Obesity Action Plan
The next item of business is a debate on motion S3M-2481, in the name of Shona Robison, on the obesity action plan.
In June, the Government published "Healthy Eating, Active Living: An action plan to improve diet, increase physical activity and tackle obesity (2008-2011)". We have demonstrated our commitment to delivering the actions that it sets out with an increase in the budget from £16 million to £56 million—£40 million of new money.
An important aspect of the action plan was our desire to build on the solid foundations that have been established through the implementation of the Scottish diet action plan, which was published in 1996, and the national physical activity strategy, which was published in 2003. Those strategy documents on diet and physical activity have been key to the work that has been developed over the past few years, and they will continue to provide the strategic map for much that we do. I am sure that their importance is recognised by members across the chamber.
To kick off today's debate, I would like to reflect on some of the actions that we are taking and how they will contribute to tackling obesity. I want also to outline how we will fulfil our commitment to developing a longer-term strategy to tackle obesity. Before I do so, I put on record my appreciation of the hard work of members such as Mary Scanlon and Nigel Don in getting the cross-party group on obesity up and running. It held one of the best-attended cross-party group functions that I have been at for some time, which perhaps reflects the cross-party support for action on obesity.
The problem of obesity has been a long time in the making and will take a long time to resolve. However, if we do not tackle obesity, we are in serious danger of losing the health gains that we have already made. The potential costs of the obesity problem are quite startling. The most recent published estimate is that, by 2050, obesity will cost the United Kingdom £50 billion in today's prices. That would translate to a Scottish figure of some significance. Our action plan identifies how we will spend the £56 million over the next three years to support people to change their behaviours. The additional £40 million will also be supported by work across Government to make our lives healthier.
Today, we have issued advice to health boards on our allocation of £19 million over the next three years in support of maternal and infant nutrition. That is in fulfilment of our commitment to provide free fruit to mothers and pre-school children, but it goes much further, in line with the best evidence. The importance of ensuring that mothers and their babies are well nourished is widely recognised. A pregnant woman's nutritional status influences the growth and development of her baby and forms the foundations for the child's later health. The mother's health, in both the short and the long term, depends on how well nourished she is before, during and after pregnancy. A child's diet during the early years has an impact on the child's growth and development, is linked to the incidence of many common childhood conditions and influences the risk of developing, later in adult life, conditions such as coronary heart disease, diabetes and obesity.
We are very much aware that women who are deprived do not access services and do not enjoy the same health outcomes, so we have focused the additional £19 million on those most in need. That supports the clear recommendations in "Equally Well: Report of the Ministerial Task Force on Health Inequalities", which was widely welcomed by members of all parties when it was published back in June. The £19 million will support health boards to increase the uptake of healthy start among the estimated 48,000 potential recipients in Scotland. Although uptake is currently high—at around 87 per cent—more than 5,000 of the most vulnerable are still not getting access to benefits that they deserve.
The £19 million will also support health boards to assist with progress towards achieving the breastfeeding health improvement, efficiency, access and treatment—or HEAT—target. It will also support boards in improving training opportunities for health professionals to help them to deliver this important agenda. Of course, I expect health boards to work with local authorities, community health partnerships and other partners in the voluntary sector to support that work. That is just one of the strands that we are working on to help to improve Scotland's diet.
In response to the recommendations of the task force on health inequalities, we have commenced a project that will increase the health care capacity in schools through the development of community-based integrated school health teams, which will be supported from an additional £7 million that is being made available. Over the next two years, we will initially work with three health boards on identified demonstration sites—in NHS Ayrshire and Arran, NHS Forth Valley and NHS Lothian—to strengthen nursing in schools, especially in the most deprived areas. The boards will involve local communities, councils, education staff, the third sector and other independent providers. That model, which we will begin to introduce later this winter, will be designed not only to harness existing skills but to develop and shape new roles in order that effective care can be offered to school-age children, young people and their families. It should also provide opportunities for teachers and school staff to be proactive in identifying those who are particularly vulnerable or have complex needs.
We will also promote and encourage more people to become active, which is the flip-side of the coin—diet is one side and increased physical activity is the other. We certainly want to build on the enormous success of our Olympic athletes who provide inspiration as to what can be achieved, but we recognise that, although we can encourage as many people as possible to try a new sport, that should not be our only focus. We need to encourage people to be more active in their everyday lives. We need to change people's perceptions of how to become active to reinforce the key message of 30 minutes of physical activity a day. Taking the stairs instead of the lift, getting off the bus a stop or two early, walking briskly to the shops, doing the gardening and playing outside are the sorts of everyday activities that children, young people and adults can be encouraged to undertake.
We will continue to support children to be active at school, through the two hours of physical education and the active schools programme. We are working to encourage adults to be physically active, and we are doubling the support for paths to health, which already has 20,000 people walking every week, supported by nearly 2,000 volunteers. With regard to the Labour amendment, we are happy to come back and inform Parliament of some of the more detailed aspects of the plans for PE and outdoor education.
We can build on the work that is supported by other parts of Government that contributes to our objectives. We are, for example, supporting the seven smarter choices, smarter places sustainable travel demonstration towns—that is a bit of a mouthful, but it is very important—with £1.5 million. We are taking a whole-system approach to get people to use sustainable transport as well as boosting their physical activity levels. It is about joining all those things up.
I will talk a bit more about some of the actions that we are taking to target obesity specifically, although diet and physical activity are key strands of that. We are devoting nearly £15 million to programmes that support people to achieve—and, which is important, maintain—a healthy weight. We previously announced £6 million for health boards to support the introduction of a child healthy weight intervention, which we expect to target up to 20,000 children over the next three years.
We are also continuing to support and expand the very impressive and productive counterweight programme, which the previous Administration initiated. The first two waves of the programme were targeted in those health board areas that hosted the keep well pilot. From August, the health boards that have not been participating in the keep well programme—including the island boards—will introduce the counterweight programme.
One of the more exciting projects that we are developing is a community-based healthy weight intervention. It is based on a French model that is described in the "Healthy Eating, Active Living" plan. The French model is interesting, because a decline in childhood obesity was measured in the communities in which it was active, which tells a compelling story.
Features of the French model such as providing nutritious school meals and encouraging children to walk or cycle to school have already been replicated in Scotland for some years. However, we need to translate those elements of the French model that were unique and which seem to have made a significant difference, such as taking a more joined-up approach at a local level between different initiatives, which focused the work and achieved a bigger impact.
