23
Examination of witness
Preet Kaur Gill MP.
Q271 The Chair: Good morning and welcome to this public meeting of the House of Lords Committee on Food, Diet and Obesity. We are today holding the 19th evidence session of the committee’s inquiry exploring the role of foods, such as ultra-processed foods and foods high in fat, salt and sugar, in a healthy diet and in tackling obesity. Today is the final day of oral evidence in order to inform the committee’s detailed report to be published later this year.
Later this morning, we will hear from Professor Robin May, chief scientific adviser to the Food Standards Agency, but before that and following our meeting with the Minister for Public Health, the right honourable Andrea Leadsom MP on Tuesday 7 May, we are hearing from Preet Kaur Gill MP, shadow Minister for Primary Care and Public Health. You are very welcome. We look forward to hearing your evidence. I will ask you to introduce yourself briefly the first time you speak. Today’s meeting is being broadcast, and a written transcript will be sent to our witnesses to check for accuracy before publication.
I refer to the list of Members’ interests, including my own, as published on the committee’s website and as set out in the committee’s first evidence session on 8 February. Before we hear from our witnesses, I repeat what I said at the start of the 7 March evidence session. While it would be inconsistent with Lords committee procedure to compel our witnesses to do so, for the sake of transparency we will give all our witnesses the opportunity, voluntarily, to declare any interests that they deem relevant to the work of the inquiry the first time they speak.
Having said all that, Ms Gill, I would like to ask you the first question, if I may. Can you set out Labour’s overarching approach to enabling people to eat healthily and preventing obesity, bearing in mind that the committee has heard that every Government since 1992 has missed targets to reduce obesity, despite the publication of 14 strategies and the implementation of almost 700 policies? In your view, why is that? What would distinguish Labour’s approach to preventing obesity? Have you learned lessons from the failures of the past?
Preet Kaur Gill MP: Thank you so much. I am the Member of Parliament for Birmingham Edgbaston and shadow Minister for Public Health and Primary Care. I thank the committee for inviting me to speak.
This is an important topic. Tackling the obesity epidemic is one of the greatest public health challenges of the 21st century. Looking at the lessons of the past, it is not quite as straightforward as just regulating the industry; there are social determinants of health, and it is interesting. I have some case studies that I would like to share with you as I respond to the first question.
Three in five of us are now overweight and the proportion of us who are obese has risen, as we have seen, over decades. Frontier Economics has looked at the economic impact of that on our society, and it is now something like £98 billion a year. That tells you that it is not an option not to act or do nothing. It is putting enormous strain on our NHS, as we already see. Largely, food and diet lead to disease, but diseases such as type 2 diabetes are preventable, and recognising that fact is important. As shadow Health Minister, it is why I have been keen that we set out a focus on population health that looks at prevention. We have seen that children’s centres, the very places for early years, have pretty much been decimated. Birmingham, for example, decommissioned children’s centres.
As for access to support for parents, weaning habits for young children, what is in their best interests in what a healthy diet looks like, and why toothbrushing at an early age is so important when we see the rise of tooth decay, none of that stuff really exists in the way it did, and the impact means that parents are left alone and do not know where to go to access a lot of that information. The Government’s Start for Life programme in family hubs is an opportunity for Labour to build on. Certainly, there is a recognition that the more that you do on prevention early, the more it will really make a difference.
What is Labour’s approach? First, I believe that people want to take more responsibility for their own health. People today have more information at their fingertips in a way that they did not have. There are things like the Eatwell Guide, but it has not been updated for the last seven years and is not linked to the NHS app. We could make information more easily accessible and available to people. There are things that we could and should be doing.
We have seen a plethora of diets coming out over the decades to reduce weight and obesity. There are things like Fitbits, but none of it has really had an impact in addressing obesity, given the rise of obesity over the last couple of decades. I do not think it is just about providing correct information to people or wagging fingers at them. Lots of parents have this challenge. They know that shaming their children or wagging their finger is not effective. It is not even kind, and it will not address the issue. We probably need to have a much more fundamental think about modern life and supply and demand, and how busy our lives have become, and then how the food environment has shaped that demand and the fact that we do not have enough time to think about what we are going to cook. It is a challenge that I have every day and every week: what I can provide for my children that is healthy, and not processed foods or junk foods.
I agree with the assessment that eating well is getting harder. I am sure your committee has heard lots of evidence on that. Healthy food is much more expensive. In a cost of living crisis, with food prices being so high, we have seen the prices of staple produce such as bread, milk and eggs increasing, so it makes it much harder. It is also less available, and that is important. Accessibility to good, healthy options is limited depending on where you live in the country and where you come from.
Companies have become better at marketing and addicting us to cheap junk food because of the demand that exists. The CEO of Kellogg’s made a good point when he said he was now trying to market cereal for dinner because people were looking for cheap alternatives in a cost of living crisis. That just tells you where the industry is at with this. The fact that nearly one in four children in year 6, when they leave primary school, are seen to be obese—and, of that cohort, one in four has fatty liver disease—gives you the indicators. How do we use data? That is so important for Labour. How do we make sure that public health and primary care are joined up, looking at the inequality and the drivers of those statistics? They cannot just remain statistics. We cannot let children leave primary school and then not do some work with them in secondary provision, and somehow think it will be okay.
A good example that someone shared with me is that in Knowsley there are only two places where you can buy fresh fruit and vegetables, compared with over 40 fast food outlets. That tells you the level of inequality, deprivation and poverty. Ultimately, this is a question about the places and the country we live in. It is, essentially, about inequality, and I am sure you have heard a lot of that. We have made a very explicit health mission to tackle health inequalities so that we can build a much fairer Britain, because children from deprived groups in England are more than twice as likely to be living with obesity, and that is undoubtedly the puzzle that we need to solve.
What has Labour set out so far? We have a child health action plan and we will ban junk food ads online and, of course, pre-watershed on TV. I know that this is something that the Government want to do, but it has been delayed, and I do not understand why we cannot take action now. We need the secondary legislation to be brought forward because we know that that will make a stark change. We have said that we will install a supervised toothbrushing scheme aimed at three to five year-olds because we have seen the rise in tooth decay as a result of young children’s diets.
