This year’s Oxford London Lecture is called ‘Knowledge, nudge and nanny: opportunities to improve the nation’s health’. Delivering it, Professor Jebb comments that, to date, food policy has tended to rely mainly on educational programmes that put the responsibility on the individual for their food choices while doing little to improve a food system that makes less healthy choices the default for many people. She argues for more support for individuals as well as changes in places where food is available – in shops, food outlets and the workplace – to make healthy eating a practical reality across the nation and cut the rates of diet-related disease.
As Professor of Diet and Population Health in the Nuffield Department of Primary Care Health Sciences at Oxford University, she tells the audience: ‘My research is focused on identifying and testing strategies to enable people to manage their diet in the circumstances in which they find themselves today, where food is abundant, palatable, convenient and cheap. But more generally, we need a fundamental shift to the prevention of ill-health through policies that make it easier for individuals to adopt a healthier diet without healthy eating feeling like taking up an extreme sport.’
She points out that ‘a portfolio of actions’ have persuaded many people to stop smoking–from educational campaigns, restrictions on tobacco advertising, and tobacco taxes to treatments provided in doctors’ surgeries for those wanting to give up. She points out that this approach provides important lessons about the need for treatment services.
‘We know from long-term intervention studies that even modest reductions in body weight can substantially cut or at least delay the onset of diabetes by more than 50% in the first four years. All too often we think that we can’t treat obesity, yet we have clear evidence of effective interventions ranging from bariatric surgery right through to behavioural weight management services, or even self-help programmes.’
She dubs her public health approach as ‘the 4 Ps: People, Products, Promotions and Places’. Alongside her research to support people to make changes, Professor Jebb is the Chair of the Public Health Responsibility Deal Food Network, the body that negotiates voluntary agreements with the food industry.
She reviews their current progress, praising the achievements of some companies who have made cuts in the fat and sugar content in some products, or reductions in portion size, but she says ‘a much stronger global alliance’ is needed to demand broader changes on the part of the food industry. During the lecture, she also illustrates the power of promotions. Her research into the effect of so-called ‘gondola ends’ in stores showed an uplift in sales equivalent to a 4% price discount on beer and a 22% discount on soft drinks. She hints that new laws might be necessary to limit the promotion of unhealthy foods, saying ‘This goes to the heart of business competitiveness and does not easily lend itself to voluntary action – a level playing field is required which may demand legislative action.’
Professor Jebb restates her support for a tax on sugary drinks, pointing out that there is now empirical data to show that food taxes reduce the consumption of the taxed products. She describes sugar-sweetened beverages as an ‘easily defined category with clear health harms’.
‘Tax is an established part of alcohol and tobacco control policies, but we hesitate to use it to guide food choices,’ she says. ‘This may be unpalatable – few of us willingly sign up to pay more tax, but given the scale of diet-related ill health facing us can we afford not to?’
Finally, she urges the public sector to take a lead on healthy workplaces, describing the lack of healthy food options in hospitals as her own ‘bugbear’, saying: ‘This is short-term thinking – income for hospitals today at the expense of rising health care bills tomorrow.’
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