We have to find our own Scottish solution to some elements of the French model, such as the use of a local champion to drive forward the project. We will be writing to local authorities and health boards in the next few weeks to invite them to express an interest in hosting one of the community health weight initiatives over the next three years.
I have picked out just a few of the projects that we are taking forward in order to highlight the work that we are doing, but the rest are laid out comprehensively in the action plan. However, we recognise that those actions alone will not solve the obesity problem that this country faces. We believe that if we are to fulfil our purpose of creating a more successful country with opportunities for all, we need to increase sustainable economic growth, and we need to do things differently.
Obesity is one of the problems that, like climate change, does not have a simple solution and requires a new way of thinking. In "Healthy Eating, Active Living" we announced our commitment to develop a longer-term strategy to tackle obesity. The development of that strategy is timely, as we are developing a national policy on food and drink and are taking stock of the national physical activity strategy to understand how it has influenced the development of policy in all areas of Government. Both of those exercises will report in the next few months and both will have to reflect on our commitment to tackle obesity.
Although we are doing many positive and welcome things that have improved our health, we have, as a society, tilted the balance away from actions that promote good health. We have created an environment and a lifestyle that we all enjoy but which makes it inevitable that obesity will grow as a problem. We need to tackle that as a society, which requires people to change their lifestyles and their habits. The role of Government is to make that as easy as possible, to support the good initiatives and, in particular, to get an early start by supporting our children. We must reposition the balance to ensure that the impact of our actions at least goes in the right direction, and of course we have to monitor that. I am happy also to accept the Liberal Democrat amendment and its recommendation that we measure improvements.
We are committed to change. We are committed to tackling obesity, and work has begun to identify the actions that we must take if we are to do that. We want to engage with our key partners in the next few months to discuss the shifting of the balance. I hope that we will get contributions not just from members who are in the chamber today but from the cross-party group on obesity and beyond.
I move,
That the Parliament welcomes the commitment of the Scottish Government to tackle obesity as highlighted in the recent publication, Healthy Eating, Active Living: An action plan to improve diet, increase physical activity and tackle obesity, and further welcomes the £56 million over the next three years, which the Scottish Government has made available to build on the existing good work in support of the Scottish Diet Action Plan and the National Physical Activity Strategy as outlined in the action plan.
I thank the minister for accepting our amendment, which I will mention later in my speech. I am terribly conscious that, when we speak in such debates, we are tempted to make sure that we breathe in properly. Perhaps we are all conscious of our own failings in this field. I promise that I will be eating properly next time I am seen in the canteen.
Shona Robison was right to say that tackling obesity is an important national priority and a challenge for us all. In recent years, we have become much more aware of the scale and depth of the challenge that we face in Scotland. I am sure that we were all shocked to learn that Scotland is placed second in the world—we come second to the United States—in the obesity league. It was a revelation to me when I learned the stark reality of the situation. We must pay serious attention to that.
People throughout the western world have also been shocked by the growing realisation that we could be the first generation that lives longer than the generation that follows it. That is a wake-up call for us to think about our priorities and the way in which we live.
Like other members, I received a briefing from the British Medical Association, which contains some startling statistics. One in five primary school children is overweight. Some 8.5 per cent are obese and 4.3 per cent are seriously obese. Those are serious challenges. The familiar pattern is that the highest levels of obesity occur in deprived areas—my colleague Elaine Smith will comment on that in depth in her speech, with her customary dedication to the issue. As the minister said, the consequences of the current and projected levels of obesity in Scotland are severe. Each day, 40 people are diagnosed with type 2 diabetes. The BMA goes on to tell us about the concerning implications for levels of heart disease, osteoarthritis and some cancers, alongside which are the consequences for self-esteem, mental health and depression.
The minister was right to highlight that, on the one hand, we are making great progress with some of the big killers and some of our big traditional health challenges, but that, on the other, we have a growing time bomb. Dean Marshall from the BMA said that we are in danger of raising a generation of children who are burdened with long-term chronic conditions. That will have enormous consequences for the way in which we run and resource our health service. It is indeed a wake-up call.
I put on record Labour's support for the Government's work on the issue, which, it is acknowledged, is a continuation of the previous Executive's work. It is proper that we focus on children and place a particular emphasis on work with them.
Labour lodged its amendment because we want to be clear about the specific commitments that the Government made and ensure that we get progress on them. There is no doubt that there is consensus in the chamber about the scale of the problem and the need to take decisive, comprehensive action in a range of fields. Later in my speech, I will focus on the action that we need to take and the partnership that we need to create to sustain an attack on obesity but, before I do so, I ask the minister to clarify some points when she replies to the debate. I am not sure whether she was telling us that pregnant women in Scotland will get free fruit and that an announcement will be made about that. When will the two hours of PE every week in Scottish schools and the five days of outdoor education be implemented?
Finally, we learned during yesterday's debate on the programme for government that we are soon to receive a report on the free school meals pilot. I wonder whether the minister could give some more details on that. Scotland has properly been recognised as leading the field in nutrition in schools, and we would always want to follow up developments in that agenda.
We need to develop our thinking about how we address issues of obesity, nutrition and exercise in our culture. There is, for example, an interesting debate to be had about the state's role in that respect. I understand that the Conservatives are having an interesting debate—I use that word loosely, of course—about nudge politics, and I would be interested in hearing more about that. I am not necessarily talking about the nanny state or, indeed, the neglectful state, but I believe that there is a role—and some support—for Government action as well as individual responsibility on this issue. The Parliament needs to have that debate if we want to create the policies and strategies that will help us to meet these challenges.
Will the front-bench spokesperson tell us where Labour stands on the question of this kind of harm being self-inflicted? She listed the possible conditions and diseases that can be caused—at least in part—by obesity. However, in some quarters, it is felt that such conditions are self-inflicted, which might have implications for the delivery of health services.
I do not think that we have passed a policy on that subject at our party conference, but I can certainly give the member my reaction to such a view. I am sure that other colleagues will comment on it.
I would not want to subscribe to any national health service policy that put a red line through someone's ability to get treatment simply because of their past or present behaviour. The explanations as to why certain people behave the way they do are simply too complex. I do not think that a policy that seeks to level blame at certain people or, indeed, areas and to withdraw services or resources from them is the proper way forward or helps us to challenge the problem.
Does that apply to Frank McAveety and his pies?
I will let Frank McAveety speak for himself on that matter.
I have six minutes to fill.
Order.
I am sure that Mr McAveety will respond to Margo MacDonald's point—and in a most entertaining way.
