usual treatment, this is a challenge to be overcome, and there should be
a shared balancing of risks and benefits of treatment.
We respond to the specific questions as follows.
1.
Information is widely available in general terms.
Labelling of food products is inadequate. Usually the writing is too small to
read easily.
Misleading slogans such as “92% fat free milk” and “No added sugar” in products
containing artificial sweeteners should be banned. Packaged products containing
no added sugar, salt, fats or artificial ingredients should be readily
available. The Government should establish standards for such products and an
easily recognisable mark should be applied to products complying with such
standards, and scorings allocated for increasing levels of unhealthiness.
Priority should be given to introducing such products for young children who
have not yet become accustomed to a diet in which everything is sweetened and
salted.
The implications of the technical data on labels are far from clear. The
labelling regulations should be amended to require conspicuous statements
showing how the contents relate to the recommended and safe maximum daily
intake. For example a label might say in legible lettering:
This tin of soup contains two servings. Each
serving contains the following ingredients which can be unsafe in large
quantities (and for some people may be unsafe in much smaller quantities):
|
Ingredient |
% of recommended daily intake |
% of maximum safe daily intake for a normal
adult |
|
Calories |
25% |
20% |
|
Salt |
50% |
41% |
|
Sugar |
25% |
22% |
|
Fats |
40% |
32% |
|
Of which saturated |
70% |
58% |
|
Artificial sweeteners |
No recommended daily intake
|
280% |
|
Pesticide residue 1 (to be named) |
No recommended daily intake |
50% |
|
Pesticide residue 2 (to be named) |
No recommended daily intake |
1100% |
More needs to be done to encourage
healthy activities, such as cycling to school. There need to be long term
programmes for cycle paths and removing through traffic from residential
streets, to enable healthy choices also to be safe choices. Adequate security
needs to be provided to prevent children walking or cycling home being
intercepted by paedophiles, bullies, drug dealers, etc.
2.
There are at least two aspects to encouraging healthier choices.
Inducements to unhealthy choices should be taken away, and healthy choices
should be readily available.
Advertising that will be seen by young children needs to be much more
restricted. For example advertisements for confectionery should not be shown on
television before 9 pm. Shops selling food generally (including supermarkets)
should be banned from giving special prominence, such as alongside tills, to
items like sweets that would be impulse buys for young children. Commercial
sponsorship of events and services for children should only be allowed if it can
be demonstrated not to encourage unhealthy choices. For example school vending
machines should include in items on sale unsweetened drinks, fruit, unsalted
sandwiches etc.
The experience of a large proportion of young people consuming illegal drugs
shows that even when unhealthy choices are not legally advertised or available,
people will still make illegal choices. This problem may lessen if policies and
resources could encourage activities which are more beneficial (or at least not
damaging) and diminish hopelessness, unemployment and alienation.
Education in preparation of whole foods should be reintroduced into schools.
Healthy choices need to be readily available. This would include all kinds of
institutional catering. People who are housebound or in institutional care
should have advice and facilities for appropriate exercise.
3.
Public health is affected by all aspects of Government policy,
including housing, air and water quality, land use policy, access to leisure
facilities, transport and employment. Where landlords are currently obstacles
to home improvements, compulsory powers should be extended
Information on health living should be available in appropriate languages for
each locality. This does not necessarily mean written materials. In many
instances briefing of community leaders and promotion of debate within
communities may be more appropriate.
Health checks should be readily and conveniently available, both near the home
and near places of work. Screening programmes should be extended to all medical
conditions where the screening results are reliable and effective treatment can
be made available.
Taxation policy should be modified in two ways. As individual poverty is one of
the strongest predictors of ill health, the levels of taxation and benefits
should be changed towards reducing inequality of disposable income. VAT should
be charged on packaged and takeaway foods that do not comply with a high
objective standard of healthiness.
We oppose fluoridation of water supplies. Fluoride toothpaste will supply all
the potential benefits and can be avoided by the minority of people who are
injured by fluoride in water. It is not acceptable to force a small number of
people to injure their health in order to prevent injury to others who could
avoid injury by their own actions.
4.
Smoking should be banned generally in enclosed public places and
workplaces. In residential homes no resident should have to enter any room
liable to passive smoking.
5.
Most of the changes that we advocate above will require Government
action, either through formal regulation or by promoting and monitoring the
implementation of codes of good practice, which are only likely to make progress
if the threat of regulation is in the background.
6.
The necessary changes need leadership, from the national government
downwards. Where people are role models, they should be encouraged to display a
healthy lifestyle. Initiatives by schools, employers etc may deserve wider
replication, and the media should be encouraged to publicise innovative good
practice.
Regeneration projects need to have enough time to achieve their aims. If they
are making useful progress but have further work to do, funding should not be
cut off when the initially approved time period has elapsed.
Yours sincerely,
Sheila Porter-Williams
|