Dolly Theis is completing her PhD at Cambridge University’s MRC Epidemiology Unit. She contested Vauxhall in the 2017 general election.
This article is the second of three I have written about obesity policy for ConservativeHome this week. Yesterday, I set the scene and explained why obesity policy affects us all.
Today, I am excited to dive with you into the Conservative Party’s own history, beginning with Sir Robert Peel, to find out what previous Conservative Party “greats” have done to solve nutrition problems and see what we might learn.
Finally, tomorrow I will set out why I think we have failed to tackle our broken food culture and system and what I think Government should do going forward – which I don’t think will be what you expect. I am hugely looking forward to reading your comments, from the brutal to the thought-provoking.
Obesity returned to the government agenda with a bang in May 2020, when Boris Johnson’s own experience of ending up in intensive care with Covid-19 convinced him of the urgent need to do something about it. The fourteenth government obesity strategy was published two months later. Given we have had so many obesity strategies, why are ministers still struggling to solve it? And can history teach us anything?
In the first year of my public health PhD, I drew up a timeline of all public health policies related to diet and nutrition in Britain from the early 19th Century to the present day to gain some sense of the trajectory leading us here. What struck me first was how repetitive public health policy debates are. Then it was how long-standing and rich the Conservative Party’s own public health policy history is. Writing this at the time of a global pandemic, with a Conservative government feels fascinatingly meta.
The third thing was that what we refer to as “obesity policies” today are largely food and nutrition policies, which link to a long history of such policies preceding obesity becoming a political problem. Food and nutrition policies affect us all. Calling them obesity policies can misleadingly imply they only affect certain people. By understanding this, we can turn to history and, I hope, learn many more insightful lessons.
Before turning to food policy in the early 19th Century, I emphasise that obesity is a complex issue. Although I focus on food policy here, let us not forget that transport, environment, physical activity, housing, education and many other policy areas are critical to the obesity policy debate too.
Right then, over to history. The modern Conservative Party was founded and quickly split up by a food policy: the Corn Laws. Many of you will be familiar with the story which, to embrace concision, goes something like this.
Sir Robert Peel, founder of the modern Conservative Party, becomes Prime Minister for the second time in 1841. In 1845, the disastrous Irish Potato Famine strikes, hammering the nation’s food supply and more than doubling the price of potatoes.
Peel is convinced that repealing the Corn Laws – which artificially elevated grain prices to protect British landowners to the detriment of the urban poor who were forced to spend most of their earnings just to eat – would solve the crisis by opening the trading gates to cheap US corn imports. So repeal them he does. But he isn’t supported by his Party.
One way to remember the split up is by thinking of those who backed Robert Peel’s free trade move as “peeling away” with him from the Conservatives. This group, known as the Peelites, later join forces with the Whigs and Radicals to establish the Liberal Party in 1859.
Why is this relevant to today’s obesity policies? Because it raised the pertinent question of who should be prioritised when it comes to food: food producers and manufacturers or consumers? Peel prioritised consumer access over protecting British food producers. Today we are debating whether to allow cheap US food imports under post-Brexit trade deals and how to prioritise local British-grown produce.
The Corn Laws ignited an ideological division which remains alive and well in the Conservative Party today between free marketeers and those who prioritise other concerns. Today’s neo-liberals believe government intervention and Conservatism are incompatible, and obesity exacerbates this ideological divide more than most issues. Cries of nanny-statism reach operatic levels the moment a politician speaks about it.
Yet if the Corn Laws are often heralded as a free market success story in terms of food access, food access is one thing. Quality is another.
Thirty years later, Benjamin Disraeli’s Government enacted the Sale of Food and Drugs Act 1875, which has been called a “legislative milestone” that set the “foundation of modern food law.” It recognised that food access was only a good thing if it was good quality. Harmful food could be as detrimental as no food at all.
The act dramatically improved food quality, prompting the almost complete disappearance of adulterated tea and bread, and was part of a major set of public health reforms at the time including legislation to improve housing, work conditions, sanitation, and water. Disraeli’s prioritisation of health and food quality over more simplistic celebrations of free market access was beautifully communicated in his 1872 speech in Manchester:
“Sanitas sanitatum, omnia sanitas [health above everything]. Gentleman, it is impossible to overrate the importance of the subject. After all, the first consideration of a minister should be the health of the people. A land may be covered with historic trophies, with museums of science and galleries of art, with universities and with libraries; the people may be civilised and ingenious; the country may be even famous in the annals and action of the world, but, gentlemen, if the population every ten years decreases and the stature of the race every ten years diminishes, the history of that country will soon be the history of the past.”
The Covid-19 pandemic could not be a more relevant context for this quote. Britain’s poorer state of health, including having one of the highest obesity rates in Europe, makes us more vulnerable and is likely to have contributed in part to needing stricter lockdown measures, which in turn has meant we have been unable to maintain (let alone grow) our economy. To echo Disraeli, we can strive for and build the most vibrant free market economy in the world, but if we are unable to cultivate our economy due to being in such poor health then what is the point?
That is not to say that a healthy population and vibrant economy is a zero-sum game. In fact, quite the reverse. Good health should be recognised as something that enables us to build, maintain and enjoy a strong market economy. Same goes for our environment. Healthy planet plus healthy population equals healthy economy long term.