That said, at the heart of Margo MacDonald's question lies a very serious point, which we are just beginning to debate, about the role of personal responsibility and, indeed, how we might facilitate that. After all, the Government cannot substitute for the individual or the family; it is too much to expect it to be mother. However, we can support people in taking responsibility, and I certainly think that many of us in the chamber would want to have that debate. In any event, we need to create a partnership in Scotland to develop a sustained response to obesity that involves different tiers of government, families and communities and which supports not only individuals but the contribution of the voluntary sector.
I know that, at a UK level, work has been carried out with retailers to help us to come to a much better understanding of the food that we buy and eat and to ensure that we have much better information on which to make informed choices. Such an approach might allow us to shake off some of our past guilt about eating the wrong food or feeding the wrong food to our families. I have to say, though, that, as someone who rarely makes a meal, I cannot claim any responsibility in that respect.
The point is that many families live busy, pressurised lives and need to be empowered to make the right choices. In that respect, I welcome the UK Government's work with the Food Standards Agency, which is examining the three types of food labelling and is making retailers aware of their responsibility to provide clear and accessible nutrition information. There is a growing demand for information to allow us to make decisions on these matters.
There has also been progress on children's advertising. The UK Government has introduced regulations limiting television advertising of food and drink to children, and the effects of that legislation are being monitored. However, I feel that we could go much further. We could, for example, ensure that our young people receive proper information and are not manipulated into eating food that is not healthy for them. We should look to places such as New York, where interesting work is being done on providing information on calories in restaurants and making people aware of what they are eating and on the issue of trans fats in foods. We should be prepared to broaden our horizons.
As members might expect me to say, we should also consider community organisations, which play a vital role in ensuring that people get access to good food, particularly in deprived communities. A food co-operative in Cranhill in my constituency makes an enormous difference and has provided all sorts of opportunities for people to eat healthily.
I think that the Presiding Officer is going to encourage me to wind up. However, I would like to say just a bit more, if I am allowed—I am looking benevolently at the Presiding Officer. As the minister said, we need to think again about our whole approach to exercise and activity. A lot of good work on these issues is going on and there is a whole community infrastructure for walking clubs and keep-fit classes, but we need to do much more.
We need to ensure that we properly resource the health service to meet this challenge. We need to properly resource community organisations and the voluntary sector, given the vital contribution that they make. However, the Government also has an enormous responsibility to raise awareness and change the culture. There is a shared agenda about that throughout the chamber. We all have to step up and realise the scale of the obesity time bomb. Just behind the United States in the world league table is not a good place for us to be.
I move amendment S3M-2481.2, to insert at end:
"and calls on the Scottish Government to bring forward to the Parliament details on how it intends to meet its commitment to two hours per week PE tuition in schools by specialist teachers and guarantee five days' outdoor education for every school pupil."
It is not clear to me that the minister's message has even percolated the corridors of this very Parliament. I was somewhat taken aback to observe in the canteen at lunch time, on the day we are debating the important subject of obesity, several members—I hasten to add that they did not include Frank McAveety—tucking into Scotch pie and chips. That might just be indicative of the culture change that needs to be effected if we are to overcome the problem of obesity.
It would be churlish of me not to welcome, on behalf of the Liberal Democrats, the publication of "Healthy Eating, Active Living: An action plan to improve diet, increase physical activity and tackle obesity (2008-2011)" and the additional funding that is being directed to the programme. I, like Margaret Curran, am pleased that the minister acknowledged in her opening speech the good work that the previous Administration did in this field.
I wholly agree with Margaret Curran that the background in the BMA report makes for very grim reading indeed—I do not need to rehearse the statistics it contains. The sad thing is that—as usual—obesity is most prevalent among people from deprived backgrounds; it simply adds to the litany of health inequalities. That was certainly proved by the recent review of the Scottish diet action plan, which
"highlighted that progress was uneven and that the effect of inequalities on achieving population level impact had been"—
significantly—
"underestimated."
That is a sad additional factor.
There is no argument in the chamber about the need for more healthy living; the debate centres not on the need, but on which interventions are likely to be most effective.
In the time available to me, I will concentrate on the aspects of the plan that are most applicable to young people. I will not deal with young infants; I see sitting at the back of the chamber a Labour member whose real interest in that matter I would not attempt to compete with.
I am pleased to see that we are going to build on the hungry for success school meals programme, which has already increased substantially the nutritional quality of school meals. It is also good to see that health boards will progress the healthy weight intervention programmes. More important is the way in which the Government will try to align food policy, food production and nutritional standards.
One disappointing feature—albeit it is not wholly within the responsibility of the Minister for Public Health—which the BMA highlighted, concerns the importance of good food labelling in informing the consumer about the choices they make. The Food Standards Agency recommends a traffic lights approach. It is disappointing that the two major sets of supermarkets have divided into rival camps and are attempting to justify that in their literature and claiming that their system is better than the other one. It might be better if they considered the interests of the individual consumer rather than believed that competition in their approaches will bring about a healthier result. If the minister is engaged with representatives of the retail trade, in particular the Scottish Retail Consortium, I hope that she might put that point to them forcefully. The excellent work that is being done across the board is being diminished by that type of competition.
We welcome the progressing of the keep well programme, the continuing development of the active schools programme, dance in schools and the provision in the curriculum for excellence of two hours of good-quality physical education.
We have two points to make in relation to schools and school-age children. First, we all understand the point, which is made by some educationists, that it is difficult to fit the recommended time for physical education into an already crowded curriculum. Liberal Democrats believe that we have now reached a critical point, as Margaret Curran outlined with reference to the statistics. In relation to obesity, we must win round all those who are engaged in education, both primary and secondary, to the view that we simply will not improve educational attainment unless we give priority to tackling obesity. People simply must understand that.
We have hard choices to make. If we are to make space in the curriculum, something has to go. We should not be prescriptive about that, and we must consider the individual circumstances of individual schools, but we must force people to come to a choice; we cannot go on saying that we will make people achieve more if we admit that their lack of physical ability is impairing their ability to absorb what they are taught in the classroom.
We need to draw a distinction between programmes that are designed to ensure that young people take an appropriate amount of exercise and programmes that are designed to introduce young people to sport. For many people today, the programmes might be the same but, in the current circumstances, too many young people recoil from engaging in sport because their basic level of fitness makes it a wholly unappealing prospect. The corollary is that if we separate sport and fitness, we might, at a later stage, attract more young people into sport once they have reached a level of fitness that makes the prospect of engaging in a sport less daunting.