We have committed to rolling out school breakfast clubs. It is important that every child has a nutritional start to their day. We know that hungry children will not learn. It is not just about having a good breakfast in school; it is the social interaction and the physical activity that comes with that, whether it is in breakfast clubs or after-school clubs. We know that any effort to tackle the crisis in the NHS that does not shift the focus to prevention is penny-wise and pound-foolish. As well as giving people the information they need to make the right choice, we need to build environments that make the healthy choice the easy choice.
I want to give an example that I think conveys the level of the challenge that we face. We need to look at this in the wider context of social determinants of health. A GP from Morecambe Bay talked about a young child who came to his surgery. With the weight measurements, you get a letter from your school. It is quite alarming to see that your child is obese, and of course a parent worries about what that means. You do not want to then shame that child into thinking that they have done something wrong. It is quite complex. The GP heard from the parent that that young child had lost their father. That is a much more complex situation than just eating the wrong types of unhealthy food.
She talks about her challenge: “What do I do? Do I shame him? Do I tell him off? How do I make that difference?” What the GP said sums up what inequality in access to food in this country looks like. He said, “It’s not as simple as, ‘You are what you eat’”. He said the child and his mother live on an estate with no easy access to healthy food. There are poor transport links to any supermarket. They are surrounded by junk food cafés, five times more than you find in a more well-to-do area. What are they supposed to eat? Cheap and easily available food sources are now more sugar-filled and calorific than they used to be.
For the families that GP works with, he says it is not just that they face poverty; it is the level of destitution that they face. This is an important factor to think about. There are layers of complexity that are associated with whether people are in debt, whether they have precarious or limited employment, whether they are in unaffordable and overcrowded homes. We know that that makes a huge difference to them. Poverty and deprivation shape the choices that we make, and that is important.
Labour understands that environment, and that is the reason for the shift and the focus on prevention. How do we get local services to be much more joined up using the data? How do we get public health and primary care to work together? They understand the populations that they are serving. They understand the demographic make-up where they are. There is an opportunity to localise some of the service. Of course, you have to have direction, though, from government.
Q272 The Chair: Thank you. You have mentioned a lot of the drivers of poor diet and obesity, and we will come to questions about many of those as we go through this morning’s panel. Hopefully, you will be able to mention any specific actions that Labour would take if it came into government.
The committee has heard calls for statutory targets on health outcomes against which any Government would have to report. What would Labour’s response be to that proposal?
Preet Kaur Gill MP: For the industry?
The Chair: No, for the Government, rather like climate change.
Preet Kaur Gill MP: We have already said that we will form a coalition with the industry to work with us to help us shape our policies. We will have a cross-government approach to tackling some of this because, of course, it cannot just be done in DHSC. We have already said that, similar to the climate committee, we would have a cross-government committee that looks at all the issues.
On setting targets, we already do weight and height measurements. We have indicators with lots of good data. What are the Government doing with the data? That is the important bit from your question. It is not good enough just to know the statistics and simply accept them. The challenge is what we then expect local government to do. How do we work in partnership with them? We lost Public Heath England during the pandemic. It was replaced with OHID. Now OHID has been dismantled. That just tells you that there is no shift and focus from the centre on prevention. Where is the accountability for any of the targets that we have? How do we absolutely make sure that we are doing something different in addressing that? There is a lot of work to do in the public health space.
The Chair: I see. Thank you.
Q273 Baroness Pitkeathley: Good morning. Thank you for coming to give evidence to us. You have mentioned the food industry and working with it. I will come to that, but first I want to ask you about tougher regulation of the food industry. Many of our witnesses—indeed, most of our witnesses, including those from industry—have called for tougher regulation to reduce unhealthy consumption and promote healthier food consumption. What is Labour’s position on that?
As to working with the food industry, there may be a difficult conflict to solve since the aims of the food industry and those of the Government may not be aligned. How would you work to solve some of that conflict in the way that you mentioned working with industry? Perhaps you would not seek closer alignment. Perhaps you would be on the tougher end of regulation.
Preet Kaur Gill MP: We have to take tough action, especially where the Government have turned the other way. There are lots of measures that they have delayed implementing. Bringing forward the junk food advertising and online paid ads is important. I do not understand why we have to delay that. If we came into government and are privileged to serve, we would absolutely make sure that we bring forward the legislation, enact it and work with industry on that.
Industry has an option to advertise healthy food options as opposed to constantly bombarding us with unhealthy products. There is strong evidence that being exposed to junk food advertising leads to children consuming more junk food. It is just one of those natural things. Food advertising bans can reduce consumption of unhealthy food. Where we know it works and where the Government already have legislation, we are urging them to bring it forward and not delay it further. I have already talked about childhood obesity in primary schoolchildren. This is a growing epidemic and definitely something that we need to do more on.
There is a case for tougher regulation of the food industry to some degree, and we need to look at what has already worked. We know that reformulation in terms of the sugar levy has been positive. It is a case of working with industry to look at what products could be part of the reformulation process. We already know that some of the industry is doing really good work and is ahead of the game. We have to be clear. There is so much product on the market. What will make the difference? What are we consuming more of where industry could very quickly look at reformulation?
I am conscious, though, of the science of ultra-processed foods. The British public do not generally know what they are consuming, what is in the food, and what every ingredient actually means. We have to be careful, because a lot of the ingredients are there to make the food safe and to give it long shelf life. If we are talking about making foods less processed, what are the ingredients that do that and what does that mean for the food that we will then consume?
The Government have lots of voluntary measures with the industry. They have not worked in the way that the sugar levy has. I am really keen—it probably goes to your second question about working with the industry—that the industry should not wait for a Labour Government. It should just get on with delivering. I have seen good examples. Nomad Foods took over Goodfella’s pizza. It is now 100% non-high fat and sugar. The industry is showing that it is doable and it can do it to products.
Baroness Pitkeathley: What about those in the industry who do not see it? How tough would you be on them?
