Government White Paper: "Choosing Health"

The much anticipated White Paper: "Choosing Health: making healthier choices easier" (CM6374) was published on Tuesday 16th November and is available on the Department of Health website.

The document sets out a "wish list" of how public health may be improved, it covers measures for cutting smoking, obesity and excessive alcohol consumption, for improving sexual and mental health and extending the availability of the existing NHS Direct service.

The White Paper covers such a broad range of issues that it has importance to all organisations, not just the food, tobacco and hospitality industries. The government, within the White Paper, has specifically committed itself to build health into all future legislation by forthwith including health as a specific component in regulatory impact assessment.

Health & CSR at Work

"Health" is considered not just in relation to consumables such as food, alcohol and tobacco, but also "employment for health" dealing with how employers can best support and promote the health of employees. The Health and Safety Executive's (HSE) recently published management standards for stress in the workplace and "best practice approach" to help the proactive management of long term sickness absence are both referred to as examples. Corporate social responsibility is addressed in the context of employers creating an environment that helps people make health choices, (an example referred to was the tax efficient bicycle purchase from salary to promote the physical activity of cycling to work.)

These concepts might be perceived as slightly woolly but the intended aim is reducing long term sickness and creating a more productive workforce.

Smoking

An aspect of workplace health that the White Paper proposed specific legislation on is smoking in enclosed places. This was the one area where legislation is actually to be implemented and the government what it views as the lack of substantial voluntary progress since the earlier 1998 White Paper Smoking Kills.

Legislation is proposed as follows:

• All enclosed public places and work places (other than some licensed premises) will be smoke free;
• Licensed premises will be treated as follows:
• All restaurants will be smoke-free;
• All pubs and bars preparing and serving food will be smoke free;
• Other pubs and bars will be free to chose whether to allow smoking or to be smoke-free;
• In membership clubs the members will be free to choose whether to allow smoking or to be smoke free; and
• Smoking in the bar area will be prohibited everywhere.
• The timetable for this would be by the end of 2007 for all enclosed public places and workplaces (other than licensed premises) and by the end of 2008 for licensed premises.

As a corollary, there will be tighter restrictions on advertising of tobacco and the government will consult on how to use picture warnings on tobacco products most effectively.

Food & Alcohol

Other than issues connected with the NHS, work in the community and education; the main consequences of the White Paper concern the promotion and labelling of food and alcohol in respect of reducing obesity and binge drinking.

Obesity

All proposals in relation to labelling and promotion of foods will be voluntary. However, this will be monitored and if, by early 2007, these measures have failed to produced a change in the nature and balance of the promotion, the government threatens to take action through existing powers or new legislation to implement a framework for regulating the promotion of food to children.

One aspect, which it is stated a legislative approach will be taken would be via the UK presidency of the EU in 2005 in order to adopt political pressure to simplify nutrition labelling and make it mandatory on packaged foods.

Voluntary proposals on reducing obesity are as follows:

• Signposting: by mid-2005 it is proposed there would have been introduced a system that could be used as a standard basis for signposting food. These criteria will also be used among things to identify which foods can be promoted to children.
• Product development: the development of healthier foods;
• Labelling information: developing nutrition labelling and associated messages beyond legal requirements;
• Promotion and pricing: communication strategies to promote healthier eating, including fruit and vegetables, through point of sale information, leaflets and websites;
• Customer information and advice: including healthy eating and the promotion of sensible drinking messages to combat alcohol misuse.
• Increasing the availability of healthier food, including reducing the levels of salt, added sugars and fat in prepared and processed food and drink and increasing access to fruit and vegetables;
• Reversing the trend towards bigger portion sizes; and
• Adopting consistent and clear standards for information on food including signposting.

The proposed targets, development of guidance on portion sizes and actions to take forward these policies will be published in a further white paper; Food and Health Action Plan, to be published in early 2005. The industry has already been implementing a number of these proposals in particular in reducing salt and fat content and portion sizes and introducing healthier ranges.

One aspect of the proposals that is likely to become a bone of contention between industry and the FSA would be the development of any signposting system and how it would operate. By March 2005 the FSA proposes it will have published a set of nutritional criteria. The White Paper proposes a goal of early 2006 for there to be a clear, straightforward coding system that is in common use and that can be understood at a glance in operation. This "signposting" of foods may be seen by some as the useful provision of information to consumers and by others as a misleading subjective nutritional view of a specific food as opposed to the promotion of a healthy diet as a whole.