The development of dance in schools is a step in the right direction, but we need more options to make engaging in physical activity attractive to young people. We would be interested if the minister, in winding up, could indicate whether she accepts the distinction that I have just made, and whether, in developing the obesity action plan, she will draw that distinction in a way that makes sense if we are to improve people's level of activity. Subject to that distinction being taken on board, it follows that we will support the Labour amendment, which the minister has already accepted.
I am grateful to the minister for indicating her support for our amendment, the intention of which is to close what I thought was an unfortunate omission in the action plan. The plan sets out logically the statistical basis for its programme, but although it covers "Delivery and Evaluating Success", I do not believe—with respect—that it sets out how that success can be measured. The Liberal Democrat amendment remedies that deficiency by requiring that annual progress be measured and reported on by reference to the very measurements that are set out in the report, which provide the basis for suggesting that we have a problem with obesity. If that is a sufficient basis for acknowledging that we have the problem, I am glad that the minister accepts that it is also a good basis on which to gauge whether the obesity action plan makes progress.
I have pleasure in moving amendment S3M-2481.1, to insert at end:
"and believes that progress in tackling obesity should be assessed and reported on a regular basis according to the 10 measurements set out in chapter two of the action plan."
I welcome this debate on the obesity action plan. My colleague and I sincerely hope that the Liberal Democrats will not make the eating of Scotch pies a criminal offence in future.
We are too liberal to do that.
Indeed. I thank the minister for attending the reception on obesity that I hosted in the garden lobby in June, which, as she said, showed that there is not just tremendous good will, commitment and interest throughout Scotland but a willingness to engage with the Parliament on the issue. I put on record Nigel Don's work in setting up the cross-party group on obesity. I understand that he has an excellent adviser in his wife, who is a nutritionist.
We will support the Government's motion and the Labour Party and Liberal Democrat amendments. Although we might disagree on aspects of the implementation of the obesity action plan, we are supportive of the overall approach. As Murdo Fraser said yesterday, Scottish Conservatives will support the Government on issues that we consider are in the best interests of the people of Scotland. There is no doubt that obesity is a huge issue, so action to address it is in the best interests of people in Scotland.
I am delighted that Margaret Curran remains a member of the Scottish Parliament. Although she and I might disagree on political issues, I respect her political abilities. However, I regret the motion that she lodged on the comments that were made by Andrew Lansley, the Conservatives' shadow secretary of state for health—I regret having to say that, because I am bringing in a note that is not in tune with the rest of the debate, but I have a duty to address comments that have been made in condemnation of a member of my party. Conservatives know that health is truly devolved to the party in Scotland. We take no orders from our colleagues in Westminster—I appreciate that such a principle might be difficult for the Labour Party to comprehend. The only reference to Glasgow that Andrew Lansley made in his speech was when he said:
"If spending on healthcare alone determined health outcomes, Glasgow would be the healthiest place in Britain and Wokingham the least healthy."
Andrew Lansley's comments are in tune with points that members have made in this debate and the key point in the European Union white paper "A Strategy for Europe on Nutrition, Overweight and Obesity related health issues", which is:
"the individual is ultimately responsible for his lifestyle, and that of his children".
We agree with Margaret Curran that the Government has an enormous and crucial role to play, but Government activity can be successful only with the commitment of individuals. I suggest to Labour Party members that they respect devolution in relation to portfolios in Scotland and England and that they fully read speeches before they make ill-founded comments, particularly given that health and wealth inequalities grew during 10 years of Labour government at Westminster and Liberal-Labour coalition in Scotland.
I thank Mary Scanlon for her personal comments—I do not take her political points personally. Does she disassociate herself from comments that David Cameron has been making? Does she believe in the nudge politics that increasingly seem to be Conservative philosophy, or are nudge politics an England-only philosophy?
I have taken the time to read speeches by David Cameron and Andrew Lansley, who have said nothing that is not in tune with what we are saying. Individuals need support. Members talked about the removal of cigarettes from visual displays, which might be a nudge policy, if the evidence that such an approach discourages people from smoking cigarettes stacks up. We have to be realistic.
In 1996, the Scottish Conservative health minister, James Douglas-Hamilton, launched the Scottish diet action plan. Had Labour ministers pursued the recommendations in that plan, the BMA figures that other members have highlighted might have been less concerning than they are. That is without mentioning the steadily rising cost to the national health service, which is £171 million a year, and the huge rises, to which others have referred, in the incidence of type 2 diabetes and other related conditions, particularly kidney failure, which increases day by day.
There is a need not just for attitudes to be changed, but for Government support and for equity of access to support and advice for weight management. As Margaret Curran said, Scotland is second only to America on obesity levels and has twice as many obese adults as Ireland. I am sorry that Tavish Scott is not here; I do not believe the Dr Foster Research finding that Shetland has the highest level of obesity in Scotland. As a member for the Highlands and Islands, my impression is that Shetlanders take full advantage of the excellent health and fitness centres in their communities.
People who seek weight management support find it difficult to know what is available through the NHS, although I appreciate that the Scottish intercollegiate guidelines network guidelines are being updated. Is even a school nurse trained to identify and assist children who will have obesity problems? Does a system exist for a school nurse and a health visitor to work with a family? I have found no such system. I welcome what is happening—I disagree with little—but we need to know the pathways into help and support. When—whether at nursery school or another school—does someone say, "There is a problem here. You are likely to have additional health problems in the future. We would like to help"? There is no point in helping a five-year-old or 10-year-old child unless their family is helped, which is why the health visitor is crucial.
The member asked whether a system exists whereby help can be accessed at community level. At the community health flats that have been established in Edinburgh, people can learn about diet, learn to cook and be helped. Islands of community activity can provide a template.
Margaret Curran mentioned that many voluntary organisations and others throughout Scotland do sterling work.
The action plan is unclear about the independent sector's role in addressing obesity and about slimming on referral from general practitioners, which has proved successful elsewhere.
As Ross Finnie said, we need a single labelling system that is clearly presented and clearly understood. When I go shopping, I find it difficult to comprehend whether so many grams of sugar, salt or fat are good or bad, when the next label describes the percentage of the recommended daily allowance. I have to think whether 6 per cent is 6g and how much of my daily allowance that is. Even if people want to buy nutritious food, that is not easy. I associate myself with Ross Finnie's comments. Clear and standardised labelling on alcoholic drinks is also essential, as most people in Scotland are responsible drinkers.
The Conservatives would like to hear the Government's response to our outdoor education policy, which would entitle every pupil to a week's residential course in outdoor education between primary 7 and secondary 3. We appreciate that that would not be the answer in itself, but it would at least be an introduction to the great outdoors that it is hoped would encourage more outdoor involvement in adulthood. We hope that a future review will address that.