Preet Kaur Gill MP: In opposition, we are not speaking to the industry and do not have the evidence or the consultations that the Government have. I want to understand what the barriers are for the industry where some are not doing it and why, especially if others are. If the voluntary measures do not achieve what they are meant to do, of course we have to look at tougher regulation. I am all for looking at the evidence and making sure that we shift the dial on this.
I am looking very closely at the evidence on how far the Government get in their calorie reduction programme. I know that their sugar reduction programme has not gone anywhere in achieving where it needs to be on the target. There is an issue. Is it about government not working with industry and not challenging it more? I do not know the answer to that question. I certainly would not want to do things to industry, but work with it to say very clearly that, if things do not happen, of course there will be much tougher regulation.
There has to be a partnership approach. The industry has to have a stake in the health of the nation and have a sense of responsibility to do its part. It is quite clear, as the evidence shows, that it can reformulate. Most of the fizzy drinks on the market have been reformulated to have their sugar content reduced, and that is positive. There has to be consensus within the industry. What are the other products that have high fat, sugar and salt content where we could take the same sort of approach? There are thousands of products on the market. It is drilling down with the industry where we can make a huge difference.
Q274 Baroness Boycott: I declare my interests as set out on the register. I want to pick up on something that you said in your very comprehensive answer to the Chair’s first question. You said you were going to ban junk food ads online. I want to slightly pick that apart.
Last week, we heard a lot from children about how all through their exam time junk food companies target them with half-price meals and free chips because they are in exams. We also heard from a child who brought in a can of something called Monster; it has 19 teaspoonfuls of sugar in it. It is targeted completely at children and it is targeted almost exclusively online. We heard about how companies like Prime work with sports companies. Is there a serious commitment by Labour to try to stop them? How will you stop them? It will take a lot of standing up to industry to stop that. We thought that as a committee it was pretty insidious.
Preet Kaur Gill MP: Absolutely, you have to stand up to the industry. We would have been much further forward in understanding what the impact of legislation was had the Government already brought in the ban on the pre-watershed and online paid ads. We would have had a period of looking at what the direct impact was. Not delaying things that we know can work and will work on targeting and marketing to our children is important. There is something to be said about having to do that and taking action on that. You are right; it is a huge challenge. Most young people do a lot of their socialisation on their phones, and that is where a lot of this is happening. If we ban paid online ads that are marketing junk food at children, we will start seeing a significant difference, I believe. We should be pushing the industry not just to ban it but actually to promote healthier food options.
Baroness Boycott: You said to the Chair, “We will ban junk food advertising online”. Is that actually what you will do?
Preet Kaur Gill MP: Yes.
Baroness Boycott: I think it is brilliant.
Preet Kaur Gill MP: Yes, we will ban paid online ads. We have made a clear commitment.
Baroness Boycott: How will you define junk food at that point? Will that include energy drinks like Monster and Prime?
Preet Kaur Gill MP: We are looking at the evidence, as you would expect us to do. I will not set out the manifesto here today. I am engaging with the industry. I am looking at the things that are making the huge difference around Prime. You are right. You raise some important issues. Labour has made a commitment to banning online ads and paid-for ads that promote unhealthy foods high in fat, sugar and salt. That is in our mission document.
Baroness Boycott: Will that be in your manifesto and in your first King’s Speech?
Preet Kaur Gill MP: Yes, it is in our mission document. We are very clear that we have to do that. We cannot delay that any further. If we come in, we will absolutely make sure that we push that.
Baroness Boycott: Thank you for the answer.
The Chair: Can I take that a little further? Banning paid-for online ads, to me, sounds as if you would ban ads that people positively go for, looking at websites or supermarket online delivery apps and that kind of thing. A lot of children are regularly getting junk food pushed at them directly to their mobile phones. There are also such things as advergames where computer games have advertisements in them. Would you go as far as trying to use existing legislation, such as the recent legislation to stop harmful algorithms sending things to children about self-harm, suicide, sexual abuse and all those dreadful things? Could that be used to stop what we know is harmful for children, who are being harassed relentlessly to eat junk food that is also harmful to them?
Preet Kaur Gill MP: That is an important point. You are right. Lots of people do online shopping. You have the supermarkets, their pages and their visibility, so it is not targeting them. We are looking at targeting very much what you are talking about, which are the paid-for ads that are being pushed and marketed at children and directed at them. The algorithms are set up in such a way that when they are scrolling they see those products much more.
You are right; we would have to look at what existing legislation has gone through around the online harms Bill. We know that that has already gone through. Would we need secondary legislation to make sure that we go further and we address the issue? Social media platforms find a way round all of it. It is being really clear about what we are trying to do and how we can achieve it. Certainly, it is about that which is directed and marketed at children, yes.
The Chair: Thank you. Certainly, the young people we heard from have been pleading with us to protect them from all that stuff. Government has a role there.
Q275 Baroness Ritchie of Downpatrick: You are very welcome, Ms Gill. I would like to concentrate on the food industry and the formulation of policy on tackling obesity. What role, if any, should the food industry play in that?
Preet Kaur Gill MP: Labour has already set out in its mission document that we will build a coalition of people within the food industry who understand that we need to tackle obesity and why we need to do that. The message to the rest is “Get on board the bus”. I am currently working on the Tobacco and Vapes Bill, which is where I will go straight after this. That will be the next biggest thing from a public health perspective that we have to tackle. Government cannot do it alone. It is important to recognise that. I understand the conflict of interest. Why has the voluntary programme not worked? Has industry been lobbying government? We have to be cognisant of that. It is an important point.
I recognise, talking to Nomad Foods and others, that the industry can deliver action on obesity. We have to listen to it. We have to take some of its advice. We have to look at the evidence base more broadly and make sure that what it is telling us is correct. That is important. We know that it can do this and that it can deliver certain targets around reformulation, reducing fat and sugar content, and labelling. I do not know about you, but when I go to many shops and restaurants I welcome the fact that I can read how many calories there are in what I am about to consume. All of that is important.
Industry has an important role to play. I do not want to do things to the industry that make the industry not want to engage. It is about having a healthy partnership and understanding, and knowing that it has a role to play in the health of our society, particularly the obesity epidemic facing young children, given that it is marketing its products—unhealthy food products, especially—to children.
