Obesity should be tackled at a local level, with health boards empowered to find the right solutions for their areas
Although action is long overdue, the government is right to be looking for fresh thinking on how we can tackle what is undoubtedly our greatest public health challenge. Last year the parliamentary public accounts committee accused the government of "dithering and confusion", so I welcome this new focus. My frustration and fear is that dictating strategy so much from the centre, handing money down from Whitehall to the select few, will not deliver the sort of change required.
First, why is action necessary? If current trends continue, 40% of Britons will be obese by 2025. Even today, over a third of children who leave primary school are overweight.
This problem is starting early and a recent study by the Department of Health showed that nine out of 10 parents were unaware that their children were overweight.
A Foresight report last year estimated that by 2050 obesity would cost the NHS £50bn a year.
Whichever way you look at it, obesity has the potential to crush the life out of the NHS. But far more importantly, the health consequences for individuals are disastrous. Just look at the increasing incidence of diabetes. The potential also for increasing rates of heart disease, arthritis and some cancers is frightening.
As our society has got richer it has also got fatter. But the troubling paradox is that the most deprived communities also have the highest levels of obesity. The Foresight report warned of a "polarisation of the population, into the junk food eating, less-educated poor and functional food eating, better-informed higher classes". In the poorest areas of the country, access to healthy foods and exercise facilities is more difficult.
So what needs to happen? I certainly accept the case for the government piloting fresh ideas. Redesigning our towns and cities to encourage walking and cycling is the right thing to do. And I am very much in favour of exploring whether incentives can work to empower people to make informed choices.
Those who condemn this as yet another example of the nanny state have got it wrong. The state should be acting as enabler. There is a common interest here for both the state and citizens: reducing inequalities, controlling health costs and encouraging people to stay healthy. But for this to work, we have to move away from the dependency culture which exists in this country where, for any initiative to happen, it requires a hand-out from central government.
The Liberal Democrats' vision is of a radical shift of power away from Whitehall to local communities – locally elected health boards working with local government, integrating health and social care, addressing the health needs of their area. Along with democratic accountability to the communities they serve, health boards would also have the power to raise funds locally, with a commensurate reduction in national taxation.
We raise more of our taxes centrally than any other country in Europe apart from Malta. With that power, local health boards and local authorities could be free to innovate, to determine what is right for their area – and to find ways of reducing healthcare costs in the longer term.
A scheme they may choose to follow is one that has been introduced in Nova Scotia with strong public support. There, families get a tax-back payment if their children enrol in sports or activity clubs. A similar incentive payment could be made to those on benefits. In other countries, where healthcare is funded through insurance, providers have found that offering incentives – in the form of reduced premiums – to participate in screening, health risk assessments and physical activity reduces claims. In other words, this approach keeps people healthier and cuts cost. Surely there are positive lessons to learn here for a tax funded system.
I give the government credit for, at last, initiating some action. But please don't believe that what we have heard so far will make a dramatic difference.