If someone asked me how to access advice and support for weight management, I would have to say, "Visit your GP. Beyond that, the rest is uncertain." Even with an action plan and an extra spend of £40 million, what individuals are entitled to through the NHS is not entirely clear. I ask the minister to work more closely with GPs to ensure that all those who face health risks because of obesity are aware of and can access weight management services in their locality.
I welcome the report.
It has been interesting to listen to members' speeches, given the wide nature of the debate. We can all talk about different things and still leave cracks between what we are saying. As usual, I will try to pick on areas that have not been discussed thus far.
The cross-party group on obesity has been mentioned. I am grateful to the members who enabled it to be established. Mentioning it gives me an opportunity to plug the next meeting on 17 September at 6 pm, when some professionals will give their responses to the report.
Although we face many problems, the issue is not the numbers, but the trends. We can discuss levels of obesity and what it is to be overweight, but the worrying bit is not those numbers but the fact that every trend is an upward trend. I attended a presentation by a respected figure in the health world who said that there is no earthly reason why all the graphs should not reach 80 or 90 per cent in a couple of generations. If all our grandchildren's generation reach 70-odd, they could all be obese. That is where the trends are going; we are not immune to them.
We all recognise that the problem is one for society. There has been some interesting banter about individual responsibility, which is undeniably a factor, but it is clear that even an individual with the best of intentions can have a problem with weight gain.
One issue that we have to address, which the report does not really highlight, is the commercial world—the suppliers and manufacturers. We are bombarded with adverts to buy foodstuffs, particularly high-density foods that we probably do not need to eat. An Olympic swimmer who swims 50 miles a day or an Olympic cyclist who cycles the equivalent of halfway round the Himalayas each day can burn off the calories that they consume, but most of us simply do not need a diet that is high in calories.
Today, I walked to the Parliament, as I always do. It takes about a quarter of an hour. During the day, I walk around the building, which—as members know—is not that far at all. I also walked up the stairs to the fifth floor of the MSP block three—perhaps four—times today, which I suspect is considerably more than most members have done. At the end of the day, I hope to walk to the station and I will walk from the railway station in Aberdeen to my home. Overall, I think that that adds up to about three quarters of an hour's exercise.
If time allowed, I would read an article from Obesity Reviews in its entirety, but I have time only to quote briefly. It says that
"There is compelling evidence that prevention of weight regain in formerly obese individuals requires 60-90 minutes of moderate intensity activity",
such as walking, but that
"Although definitive data are lacking, it seems likely that moderate intensity activity of approximately 45 to 60 minutes per day … is required to prevent the transition to overweight or obesity."
In other words, that is what is required of us all if we do not want to become overweight, never mind obese. As I have outlined my exercise regime today, members can see that I will struggle to achieve that target. If that is the case for someone who likes walking, as I do, the extent of the problem is clear. We are going to have to change the way in which we live and work.
I will now consider why we put on weight. An article in The Medical Journal of Australia talks about people's average weight gain during their lifetime:
"The current rates of weight gain, varying perhaps from 0.5 to 2kg/year in the very susceptible, amount to about 10-40kcal … in the average daily discrepancy between input and output"—
in other words, a small additional energy turnover is involved—
"However, we need to walk briskly for 80-90 minutes daily … about 350 kcal"
to maintain a healthy balance.
The disparity between the two numbers—the 350 kilocalories-worth of exercise and the approximately 20 kilocalories-worth of fat that someone puts on—relates to the fact that, when we overeat, most of the foodstuffs are not absorbed. It is only a small amount of the overabsorption that leads to weight gain over a period of time. When we understand that, we begin to realise how difficult it is to stop it happening. The little bit that we absorb needs to be countered by a very large amount not going in—in other words, we are all overeating quite significantly. To make a difference, so that we do not put on weight, we must eat a lot less. I suspect that, by and large, people do not appreciate that problem.
As always, time is against me, but I will raise one other issue. I ask the minister to be prepared to put some money into science. I am sure that the counterweight programme is well intentioned and has produced good results, but if we are to roll it or anything else out on a large scale, we must do some longitudinal research. It is easy for any intervention to have an effect over a year or two, but 10 years later we may find that it has made precious little total difference. That does not mean that the intervention is of no value, because it will have improved life in the trough, but there is a risk that we will institute measures that do not have long-term benefits. We should concentrate on interventions that have long-term benefits; we will find out whether they have such benefits only by supporting good science.
I welcome the opportunity to take part in this afternoon's debate on the obesity action plan. It is an important debate, given the scale of the issue in Scotland. We live in a country in which people who are obese have an 18 per cent greater chance of ending up hospitalised. Forty-seven per cent of cases of type 2 diabetes can be attributed to obesity. As has been mentioned, 21 per cent of primary 1 schoolchildren are overweight. In addition, obesity doubles the probability of sight loss. I welcome this afternoon's debate, which is a serious attempt to look at those serious problems.
I welcome the action plan, which builds on some of the work of the previous Executive, including the 2006 diet action plan and the hungry for success initiative. A key part of the plan is to look at the work that takes place in schools and early years. There is a big job to be done to ensure that young people choose fresh fruit over fast food. Many positive initiatives are in place throughout Scotland. In my constituency, the Rutherglen and Cambuslang community health initiative does a great deal of work to promote healthy eating. St Andrew's Hospice, which does a great deal of work with Lanarkshire schools to promote healthy living and eating, has a stall in the garden lobby.
It is critical that there is a healthy environment and promotion of healthy living in the workplace, because that feeds into successful local authorities and successful businesses and has an impact on the economy and the health service. Yesterday we heard a great deal about economic growth, but for that we need a healthy Scotland and a healthy workforce. We also want to reduce the strain on the NHS and, in the longer term, to use funds for more positive programmes.
I highlight the work that is being done with older people. People are starting to live longer and, as Margaret Curran indicated, we want that to continue. If people's minds and bodies are agile and fit, they can remain well when they are older. We should build on the success of the recent Olympics and use sport as a catalyst for encouraging healthy living and fitness activity. The action plan indicates that the incidence of walking has increased from 39 to 46 per cent, but we must do much better than that. The 2014 Commonwealth games and the 2012 Olympics can help us to promote many more fitness programmes throughout Scotland.