Baroness Ritchie of Downpatrick: Over the last number of months, we have heard concerns from many people who gave evidence that the food industry exerts disproportionate influence over the Government. Witnesses have argued that there should be strict guidelines for engagement between the food industry and government and that all meetings should be transparent. Do you agree with that?
Preet Kaur Gill MP: Yes, absolutely. There has to be transparency to get confidence. There are lots of good players in the industry, and of course there are those who feel that they do not have to take any action and somehow this will get resolved. We have to take them with us, which is why Labour is setting out that it will build a coalition of people in the industry. Of course we will work with others—the FSA and scientists. It is important that we start having that debate about industry’s role and responsibility.
The food environment has to change. Geopolitical shocks on our food supplies, such as the war in Ukraine and the pandemic, show that we have to be much more sustainable in thinking what the accessibility of food looks like for the future and our food security. It is really welcome that Labour’s procurement rules talk about 50% of the produce that we procure in hospitals and in schools being British. We need to support our farmers, and we need to know what we are growing in the United Kingdom that we could source and utilise.
The industry has to recognise that we have to think about how we work for the whole system. The NHS and public taxpayers cannot continue to have to pay because the industry is marketing unhealthy junk food and feels that it does not have to do anything about it. No, it will have to take action.
Q276 Lord Krebs: A recurrent theme we have heard from the industry witnesses, including Nomad Foods, to which you referred earlier, is the concept of a level playing field. They want regulation so that everybody has to play according to the same rules and the bad guys cannot get away with not playing to those rules. Do you agree with that?
Preet Kaur Gill MP: They make a really good point. They are basically saying that there are those in the industry who benefit from selling unhealthy foods and they are not paying for the harm that it is doing to our society and our NHS. What is their role and responsibility? As I say, in opposition, it is very difficult for me to set out tough regulation right now. I have to work with industry. I want to understand what the barriers are and what has prevented it from taking action. Why do we have some bad actors, whereas there are those who are proactive and show that it can be done? There has to be a level playing field; I agree with you. The big providers have to play their part.
Q277 Baroness Boycott: This follows on from what Lord Krebs asked. We have heard that the largest food and drink manufacturers derive most of their income from unhealthy products. The FT said that, if you were judging food on a healthy basis, 68% of the products Nestlé produces would be banned. Those companies are very big and very powerful. Yes, the Government have managed to produce the soft drinks levy, but it was a levy, it was applied across the board, and it was mandatory. We feel that there are a lot of issues between whether things are mandatory or voluntary. That is one question. Will you make targets mandatory?
I would love to know whether you will look at more mandatory or fiscal measures to be taken on industry. Mexico and other countries have started taxing sugars in products, not just in soft drinks—HFSS. They have done very interesting things with labelling where they put black stickers on cereal boxes. They have removed the use of cartoons that relate to how food is sold to children. All those measures seem to be having very good effects. They are obviously measures that the industry does not like, because at the end of the day it is selling less of its highly profitable, unhealthy food. It seems to me that what the Government are always up against is the vast wealth of the food industry and its power to dissuade the Government from cracking down on our current biggest health crisis. I want to know how brave you will be.
Preet Kaur Gill MP: We have to find ways to incentivise and encourage the industry. I thought the Government’s voluntary programme, especially around sugar, would have done that, but it has only achieved something like 3.5%.
Baroness Boycott: Why do you think a voluntary programme can work when we have had many years of the obesity story? The line goes one way, and that is indisputable.
Preet Kaur Gill MP: As I say, in opposition, it is difficult to have the plethora of information, evidence, consultation and conversations in the way that the Government do. I am not saying that the Government are not pushing the industry further, or not telling them that regulation is coming further down the line. If voluntary measures were not working, of course we would have to look at regulation and of course we would have to do things differently, but I want to work with industry to understand what those products are.
Most of the public do not know the difference between processed foods and ultra-processed foods. Should we have labelling that says, “This product is ultra-processed”? Should we have information that says how many ultra-processed foods you should consume versus processed versus fresh? There is so much on the market. This is one element of addressing obesity. It is not the only way. We have to look at all the other social determinants of health and public health per se.
If you are asking me to set out the manifesto now and tell you what we are going to do, I will not be able to do that, but I will assure you that we are looking at the evidence. Your committee has been taking lots of good evidence. I am keen to look at your recommendations, as I am those of the Health and Social Care Committee. I hope you think that Labour is taking this issue very seriously. We know that we cannot not act. We also know that what the Government have tried to do has not worked. I get that. The sugar levy gives us an opportunity to think about why, if it has produced that level of results, we are not doing that with more products.
I welcome the industry calling for that type of regulation and level playing field, and I will give it some very serious consideration in relation to what those products are. Are they the ones that are marketed to children? You are right; we have to learn examples from places that are already doing this and doing it much better than we are. There is an opportunity to look at that evidence base, and I am certainly keen to look at what Mexico and other places are doing.
The Chair: I am very encouraged that if you were to come into government you would read very carefully what this committee will recommend.
Q278 Lord Brooke of Alverthorpe: Have you given any thought to incentivisation in the food industry that would make it change? Have you had conversations with it about what would attract it to change?
Preet Kaur Gill MP: We have been reaching out to those in the industry when they contact us. I am constantly saying, “Please send me what you think we should be doing. What would make the difference?” You could do lots of little different things, and you have to do lots of different things, but some things that you can do can make a huge amount of difference. Many of them have written back to me being very clear about what they would like to see. I am engaging with them, looking at the evidence base and making sure that I triangulate everything I say. I am checking out whether what the industry tells me is correct. That takes a while in opposition and not having access to so many civil servants, as you can imagine.
Regarding incentivisation, I will look very closely at what comes out from the calorie reduction programme and the ongoing sugar reduction programmes. It does not bode well, given what we currently know. We have to find a different way of incentivising and working with industry. Certainly, I will be doing that ahead of a general election.
The Chair: Thank you. This committee is not in government either, but we have figures that show that although the voluntary salt reduction programme has achieved some considerable success, the voluntary sugar reduction and calorie reduction programmes have not. That is why we are looking at the possibility of making it mandatory.
