Statistics PoliticsEconomics

* The NHS is increasingly struggling, but the principle of universal access to care is a good thing. * Obesity and diabetes are increasing over time * Will present some statistics on obesity * In 2011, NHS annual spending on diabetes was £9.8 billion * Diabetes spending expected to increase to £16.9 billion over the next 25 years. This would mean 17% of its entire budget on diabetes.” (Diabetes UK) * These are problems that need to be addressed

(Sturm et al 2002)

* Table: Class III obesity (BMI of >40 kg/m2) associated with an increased rate of death. * Heart disease, cancer, and diabetes are responsible for most of the excess deaths among people with class III obesity * By comparison, cigarette smoking associated with an estimated 8.9 y of life lost (95% CI: 8.6–9.3). Kitahara et al (2014)

* In , costs to NHS (Scarborough et al, 2011): * Smoking £3.3 billion * Alcohol £3.3 billion * Overweight and obesity £5.1 billion.

Males Females © Crown copyright and database rights 2012 Ordnance Survey Adult obesity: BMI ≥ 30kg/m 2 Prevalence of obesity in adults (aged 16+) Source: Health Survey for England

Males Females © Crown copyright and database rights 2012 Ordnance Survey Adult obesity: BMI ≥ 30kg/m 2 Prevalence of obesity in adults (aged 16+) Source: Health Survey for England

Males Females © Crown copyright and database rights 2012 Ordnance Survey Adult obesity: BMI ≥ 30kg/m 2 Prevalence of obesity in adults (aged 16+) Source: Health Survey for England

Males Females © Crown copyright and database rights 2012 Ordnance Survey Adult obesity: BMI ≥ 30kg/m 2 Prevalence of obesity in adults (aged 16+) Source: Health Survey for England

Males Females © Crown copyright and database rights 2012 Ordnance Survey Adult obesity: BMI ≥ 30kg/m 2 Prevalence of obesity in adults (aged 16+) Source: Health Survey for England

Males Females © Crown copyright and database rights 2012 Ordnance Survey Adult obesity: BMI ≥ 30kg/m 2 Prevalence of obesity in adults (aged 16+) Source: Health Survey for England

Males Females © Crown copyright and database rights 2012 Ordnance Survey Adult obesity: BMI ≥ 30kg/m 2 Prevalence of obesity in adults (aged 16+) Source: Health Survey for England

Males Females © Crown copyright and database rights 2013 Ordnance Survey Adult obesity: BMI ≥ 30kg/m 2 Prevalence of obesity in adults (aged 16+) Source: Health Survey for England

* Change4Life Campaign is the social marketing part of the Healthy Weight, Healthy Lives cross-governmental strategy for England. * Social marketing attempts to convince individuals to follow their suggestions * Spent £25 million per year * Targets: Logo recognition and awareness at 88% * (how many people do you think recognise the logo of Coca- Cola?) * How much does Coca-Cola (only 1 company) spend? * £2.13billion spent globally in 2011

* Department of Health: An update on the government’s approach to tackling obesity

* Green, amber, red for good, okay, bad * Better information for consumers

* * Choosing choice rather than choosing intervention, choosing health. * Choice implicitly means nonintervention. * We are not talking about choices, we are talking about abnegation of governmental control and responsibility

* A future vision for the NHS: ‘Patients and citizens will also need to play a greater part in the health system; they can start by taking prevention seriously’ (Lancet: Sood, 2014) * ‘In line with the Government’s core values of freedom, fairness and responsibility…we will favour interventions that equip people to make the best possible choices for themselves, rather than removing choice or compelling change’ * Hands-off approach to industry: UK Govt Responsibility Deal has pledges that businesses are encouraged to sign up to

* Why have 2 decades of knowledge and policy failed? * Should Health be marketised? * Citizens as consumers * Attempts to de-politicise the public realm: ‘we just can’t afford it’ * Discursive effect

* Gatineau M, Hancock C, Holman N, Outhwaite H, Oldridge L, Christie A, Ells L (2014) Adult obesity and type 2 diabetes. Oxford: Public Health England. * Kitahara CM et al (2014) Association between Class III Obesity (BMI of 40–59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studies. PLOS Medicine; Vol. 11, Issue 7. * Scarborough P, Bhatnagar P, Wickramasinghe K, Allender S, Foster C, Rayner M (2011) The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006–07 NHS costs. J Public Health; Vol. 33, No. 4: * Sood S, Maruthappu M, Keogh B (2014) A future vision for the NHS: the case for change. Lancet; Vol. 384, No. 9954: 1551– * Sturm, Roland and Kenneth B. Wells (2002) The Health Risks of Obesity: Worse Than Smoking, Drinking or Poverty. Santa Monica, CA: RAND Corporation.