As the action plan says, there is a link between social deprivation and obesity, particularly among women. That is why it is important to get the allocation of primary care resources and health professionals throughout Scotland right. There are 34 GPs in Cambuslang and Rutherglen, with a population of 55,500, but 42 GPs in Livingston, which has a population of 52,000—and a longer life expectancy. If we are going to tackle obesity, some thought must be given to how we allocate resources and health professionals.
I welcome the action plan, but the SNP should consider some wider issues. For example, health spending is growing at 4 per cent in England and Wales and at 1.5 per cent in Scotland. Further, although the SNP manifesto mentions free access to swimming pools and health checks for the over-40s, neither of those policies has been taken up. There is concern that the school building programme is grinding to a halt when 33 per cent of schools are in need of attention. If we want schoolchildren to have two hours of physical education and to meet the target, we need gymnasiums that are fit for purpose. We therefore need to take forward a schools modernisation programme.
This has been an important debate. I welcome the publication of the action plan, but to tackle obesity the SNP Administration must consider wider policy priorities.
There is no doubt that the problem of obesity has become more widely recognised in recent years, but I am not convinced that the scale and nature of the problem and its long-term implications for our nation have been fully understood.
As others have done, I welcome the action plan, which builds on the work of the previous Executive. The additional £40 million for the action plan over the next three years will help to ensure that it is delivered effectively. What is particularly important about the action plan is that it acknowledges the balance between the dietary aspects that contribute to obesity and the role of physical activity in tackling the problem. Like Nigel Don, I think that it is important that in addition to considering the stark figures for the number of people who are obese in Scotland, we should be concerned about the trend, and the fact that the figures demonstrate that the number of obese people in Scotland is increasing.
Some members have referred to the fact that Scotland is often quoted as being second only to the United States of America when it comes to obesity levels. There has been research that challenges that, but I will come back to that later. In any case, we accept that Scotland is up there among the top group of countries when it comes to obesity levels.
The long-term implications for our nation are considerable. I suspect that it is hard to provide a definitive figure for the cost of obesity to the NHS and society as a whole—I have seen estimates of between £150 million to £200 million a year. What are clear, though, are the health costs of obesity: 47 per cent of cases of type 2 diabetes can be attributed to obesity, 29 per cent of cases of colonic cancer, 13 per cent of cases of ovarian cancer, 15 per cent of cases of angina, 36 per cent of cases of hypertension, 15 per cent of cases of gallstones, and 47 per cent of cases of gout can be attributed to it. That illustrates the extent of the problem. We should couple those figures with the figures that other members have mentioned on the young people coming into primary schools who are already clinically or even severely obese.
We must have a strategy and an action plan to tackle the problem effectively. The action plan must not be seen in isolation, so I welcome what the minister said about that. The issue is not simply to do with health and it is not simply to do with physical activity—clear social and economic issues also arise. Plenty of research has demonstrated that the incidence of obesity is greater in areas of higher deprivation. The action plan must therefore be seen as part of an overall plan for addressing deprivation and health inequalities in society. In her closing remarks, I hope that the minister will address that in slightly more detail and show how the action plan will fit into the bigger picture.
I said that we are often described as being second only to the USA when it comes to levels of obesity. However, some research challenges that view: Greece, Malta, Kuwait and the gulf states all have higher levels of clinical obesity than we have. We should concentrate on measuring the extent of our problem against that of neighbouring countries such as Norway, Italy, France and the Netherlands. In those countries, obesity levels are on average less than 15 per cent, which must lead to the question: what exactly are they doing right that we are not? If we look behind the statistics, we might think that people in those countries must be more physically active, but research shows that people in those countries are not much more physically active than we are. A considerable body of evidence—from Mike Lean, for example—demonstrates that the problem is largely to do with what we put in our mouths.
In the past, I have thought that the focus of the debate on obesity has been on physical activity. The action plan acknowledges that it has. Much of the debate has been about sedentary lifestyles being the major contributor to obesity. However, recent research from the University of Aberdeen clearly highlights the fact that the level of calories that we burn off in physical activity has not really changed in the past 20 years, although levels of obesity have continued to increase. Work by Professor John Reilly at the University of Glasgow also highlights the point that physical activity plays only a small part in tackling obesity.
I hope that, in the future, the focus will be more on changing people's eating habits. Labelling has a big part to play. If someone goes into Boots and buys a sandwich, they have the traffic-light system, which is easy to understand, but Marks and Spencer does not have that system, and people can get lost in the gobbledegook as they try to work out whether something is good for them or not. We have to get a clearer message across to people on what is healthy and what is not.
Dorothy Parker once famously opined that
"You can't be too rich or too thin."
I mention that to highlight the point that being thin can be associated with a person's status in society. People in the public eye strive to be slim. It is fairly common for overweight and obese children to be bullied over their weight; likewise, society can portray obese adults as being gluttonous. We might therefore think, as being thin is such an aspiration and being fat is held in such disdain, that we as a nation would be predominantly slim and trim. We know, however, that that is not true.
Currently, one in two adults is sufficiently overweight for it potentially to harm their health. It is estimated that, by 2010, 28 per cent of women and 33 per cent of men in the United Kingdom will be obese. In Scotland last year, 21 per cent of primary 1 children were overweight.
As we have heard, the issue is complicated, but because of the associated health risks the issue might be one of the most important that this Parliament tackles. Taking the right action will literally save lives.
I return to a point that was made earlier: obesity is sometimes genetic; it is sometimes due to medical conditions; and it is sometimes due to inability to take exercise. It is also possible that obesity is due to overindulgence in this instant-gratification society in which unhealthy food choices are readily available, along with—as the minister mentioned earlier—sedentary lifestyles and jobs. Whatever the reason, people should be accepted as they are. They should be able to access the same services as everyone else and not suffer discrimination. Nevertheless, there must be increased awareness of the fact that certain life-threatening conditions can accompany obesity, such as diabetes, cardiovascular disease and some cancers. Therefore, obesity must be tackled for the sake of the individuals concerned, for the health service and for the good of society as a whole.
Before we can successfully begin to reduce the growth in obesity, we need to understand the reasons behind it, which are multifaceted. Although obesity is a complex condition that can affect all socioeconomic groups, it is nonetheless a class issue in that the most seriously obese people are poor. The BMA tells us that the highest numbers of overweight, obese and severely obese children in Scotland are found in the most deprived areas, and that the opposite is the case, with the least deprived areas having the lowest levels of childhood obesity. It is unacceptable that Andrew Lansley, the Tory shadow health secretary, said last week that there are no excuses for being obese. I note what Mary Scanlon said earlier, and I commend her for her work on the issue. However, not all individuals are wholly responsible for their obesity; therefore, we need a societal approach to tackling the problem, as Michael Matheson just said.