Q279 Lord Krebs: I declare my interests as set out on the committee’s website.
You have referred already to ultra-processed food, Ms Gill, and I want to pick that up a bit further. In July last year, SACN, the Scientific Advisory Committee on Nutrition, produced a report on ultra-processed food in which it concluded that, although there are studies showing associations with ill health and consumption of UPF, there was not yet sufficient evidence to draw the conclusion that there were causal links. Nevertheless, some witnesses we have heard from have suggested that government should issue guidelines against the consumption of ultra-processed food. You just alluded to that. Can you say anything about Labour’s position on it?
Preet Kaur Gill MP: I hear what you say about the evidence base on that. We are already seeing some of that on ultra-processed foods leading to cancers. I am a bit cautious about looking at it compared to whether it will make the difference if we focus on high fat, sugar and salt intake. The nutrient profiling model can be effective in reducing obesity. This is an additional factor where we need to have much more research and science. As I said, if we are talking about ultra-processed foods, we have to define what they are, which ones are worse and why, and what is contained in them. How can we make ultra-processed less processed? If we do that, what does that mean for the safety of the food that we then have and the shelf life? Those are serious considerations to be had.
I am open to the policy debate and evidence. It is important that we look at it in the round. I am not dismissive of it. I know that the industry is asking us to look at what would definitely work but be cognisant that we need to do a lot more work in this area. My approach to policy-making is always to be evidence-based. It is to have a pragmatic approach on some of this. There is strong evidence that if you target foods high in fat, sugar and salt you can make a difference in reducing obesity fundamentally. That is why we would ban the ads in terms of high fat, sugar and salt intake. It is an important consideration.
Q280 Lord Colgrain: I declare my interests as set out on the committee’s website. It is very appropriate to be talking about advertising, because my question is about that. The committee has heard calls for a ban on the advertising of unhealthy food across all media on the basis that targeted restrictions have been shown to increase advertising elsewhere. What consideration has Labour given to going further than the planned 9 pm watershed on television advertising of unhealthy foods and the ban on paid-for advertising online?
Picking you up a little bit on your answer earlier about children, the children said that it was not when they scrolled down on their phones that they found advertising; they were having advertising targeted directly at them in the middle of their exam time and they were quite offended by that. That is where they need protection.
Preet Kaur Gill MP: That is an important point. We do not have all the Government’s evidence available on the consultation that they undertook, but the 2019 consultation did not propose any restrictions on the forms of advertising regulated by the standards agency for that. Largely, that was because the Government thought that 25% of children would not be visiting places such as cinemas, radios and so on. We have certainly seen a localised response from public health directors and elected mayors, and we have definitely seen that in London. Junk food is banned on transport.
Thinking about the West Midlands conurbation, there is a lot of opportunity to get a lot of this messaging out on screens in buses. Local authorities own certain screens. They put messaging out during the Covid pandemic. There are lots of different ways of localising it and banning nationally. What are the differences that we can make? Certainly, we could give a lot more thought to the opportunities locally that we could be utilising, and doing much more work in partnership with our local government colleagues. You are right; the advertising will just go to other places. We have to be mindful of that and how we can lessen its impact, especially near schools.
There are lots of big challenges when I talk to local government, especially when I think about planning applications as well. These are serious considerations. With the best will in the world, even though we want to restrict takeaways and junk food near schools, if they take local government to court, local government does not have the funds to fight some of those cases. There is a big challenge. We have to think about how advertising locally and marketing to children and people can make a difference. That is certainly something that I am looking at.
Lord Colgrain: That is interesting. There has never been a suggestion, I do not think, of schools taking local government to court. This is the first time we have heard that.
Preet Kaur Gill MP: No, I am saying that local government can restrict and try to restrict. As a former cabinet member for public health, I know that trying to restrict takeaways near schools is a real challenge because some of the big providers will take the council to court, and the council’s funds—as we know, public health grants get cut—do not always have the capacity to fight that. We have to think about how we assist local government to take action locally, especially with the example I gave about Knowsley with 40 takeaway places, and our high streets where we are seeing fresh produce shops closing down because they cannot afford the rents in some areas.
There is a lot of work. I am trying to localise this to say that, yes, of course we can do lots here in government, but we have to work with our local government delivery partners, who will also be doing quite a lot of the work. The Mayor of London has shown that you can do it.
Q281 The Earl of Caithness: I have two very straightforward questions to which you can answer “yes”, “no”, or “I’m not prepared to tell you”. Will front-of-pack nutrition labelling be mandatory, and will you impose, like many other countries, a warning label on unhealthy food on the front of packages?
Preet Kaur Gill MP: All those are important considerations that I am looking at.
The Earl of Caithness: “Yes”, “no”, or “I’m not prepared to tell you”?
Preet Kaur Gill MP: I cannot tell you what will be in the manifesto. I can tell you, though, that the two things that you have raised are something I am giving careful consideration to and looking at—not only what we can do and how we do it. The question is—
The Earl of Caithness: I am longing to know what you are going to do.
Preet Kaur Gill MP: I respectfully say to the committee that I will not be able to set out Labour’s manifesto here and now. I want to assure you today that this is a serious issue that Labour is considering. We know that we have to do a lot more than has been done. Your committee taking evidence has been really important. I will absolutely look at your recommendations and will be giving them careful consideration and response.
The Chair: Thank you. It is not just front-of-pack labelling but what sort of front-of-pack labelling, of course, that will need to be considered.
Q282 Baroness Suttie: Good morning and thanks very much for coming this morning. Can I turn to food inequality? The Food Foundation has estimated that the most deprived fifth of the population would need to spend 50% of their disposable income on food to meet the cost of the recommended diet, compared with just 11% of the most affluent fifth of the population. Subject to your comment about not being able to say what is in the manifesto, can you give us some concrete examples of how Labour would address that food inequality?