Signposting remains a voluntary proposal but one which is likely to be taken up by retailers but we have not, as yet, reached the stage of placing warnings on high fat or calorific foods. The further consultation on how this system might operate is awaited.

Advertising of food and alcohol

Reports from the Food Standards Agency (FSA) and Office of Communications (OFCOM) were examined in relation to food advertising to children. The FSA's view was that action to address the imbalance in TV advertising of food to children is justified but it is the cumulative effect of television advertising combined with other forms of promotion and marketing that results in the significantly greater effect than television alone. The OFCOM report concluded that television advertising has a modest direct effect on children's food consumption but the significance of this is small when compared to other factors potentially linked to childhood obesity such as exercise, trends in family eating habits , parents' demographics, school policy, public understanding of nutrition, food labelling and other forms of food promotion.

The White Paper concludes that to have maximum effect, action needed to be comprehensive and taken in relation to all forms of food advertising and promotion, including; broadcast, non-broadcast, sponsoring and brand sharing, point of sale advertising and labels, wrappers and packaging. Possible options of restriction are:

• When, where and how frequently certain advertisements and promotions appear;
• The use of cartoon characters, role models, celebrities and glamorisation of foods that children should only eat seldom or in moderation as part of a balanced diet; and
• The inclusion of clear nutritional information e.g. the signposting system, and/or balanced messages in advertisements to counteract the influence of high fat, salt and sugar food advertisements.

These options would be dependent upon the nutrient profiling scheme that would be developed between the Department of Health and the FSA. Once again, the level of restriction will depend upon where the food falls in the nutrient profiling to be provided by the FSA.

Further, the White Paper proposes strengthening existing voluntary codes in non-broadcast areas including the setting up of a new food and drink advertising and promotion forum to review, supplement, strengthen and bring together existing provisions; and contributing funding to the development of new health initiatives, including positive health campaigns.

Alcohol Advertising

The main proposals in relation to alcohol and advertising have already been instigated by way of OFCOM, which has statutory responsibility for the regulation of broadcast advertising, and which has published its code amendments aimed at significantly strengthening the rules in many areas, particularly to protect the under-18s. The new rules were published on 1st November 2004 and will come into force on 1st January 2005 applying to all advertising campaigns conceived after that date. (There is a grace period allowed until 30th September 2005 for advertising who will already have committed themselves to campaigns which might not comply with the revised rules). The requirements of the revised rules are that:

Advertisements for alcoholic drinks on television must not be likely to appeal strongly to people under 18, in particular by reflecting or being associated with youth culture;

• Advertisements must not link alcohol with sexual activity or success or imply that alcohol can enhance attractiveness;
• Television advertising for alcoholic drinks must not show, imply, or refer to daring, toughness, aggression or unruly, irresponsible or anti-social behaviour; and
• Alcoholic drinks must be handled and served responsibly in television advertising.

Alcohol & Voluntary Social Responsibility

The UK government has already introduced an "alcohol harm reduction strategy for England" which already included a social responsibility charter for drinks producers which proposed:

• New measures to ensure advertising does not promote or condone irresponsible or excessive drinking;
• Putting the "sensible drinking" message clearly on bottles alongside information about unit contents;
• Drinks companies pledging not to manufacture irresponsibly;
• A move to packaging products and safer materials;
• The industry contributing to a new fund to finance innovative schemes to address alcohol misuse at national and local levels.

As well as a new "code of good conduct" scheme for retailers, pubs and clubs, this code is run locally by partnership of the industry, police and licensing panels and led by the local authority, dealing with such issues as under-age drinking, alcohol related health problems and alcohol related crime and disorder in town centres as well astargeted education information for local schools about the dangers of alcohol misuse.

The White Paper further refers to a Voluntary Social Responsibility Scheme for alcohol producers and retailers to protect young people by:

• Placing information for the public on alcohol containers and in alcohol retailer outlets;
• Including remainders about responsible drinking on alcohol advertisements; and
• Checking identification and refusing to sell alcohol to people who are under 18.

Conclusion

The White Paper, although short on detail in the legislation it trails and reiterating existing policy initiatives in many respects, does mark a definite shift in government approach towards greater intervention in aspects of life hitherto considered as matters of individual choice. For businesses in the UK the White Paper signals important elements of the Corporate Social Responsibility agenda with new clarity. Welcome or not, this is at least preferable to the agenda being driven by mass tort litigation as it has been in the United States.