The Foresight report highlights the need to tackle the growing obesity trend coherently and comprehensively. It points out that we live in an "obesogenic" environment. The factors include a lack of green space and safe areas for children to play in, budget constraints that mean that food is selected on the basis of cost rather than quality, and cynical marketing by supermarkets that promote two-for-one and buy-one-get-one-free deals that are designed to make profits on edible goods that have little nutritional value.
"The Scottish Health Survey 2003" tells us that there is a marked difference between the diets of people in affluent and deprived areas: for example, women in the least deprived areas are twice as likely as women in the most deprived areas to eat the recommended five portions a day of fruit and vegetables. Obviously, cost plays a part in that, and some people have limited choices.
The fast-food industry targets children with its advertising for high-fat, low-nutrition sugary offerings that I am loth to call food. Indeed, some fast-food joints should carry a health warning. Also, the highly addictive nature of sugar should be noted, as young children have a propensity to get hooked from an early age.
The action plan is to be welcomed today, especially for its recognition of the fact that a range of partners must work to tackle obesity. The minister stated that work across Government is necessary. I would be interested to hear, in the minister's summing up, a further breakdown of the welcome extra money—the £56 million. What other funding will be available from other portfolios, and what will that be for? Although the money, which has been increased, is welcome, it does not seem to be a huge amount to make available over three years to tackle an epidemic, especially given the fact that the cost of obesity to the NHS was £171 million in 2003.
The SNP's manifesto pledge to provide free fruit to pregnant women and to children in pre-school establishments seems to have been replaced with broad-parameter guidance to NHS boards. What checks will be made on funding for that? Perhaps the Liberal Democrat amendment would sort that out.
I also welcome the mention of breastfeeding, which, it is widely accepted, helps to establish healthy eating patterns from an early age and might have an effect on the propensity to become obese. The rate of breastfeeding is lower in deprived areas. My own piece of legislation, the Breastfeeding etc (Scotland) Act 2005, is cited as an example of the way in which Scotland is leading the way in breastfeeding support. I would like to know more about the funding that is being targeted to increase breastfeeding rates and whether the new target of 32.7 per cent means that the Government has given up on the previous target of 50 per cent. I am interested to know whether breastfeeding will feature on the curriculum in schools, as I think it should and must if we are to make a difference to future choices.
On page 20 of the action plan, mention is made of increasing access to healthier food. Does that mean that there will be more funding for food co-ops? On page 38, we are told that car dependence will be reduced by various methods, but I do not see anything about buses.
The action plan is welcome. As has been said, much of it builds on previous initiatives. However, the most important issue is that we acknowledge that the obesity epidemic must be tackled through joined-up social and economic policies that also tackle poverty and inequality. In an article entitled "Inequality is fattening", Polly Toynbee writes that
"the narrower the status and income gap between high and low, the narrower the waistbands."
She concludes that
"only a genuine drive towards a society that doesn't leave out a quarter of its citizens will send the bathroom scales tipping in the right direction."
I was a bit put off at the start of the debate when a skinny malink like Margaret Curran said that she was drawing in her breath—I thought, "Heaven help the rest of us who live in the fatty puff world."
I commend the minister for the general sweep of the obesity action plan. I agree with it and it is fine. If I appear to be too critical, I apologise in advance.
The most impressive speeches—apart from that of Nigel Don, who obviously knows what he is talking about—came from Elaine Smith and Michael Matheson, who put their finger on it. The issue is about poverty and inequality; it is not just about some folk being fat and some being thin. We must change social attitudes and the division of the good things in society—I do not just mean cream cakes.
I suggested to the minister years ago—I think in the first session of Parliament; she looked at me askance when I made the suggestion—that if we were serious about the issue, we would think about taxing salt, sugar and fat content in foods when it went above recommended guidelines. I am serious about that. If we want genuinely to give people a choice, we should ensure that products are on a level playing field and that cheaper food is not the food with the high salt, sugar and fat content.
I do not know whether, like me, the minister uses her local public baths. They all have vending machines because they have to eke out their incomes. What is in the vending machines? There are Mars bars and everything else that is great—we do not need to know the salt, fat and sugar content to know what they will do to us. Why on earth are vending machines like that still in schools? They are not in all schools and not in all local authorities, but they are in some public buildings such as swimming baths and leisure centres. The vending machines have lethal food in them that is very easy for someone to reach for as soon as they have finished terrific physical activity.
We should not beat ourselves up about it. We should instead measure how successful the penetration of companies such as McDonald's and the sweet makers has been. When Rebecca Adlington won her second fantastic gold medal and smashed the world record, she was asked what she was going to do and she said, "I am going for a McDonald's." All these folk say that we want athletes to be beacons of hope and the best examples to young people so that they will not eat such food, but that is what she thought was the biggest treat she could possibly get after pulling off such a fantastic feat.
Another issue is cookery classes in schools. In a previous session of Parliament I asked questions about that and told the education minister that we should try to teach the healthy lifestyle in respect of physical education and nutrition in a collegiate way, and that physical education should not just be about physical jerks. Physical education is also about what we eat and how our bodies process what we eat. People have to know about cooking and there have to be what used to be called home economics teachers—I do not know what they are now called in schools, but I know that there are not enough of them. When I checked how many are in training, I discovered that in the year prior to the one in which I made my inquiries 11 had graduated in Scotland. The subject has fallen out of the curriculum.
Ross Finnie said that physical activity should replace some topics in the curriculum. It will be hard to persuade parents that that should happen, but if we are serious, it has to happen. We will also have to start teaching pupils about nutrition and cooking in schools, because there is now a generational gap. It is no longer someone's grannie who can tell them how to make a pot of soup or a pot of mince; they have to go to their great-grannie to find someone who did that, because their grannie was probably out working all the hours that God sent to take part in the new economy and so did not have time to cook like that.
When Mary Scanlon talked about regaining skills and informing people about good eating, I instanced the community health flats that have been established in Edinburgh. We were absolutely adamant that nutritional advice should be on hand in those flats, particularly for very young mothers. That can be done quite easily.
On physical activity, people talk airily about two hours of good-quality physical education. I ask them to define good quality. We need well-trained specialist teachers, good facilities and an acceptance on the part of schools that PE is part of holistic education. However, that does not happen.