Preet Kaur Gill MP: It is a huge issue. I said in my opening remarks that we have seen the price of staples such as bread, milk and eggs going up. In a cost of living crisis, that is a serious issue. We have seen more people in work using food banks to supplement what they can provide for their children. The most deprived households, we know, will be hit the worst. It is about the decisions you take in government on health inequalities. I already talked about some of the social determinants of health. For working people, having more money in their pockets really does matter. The Government have a responsibility to bring down inflation. They have to break down the barriers to opportunities that are holding so many people back in our communities. People have to have good, decent homes. My case load is full of people in cold, damp, mouldy homes. That impacts their health and their ability to provide cooked meals sometimes because of what they are grappling with.
In the round, we are thinking about some of those issues. I already alluded to one of the things that we would do in recognising why food prices have risen. The geopolitics in Ukraine and Russia has had a huge impact. How do we support local farmers in making sure that 50% of what we procure, where government definitely has an opportunity in hospitals and schools, is local produce and it is British produce? That is a very clear policy shift for Labour in making sure that this is sustainable going forward and, hopefully, bringing down the price. If we are growing more and we are able to sell more, and people are able to buy more British, that will be good for the economy and it will be good for people. It is recognising that many people cannot afford to buy the healthier options, as you say. That is a big challenge.
Baroness Suttie: Would you support local initiatives on fruit and veg vouchers?
Preet Kaur Gill MP: I am not sure whether I am allowed to mention individual supermarkets, but one good thing about the industry is that some supermarkets sell wonky produce much more cheaply. They are making fruit and vegetables much more affordable. Even some of the more expensive brands—I will not mention their names—recognise that there is a cost of living crisis and so people cannot afford to buy healthy options, and are trying to make some of their products much more affordable and accessible.
The voucher system is important. Most of the people who are in children’s services and families who have low incomes or need additional support get food vouchers already. Of course, the Healthy Start vouchers are available. It is recognising that the political decisions we make that give more money in people’s pockets, and mean that they can make much healthier choices, are important. It is recognising all the factors that have led to people finding it very difficult in a cost of living crisis.
The Chair: I think Lord Brooke has a question on other ways of getting healthier food to people.
Q283 Lord Brooke of Alverthorpe: This question follows through on subsidies and assistance. You just mentioned supermarkets that have been focusing on providing cheaper foods and healthier foods and it has been working well. Have you had a look at ways in which you could possibly extend that and support it over a wider area?
Preet Kaur Gill MP: It is a really good point. It is certainly welcome to see a lot of the major supermarkets taking that sort of initiative and action, and understanding that. Of course, you could apply it much more to many more products. As I say, if we are supporting farmers and growing and sustaining local economies, there is an option to do that much more.
Lord Brooke of Alverthorpe: Our witnesses have said that businesses expanded by doing this, which would be contrary to what one would have expected.
Preet Kaur Gill MP: Really?
Lord Brooke of Alverthorpe: Yes.
Preet Kaur Gill MP: That is interesting.
Lord Brooke of Alverthorpe: The committee has also heard calls to extend eligibility for free school meals and the Healthy Start scheme to all families with universal credit. I know you have your problem with the manifesto, but are you giving thought to those topics? If so, could you enlighten us a little?
Preet Kaur Gill MP: The Healthy Start voucher scheme is important. I do not think the uptake has always been there, so there is some work to do in making sure that people know that they are eligible and that they access it. If you do not have enough children’s centres and enough health visitors, and you do not have the early years providers to give that information, it is difficult for parents to navigate online what they can get and how they can access it. There is some work to be done on the Healthy Start vouchers, most definitely.
We have made a very clear, fully funded commitment on the breakfast clubs that we will provide. Interestingly, school meals are important because government can procure and leverage its procurement responsibility as to what the healthy choices look like. I have written to my children’s school saying, “Can I observe your school meals?”, because that is important. I want to do that much more. It is so variable. It is great that you can see on the apps what your child buys, but it is quite shocking sometimes, because the option is not there and they will give lots of reasons for the options not being there. It is also about recognising that a lot of schools do not have kitchen facilities, so they cannot make fresh produce in a way we did when we were at school. They have to outsource, and products are coming in.
There is a lot of work to be done on the variation. There is really good practice around the country where we could get this right. We need to work with schools and certainly with our DfE partners to think about how we can address this. For too long we have allowed it to mull along and accepted where it is at. We have seen the horrific stories of certain children getting really substandard meals. I do not think that is acceptable. Without making any further manifesto commitments, there is a lot of work to do on the school meal variation and what we can do to make a difference and bring about change.
Baroness Boycott: Why do you not just commit to auto-enrolment to the Healthy Start vouchers? Then it is done at source when you are on that level of benefits.
Preet Kaur Gill MP: That is a really good point. It is certainly something I will take away and look at. Thank you.
Q284 Baroness Goudie: Hello, it is nice to see you again. Thank you for coming this morning. Following on from my colleagues on school meals, part of it has been covered, but food standards for early years settings are voluntary. How would Labour seek to enable early years settings to offer healthier food? We know that when children start school they need to get much better food than they are getting. Would you look at better school lunches and breakfast clubs as well?
Preet Kaur Gill MP: Yes, definitely. There is a piece of work that we need to do. We already recognise that. I looked at the Scottish food standards because they are quite useful. They set very clear guidance on breakfast cereals with added sugar. We should also seek to ensure that there is updated guidance in England that reflects providing breakfast-specific foods and what that could look like. You are right. There is a lot more that we could be doing, especially with the early years settings. With those, there is a big challenge because of the cost. What they provide is a lot cheaper. They are looking at the cheapest alternatives. Sometimes the cost to the parent is considerably higher.
Giving very clear guidance will be equally important and certainly something that Labour is definitely looking at, especially with our school breakfast announcement, and what you can provide and what you should not provide. What you should provide and what you can sanction for providers will be important, and making sure that we are clear on what the guidance could look like.
Baroness Goudie: That is the only high-quality food that some children will receive in the day, so it is important that it is looked at.
Preet Kaur Gill MP: Definitely. There is already some good guidance from government on foods that contain high fat, sugar and salt. There is some clear guidance. Looking at what Scotland has done and making sure that we can update it and give much more clear guidance to providers is important. It is certainly something I am looking at.
