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Critically discuss the approach suggested to tackle obesity in the White Paper - "Choosing Health: Making Healthy Choices Easier".

In November 2004 the Government honoured one of its election promises by producing a White Paper, Choosing Health: Making healthy choices easier. Its prime objective was to improve the health of the Nation by putting in place strategies, goals and guidelines which would have the effect of raising the general standard of the Public Health.

This White Paper is actually the current culmination of a series of previous publications and discussion documents which have been leading, in a manner of evolution, to the current state. A good example of this is the setting up of the National Service Frameworks (NICE 2000) in the NHS and the papers such as Better Health: Better Wales (1998). These initiatives were consolidated in a paper by Halligan (et al.2001)and set before Parliament by Liam Donalson (Hansard 2001)

This particular Government White Paper has a number of different strands but we are specifically concerned in this essay about it's measures for tackling obesity.

Before we consider the matter in detail, we have to consider the question Is obesity in the UK a significant problem? The answer is an unequivocal Yes. If one looks at evidence such as the Health Survey of England (2001) we can see that obesity levels have trebled in the past 20 years with an estimated 24 million adults being either overweight or clinically obese and the levels are rising.

The National Audit Office has published a projection that by 2010, 25% of the adult population will be obese and cost the NHS an estimated 3.6 billion at current monetary rates. (2001)

One major issue to be confronted is the issue of choice.

There is a large body of evidence to suggest that obesity is associated with increased levels of morbidity, but it can be argued (with a degree of justification) that each one of us makes a choice as to whether we are going to be obese or not. This underpins the comments made by Tony Blair in the paper's foreword where he points out that the object of the paper is not to be enforcement but one of advice and prescriptive measures to help the individual achieve what they want in terms of a healthier lifestyle. The phrase he chooses is :

Choosing health sets out how we will work to provide more of the opportunities, support and information people want to enable them to choose health. It aims to inform and encourage people as individuals, and to help shape the commercial and cultural environment we live in so that it is easier to choose a healthy lifestyle.

Specifically the paper sets out its various objectives of - Informed choice, Personalisation, and Working Together ( by which it means involving agencies such as the NHS and employers generally) to try to achieve the desired goal.

It specifically outlines, in regard to obesity, its rationale for doing this. It cites the rapid expansion in childhood obesity in the past decade as a cause for concern in terms of health risks in the future as a reason and then specifies some examples such as heart disease, cancer, diabetes, stroke, high blood pressure, high cholesterol and a range of factors critical to our health as direct sequelae to this statement.

It has to be said that when reading the measures that the Government proposes, there are indeed, few concrete proposals which will clearly be seen as having a direct and major impact on the levels of obesity. As outlined in the foreword, the strategy is mainly one of informing people of food content ( Food labelling proposals), giving them the knowledge of how to eat sensibly (Information to the Public campaign) and how to have a healthy lifestyle (Health Direct). Perhaps the only exception to this is the prescriptive changes to be made in the provision of school food (National Healthy Schools Programme) which is laid out quite specifically and due to be rolled out nationally between 2006-9.

On a wider community based approach the Government proposes to set up cookery clubs and to promote the 5 A DAY initiative to be actioned by 2007. This can be supported evidentially by the paper by James (et al 1997)

For those who are already suffering from obesity, the NHS will receive new funding for treatment of obesity-related illness and advice on weight loss, and motivational courses for weight change

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Conclusion

In critically assessing the Government strategy in this paper one has to assess the validity of the message that it contains. There are no references in the Government White Paper to any form of authority for the views expressed, and this may be considered by some, to be a shortcoming

In terms of evidence for the links of obesity with morbidity, one only has to look to papers such as McCarthy (et al 2003) and the statistics from the National Audit Office (2001), which show that in 1998 an estimated 30,000 deaths were attributable to obesity. Obesity reduces life expectancy, on average, by nine years.

References

Better Health: Better Wales (1998) Government White Paper HMSO: May 1998

Choosing Health: making healthier choices easier 2004 Government White Paper HMSO: 16.11.2004

Donaldson L Secretary of State for Health 2001 A statement Hansard: Feb 2001

Halligan, Liam Donaldson (2001) Implementing clinical governance: turning vision into reality BMJ 2001;322:1413-1417 ( 9 June )

Health Survey England 2001: Government publication HMSO: 2001

James W., Michael Nelson, Ann Ralph, and Suzi Leather 1997 Socio-economic determinants of health: The contribution of nutrition to inequalities in health BMJ, May 1997; 314: 1545.

McCarthy, Sandra M Ellis, and Tim J Cole 2003 Central overweight and obesity in British youth aged 11-16 years: cross sectional surveys of waist circumference BMJ, Mar 2003; 326: 624.

NICE . 2000 Guidelines on information for diabetics HMSO.(2000)

Tackling Obesity in England, 2001 National Audit Office, HMSO: 2001

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