Onto the Second Boer War, 1899-1902. Under Lord Salisbury, the British Army assumed it would be a doddle to defeat the lightly-armed Boers (Dutch settler farmers). They were wrong. One reason for what turned out to be a long, painful and expensive battle was the struggle to recruit healthy soldiers. More than half of the volunteers (mainly working class) were rejected because of their poor physical state. In some towns, almost all were rejected.
The Unionist Government (first under Salisbury then Arthur Balfour) established the Committee on Physical Deterioration in 1903, which identified this cause and recommended introducing regular measuring and weighing of people, mandatory school medical inspections, free school meals for the poorest, and mothering training for working-class women. Poor diet had become a defence issue. Unhealthy soldiers do not win wars.
Flick forward to another war – World War II – and food was back on the policy menu. Instead of famine leading to food scarcity like in Ireland, war was the cause, but this time the government prioritised access and quality. Lord Woolton was put in charge of the Ministry of Food, set up in 1939, to keep the population fed. He recognised the long-term health benefits of good feeding, so never compromised on nutrition. Addressing the Warwickshire Women’s Institute, he said, “the young need protection and it is proper that the state should take deliberate steps to give them opportunity…feeding is not enough, it must be good feeding. The food must be chosen in light of knowledge of what a growing child needs for building a sound body.”
Woolton’s food policies included his ‘Dig for Victory’ campaign, which encouraged people to grow their own food and turned gardens, waste land and even bomb craters into allotments, and publishing recipes for nutritious foods such as the veggie-packed Woolton Pie. Woolton’s policies meant that many people consumed a more nutritious diet than in the pre-wartime years, and they indeed had profound impacts on health outcomes including lowering infant mortality rates.
What can these wartime governments teach us? As before, what the Government does now regarding food policy at a time of crisis will have long term health outcomes. For example, Rishi Sunak could have channelled Woolton when he introduced ‘Eat Out To Help Out’ by making it conditional on restaurants committing to certain long-term health and environment goals, such as offering more healthy than unhealthy options to make it easier for consumers when eating out, and for us to shift towards a healthier eating out culture longer-term (I note that healthy should mean delicious so please don’t fear limp salads replacing your Nando’s chips). For restaurants needing time to make these changes, a feasible timeframe and necessary resources could be worked out transparently, in partnership with the sector.
Brexit also presents a panoply of opportunities to prioritise long-term planetary and population health, of through our trade deals. The first food minister since Woolton was appointed in 2018 to devise post-Brexit food trade deals. He has since been replaced by Zac Goldsmith, so we never found out if David Rutley, a former senior executive at Asda and PepsiCo International, would have gone down the nutrition-above-all route. That’s up to Goldsmith and Liz Truss, the Trade Secretary, now, and since Parliament just voted against amendments to the Agriculture Bill which would prioritise food standards, animal welfare and the environment, their leadership in prioritising health is critical.
Back to history, and there’s little doubt that Winston Churchill’s Government prioritised health at a time of crisis. In the middle of World War II they introduced school food standards, mandatory fortification of margarine with vitamins A and D, and commissioned the first food labelling order. Under his post-war Government the first nutritional recommendations were set by the British Medical Association and rationing came to an end in 1954 (much to the delight of Churchill himself, who consumed more than his ration allowance – which he may well have justified as being for “me, myself and I”).
Focus in the 1960s and 70s shifted towards building the evidence on the link between diet and disease outcomes, most notably heart disease. Several Committee on Medical Aspects of Food Policy (COMA) reports were published, including under Edward Heath’s Government, and a low-fat diet was strongly recommended as a way to tackle increasing heart disease rates.
Yet in 1979, Margaret Thatcher became Prime Minister and it was pretty clear the population’s nutrition was not high on her agenda. In her first term, Thatcher tried to bury the 1980 Black Report which recommended how government could reduce health inequalities in diet, and she cut funding for free school milk, earning her the nickname “Thatcher, Milk Snatcher”. In her second term she scrapped school food standards and free school meals for thousands of children. In terms of population nutrition, Thatcher’s Government was a Conservative low point.
In fact, today people such as Manchester United footballer Marcus Rashford and celebrity chef Jamie Oliver are still fighting to correct Thatcher’s culling of school meal provision, and not long ago in 2014 a new set of School Food Standards commissioned by Michael Gove were published.
The lesson? Short term savings on population health aren’t great long-term and government ends up introducing the same policies it did before scrapping them, creating a sad and repetitive policy cycle.
Rising obesity rates in the 1980s led the Conservative Government under John Major to announce the first official government obesity policies and obesity reduction targets in 1992. Despite diet remaining high on the policy agenda over the last three decades – with David Cameron making childhood obesity one of his flagship agendas as Prime Minister, George Osborne introducing the sugar tax, and even Johnson introducing one before him in City Hall as London Mayor – obesity rates have not been reduced and a poor diet is tragically still all too common.
If we do not lace long-term health outcomes into all government decisions now, we will not be fit or well enough to fight the next crisis. Poor health undermines our national resilience. We cannot forget that our own leader was not healthy enough to lead the country, ending up in intensive care and temporarily handing over his prime ministerial duties. If history can teach us one thing, it is to prioritise long-term health above all else. When government does that, we end up fighting fit.
Food access is not enough. Access to healthy food must be the minimum standard for all. By channelling the likes of Disraeli, Salisbury, Balfour and Woolton, politicians today can put our health first and ensure we’re ready for anything, from building a vibrant sustainable economy to fighting the next crisis