Q285 Baroness Browning: Good morning, Ms Gill. Welcome. Last year, the Scientific Advisory Committee on Nutrition recommended that the Government consider strategies to reduce consumption of free sugars, excess protein and energy-dense foods for one to five year-olds. In 2019, Public Heath England found that some commercial baby foods have as much sugar in them as biscuits or confectionery. How would Labour approach those problems for that age group?
Preet Kaur Gill MP: This is definitely something I will do some further work on. There is already some voluntary guidance available for many of the early years settings in England. Based on a survey, 55% of settings are aware of the guidance, so there is clearly work to be done in terms of early years settings not knowing that the information is available and how they can access it. Unfortunately, nurseries serve insufficient amounts of vegetables, pulses and oily fish, and probably serve way too much high-processed food. That really matters because it is about what you introduce to a child very early on. Diversity of food choices and giving them access to fruit and vegetables is important. There needs to be some work done with early years settings as to how we can support them more in that area.
We have seen the data for young children. If you do not do the early years preventive work, once children get to primary school level, some of the indicators show that we are performing quite poorly even compared to our European counterparts. The fact that children are much shorter as well tells you that it is a very grim story and a very grim picture that we are seeing in the United Kingdom. That is because of the lack of accessibility to fresh food produce and healthy choices.
Early years settings have a huge role to play. The Government’s announcement on childcare without considering the implications of that is a concern. Under a Labour Government, having early years provision and having children’s centres was making the difference. People were able to get the public health messages and cooking classes. There are things that we take for granted. Lots of families do not have huge family support networks. Their only sense of support is being able to go to one of those providers and get the right kinds of support. People want to do the right thing; they just do not know how to do it.
Baroness Browning: In the domestic situation, will we ever get back to the days when a healthy family meal was cooked and a good portion was put in a liquidiser, and that is how the baby was weaned?
Preet Kaur Gill MP: That is a really good point. You are right; we are seeing the rise of food being marketed to babies post breastfeeding. I was taught by my mother to get the fresh broccoli, put some cheese in it and whisk it with mashed potato. You made all the stuff yourself. For lots of young parents nowadays it is about time, but people generally do not know that there is an epidemic of obesity and that what our children consume is really bad for their outcomes and health. We see that with the stark increase in tooth decay with children. That is a big issue. We know that early toothbrushing works. The evidence suggests that it works.
It is not having those early years settings, as you say, and not sharing information, as my grandmother and my mother passed it on to me. Families and relationships are complex. It is recognising that people need support, and that is okay. That is why we have public health departments. Local government is a public health organisation. It is working together to think about how we address the localised issues, how we use the data, and how we can be more joined up. It is such an exciting space to do a lot more. You have to have the political will to see that and bring about the change.
The Chair: You mentioned that people are time poor, and of course they are, so many young parents have to rely on foods marketed for children that are available in the supermarket right next door to the baby formula and the nappies. Are you concerned about the formulation and the marketing of many foods that appear to many of our witnesses to be quite inappropriate for very young children?
Preet Kaur Gill MP: Yes, I looked at some of the data on that. I had not given it due attention until some of your committee started raising it. I went away and looked at some of the data. I was quite appalled and shocked that 36% of children aged between one and one and a half consume follow-on formula milk and that it contributed 50% of free sugar intake in consumers. That is significantly high. There is clearly an issue in terms of the industry and work that needs to be done.
There was the Public Heath England evidence as well. It undertook a review in 2019 and found that the nutrition composition of many of the follow-on formulas was inconsistent with UK dietary requirements. There is a big issue that we absolutely need to address.
We know that breastfeeding has huge benefits. As I say, early years settings are important to give advice and information to parents. Why is it that in Sweden babies are breastfed much longer than they are in the United Kingdom? The data here show that it has gone down. There is more work to be done on that so that people look at the healthier choice for their child, as opposed to the marketing for products that do not meet our dietary requirements at all.
The Chair: I would certainly recommend, if you have not already seen it, that you look at the evidence we heard from Professor Ian Young, chair of the Scientific Advisory Committee on Nutrition, on infant and early years food.
Q286 Baroness Jenkin of Kennington: Thank you for coming, Ms Gill. Before I ask my question, I declare my interests on the register.
Babies and young children are now very much fed pouches, which advertise themselves as being very healthy, whereas they are absolutely stuffed full of sugar. When you look at the labelling, could you perhaps include that as well, because they are very misleading? The public health grant has been reduced by 28% in real terms per person since 2015-16. How would Labour support local authority action on obesity prevention? Quite a few of us went to Blackpool a couple of weeks ago to have a look at what they were doing, and it is a bit of an uphill struggle.
Preet Kaur Gill MP: That is an important point. Coming from local government and having been a cabinet member for public health, I know that, especially in a place like Sandwell where deprivation and obesity rates are significant, thinking about population health and a preventive approach is important. The fact that the Government have decimated OHID, which is the public health agency right at the top that is supposed to give direction to public health directors across the country, just tells you how they are not taking this approach importantly.
It is not just that public health grants have been cut by 28%. We know that, when local government funding gets cut, the public health programmes then get further cut. It is an even worse and much bleaker picture than just the 28% cuts. Labour understands the importance of making sure that public health directors know what they will get so that they can plan the year ahead and their programming in advance. Multiyear funding is definitely something we have already committed in our mission document to start looking at so that we can support local government to deliver.
I am really heartened by local government. There is innovation across our country and it is really exciting, but it should not be in pockets of places just because we have good leadership locally. We should share best practice. We can learn from each other. Why is it that Leeds, looking at Amsterdam, has been able to reduce obesity rates by a percentage? What is it doing? It is targeting early years. It has a really good HENRY scheme, a really good programme. I do not know if your committee has looked at that. I am sure you have.
Coming from a local government background, I do not want it just to be, “Brilliant, Leeds is doing well”. I want other places to learn and to do the same and use what works. That does not mean to say that central government does not have a role to play and that we do not have a strategic direction. Of course we do, and we have to set a very clear direction on how we tackle obesity and how we prevent it—treatment and prevention. It is also recognising that there is phenomenal work being done that is making a difference and that we can learn from other countries. Amsterdam is a really good example. Fundamentally, it will be local services working together, integrated care systems, which can really make the difference on some of this. They understand their populations.
Doing this brief, one thing that strikes me is that we have phenomenal data produced by public health experts and by NHS England, but how do we use the data and how do we prioritise what is important locally? We know what the drivers of inequalities are and we know what the drivers of social determinants and poor health are, so why are we not joining up public health and primary care? We know resources are scarce for everybody and we have limited amounts of money, but we need to pool budgets and work together to understand population health and the impact it is having in the long term.
There is an opportunity to do things differently. Labour has already set out what our neighbourhood care service looks like. People can access the services that they need in a community setting so that we are not spending much more on treatment of obesity, which is currently costing the economy and the NHS. It is about having preventive approaches. Within that, there are lots of things. There is planning around walking, cycling and active travel. There is so much that we need to be doing in public health and local authorities. I am really excited and looking forward to getting on and delivering, and doing some good work with leaders across our country who are already serving their populations and doing some really good work.
Q287 Baroness Jenkin of Kennington: I have been to Amsterdam, and I went when Eric van der Burg was the mayor and he had his foot on the pedal. My understanding is that because he is no longer there it has levelled off, so it is something that you have to keep an eye on constantly.
The committee has heard that the National Planning Policy Framework does not mention food and health until paragraph 96. Do you think that planning policy could be set at a higher priority in enabling people to live healthier lives? You mentioned the planning around schools for fast food outlets.
Preet Kaur Gill MP: What is the answer to this question? I am talking to the Local Government Association about it. We have to go back and look at planning rules. One of the things that the LGA says is that, if it tries to object to a takeaway, the big companies like KFC—it is already out there in the public domain—will take it to court, and it does not have the means, the money and the resources, to fight such legal challenges because they are really costly, as we know. How do we recognise that, whether it is in schools or in certain areas, there should be no more than X number of takeaways but, equally, there has to be X number of fresh produce and healthy options?
In my constituency, the only fresh produce store on the high street—where the rents are not cheap—has closed. It upset many of my constituents because they just could not believe that it was no longer going to be there and now they will have to rely on supermarkets. We have to support local economies on our high streets because they are the places that a lot of our constituents visit and access. There is work to be done around local government as to what more we can do to address the planning rules to make it much easier to bring a level playing field in terms of accessibility of foods and the food environment that is available where people live.
We should be targeting areas of deprivation much more. We do not have to do that everywhere, but we should be targeting areas like Knowsley to rebalance the food environment. You raise an important point. I have already spoken to the Local Government Association. It is not easy. We have to find a way around what we are trying to do and how, within the legislation, we can try to give support to local government to do it.
Baroness Boycott: When we had children and young people here, they pointed out that their areas were so deprived of services such as youth clubs or places for them to go after school that, in fact, the fast food restaurants provided wifi, warmth, comfort, friendliness, a table to hang out at and a place to be with your friends. They have slipped into being a social service in themselves. If that is true, you almost need to take another approach. How do we make them healthy in themselves, or build somewhere else for people to go? What they said was stark and they all agreed with it.
Preet Kaur Gill MP: It is an important point. There is a school very close to where I live. The high street is full of those £1.99 chicken places. The thing that strikes me when I walk past is the stench of the oil and not knowing how often it has been changed. It does not feel like it has been changed. There is a mandatory requirement that will take place where all providers have to showcase their rating for hygiene and so on. How can we drive up the quality of food? What is the impact of not changing your oil for 10 days? What does it mean for the food that you are eating and consuming? Is it much worse? We have to start looking at things like that from a public health perspective. You are right.
Young people need to have places of safety for themselves where they can feel safe and warm, as you say, but a lot of exploitation takes place in those environments, and that is concerning. How do we get those places to provide healthier options, and what can they do? There is an important public health conversation to be had locally, working with those providers and holding them to account. If one of the drivers was around something that you are held against, such as a mandatory requirement locally, we would have more providers thinking, “I need to change my oil because it will be tested and because the science says that it’s really carcinogenic”, or whatever it might be. I wonder about things like that, and whether there is an opportunity to do far more to drive up the quality of food.
The Chair: Thank you. We have just a moment to allow Lord McColl to ask his question.
Q288 Lord McColl of Dulwich: What is your attitude to the medical advice to the 40 million obese people in this country to do without one meal a day, which would not only make them feel better and lose weight but save money and save them from a premature death from a variety of very unpleasant and expensive diseases?
Preet Kaur Gill MP: I am not going to advocate that anybody should do without one meal a day. I have today discussed that how we address obesity is a very complex area. Of course, there are treatments. There are people who, because of obesity, already have various diseases that they are tackling, such as type 2 diabetes. My mother is one of them. I can see the impact that that has. We know that you can reverse it, but there are not enough preventive services available locally for people to access and use. That is where primary care should be. The revolution of healthcare in predictive medicine around the country should be about looking at those who are likely to get type 2 diabetes. What do we do with all those people around a preventive approach? How do we make sure that they do not get to the point that they get diabetes, or that they can reverse it?
Many of the services are concentrated in hospital in secondary care and, unfortunately, there are not the community-based initiatives for people to access locally. It is about how we make preventive services more accessible for people who are already unwell and suffering from a disease that is preventable in the first place. How do we target them more effectively early on so that they get support and advice?
I do not know if Nomad Foods mentioned this. The UK Eatwell Guide needs updating. I do not think it has been updated for about seven years. Why is it not linked to the NHS app? Why is it not digital? Why is information not available to people who have type 2 diabetes? Why do they have to accept that this is their inevitability, they have the disease and they cannot do anything about it? We hear good examples of people reversing it, and that is because they have had to change their diet. Of course, it is about exercise. We have to create the environment for people to make the healthy choice the easy choice. Unfortunately, skipping a meal a day might be easy advice for somebody, but it will not address the issue.
The Chair: Thank you. Although we would love to, the committee does not have time to go into increasing primary care services today. It is beyond our remit anyway. Thank you, Ms Gill, for coming and giving evidence today. I remind you that a transcript will be sent to you. If there are any corrections that you need to make, please do that.