Nigel Don was absolutely right when he talked about trends. Do not look at the figures and spend time working out that we are the second-fattest country after the United States of America. Instead, look at what is happening in the Mediterranean countries, which were previously held up as ideal places in terms of diet and fitness. They now have exactly the same problems we have because the big food manufacturers are packing the same rotten food into those people. Many recipes in Portugal and France now end with "ping", because the folk who normally did the cooking in the house are out working.
We have to address the big changes that have taken place in the past 20 or 30 years.
Obesity has not always been considered undesirable. The ladies who were portrayed by Rubens were almost always well endowed and in many cultures in the past, excess fat has been seen as a sign of affluence or even of benevolence. As Shakespeare's Julius Caesar said,
"Let me have men about me that are fat,
…
Yond' Cassius has a lean and hungry look;
He thinks too much: such men are dangerous."
Of course, he was right. Very soon, his old pal Cassius had the knives out for him—literally. It is perhaps good for present-day political leaders—including some members in this chamber—that stealthy political assassinations are today conducted by words rather than swords.
The reason why no one worried about the diseases of old age, for which obesity is partially responsible, was because average life expectancy until comparatively few years ago was half what it is today. The "eat, drink and be merry" policy did no one much harm because the chances were that they would die of other causes before paying the price.
However, today, things are different. I will not rehearse the figures that have been presented to us by the minister and others: suffice it to say that we all agree that there are too many obese people in Scotland and that their health will suffer as a result of their obesity. Consequently, they will place a great burden on not only themselves, but on their families and society as a whole, and they will make increased demands on an already hard-pressed national health service. Where there is potential for disagreement is around the question of what to do about it.
Some in this chamber and in Westminster hold that the solution is in people's own hands—or, more specifically, their mouths. They say that fat people are fat because they eat too much and exercise too little and they say that the individual alone can redress that situation. Up to a point, they can. What we cannot deny is that many obese people are products of an education system and a society in general that has grievously let them down.
Take eating habits, for example. I know people for whom convenience food is eating a pizza from a takeaway, and home cooking is microwaving a frozen pizza from Iceland. They certainly have not been taught basic cooking skills at school, as Margo MacDonald said. However, we cannot blame their parents—or parent, as is often the case—because they will have had no such training, either. The steep decline in the average person's ability to undertake basic cooking took place more than a generation ago.
Remedying that situation is not going to be easy—Margo MacDonald is spot on in her assessment. What is needed happens only sporadically at present: a demonstration of cooking skills in schools, using produce from local shops. I am delighted that the Government will sponsor such activities—it is a good start—but I am also pleased that there are plans to help adults because, after all, it is in their kitchens that the skills to be learned by their children will be employed.
Cooking demonstrations in shopping centres, community flats and other places where adults gather will help. The aroma of flavoursome food with the opportunity to take part in its preparation—I am salivating already—followed by a liberal tasting session could go a long way towards encouraging adults to prepare similar meals in their own homes, especially when they learn how much money they can save by utilising such skills. Getting people started is the challenge.
Then there is exercise—or, rather, the lack of it. Although eating a healthy diet is key to weight reduction, exercise can play a part and is beneficial in other ways. I am encouraged by Government plans to facilitate a wide variety of exercise activities including sport, dance, walking, cycling and jogging, and I look forward to learning about how the strategy progresses. However—I risk some unpopularity—I think that we should be careful about pinning too many hopes on the population health benefits of the forthcoming Olympic and Commonwealth games.
When Roman emperors, such as Julius Caesar, wanted to divert the public from complaining about increased taxes or deteriorating quality of amenity, they organised huge games. However, even those emperors shied away from claiming that a vigorous gladiatorial combat to the death in the arena would encourage the plebs to take more exercise. They were merely a diversion. Similarly, the games that we are organising are marvellous for stimulating a form of chauvinistic patriotism—the "we can show Johnny Foreigner a thing or two" idea—but will the sight of a muscular athlete covering 100m in 9.6 seconds encourage us all to go jogging? Will the sight of Chris Hoy winning three gold medals get us cycling to work? Forget it.
I am tempted to argue that the billions and billions of pounds that we are spending on all aspects of those extravaganzas—the dedicated car routes in our cities for officials and the five-star hotel accommodation that we lavish on the men in suits—could be better spent on providing more community physical activity co-ordinators and exercise facilities in all communities. However, that is probably a debate for another occasion.
I congratulate the Government on making a start in the battle against obesity and wish it well in the endeavour.
Having listened to Ian McKee, I am concerned—
Where is your microphone, Mr McAveety?
Sorry, Presiding Officer. I normally do not need one.
Having listened to Ian McKee, I worry about the vision that he identified. We could have Emperor Alexis of Caledonia by 2014, which is a deeply troubling prospect. I am also concerned by what I consider pie-ist remarks being made by various members in the chamber in the past 24 hours. I am thinking about setting up a Scottish pie association—SPA for short—just in case people need to recuperate.
My genuine request to the First Minister to compete for charity in a 100m sprint still stands. I look forward to Alex Salmond's response, and I am sure that a sprinting coach at the Riccarton training ground of his beloved Hearts could encourage him to get into reasonable shape.
Thankfully, most of us in politics have a fairly thick skin; otherwise our self-esteem would be damaged by some of the debates and comments made about individuals in our society who are overweight or obese. Much of it can be seen as fairly reasonable banter, but underneath there are some fundamental issues of concern.
This is the first time that Margaret Curran and I have had a chance to discuss how individuals and communities are portrayed since our experience in the recent by-election for the Westminster parliamentary seat of Glasgow East.
Reading through the press cuttings after the battle that we took part in, I saw that much of the language used portrayed people as individuals who would be able to sort out their own affairs if only they made more effort. I disagree with that. I understand the concerns that were raised by the Conservative spokesperson, but I think that there is an agenda at the top of the UK Conservative party to prepare us, as part of a longer-term strategy, for how the Tories would use public resources in future. They are trying to soften us up to the idea that the state—whether at local or national level or through the voluntary sector—can do nothing to make a real difference to people's lives and that, if only people would be more responsible, things would be much simpler and easier to deal with. I quite like that: those are the essential verities of the Tory party that I knew and loved in the past. David Cameron bravely visited for an hour and a half to give that lecture to the people of the east end before popping off back to the comfort of where he came from.
David Cameron was warmly welcomed in the east end of Glasgow. That is more than can be said for Gordon Brown, who never even set foot in the constituency.
I remind the member that the individual who gave David Cameron a good welcome did so out of courtesy. However, that individual voted for the Labour candidate in the by-election, as he was once one of my election sub-agents.
I think that the language that is being used around the debate will unravel over the next few years.
The fundamental issue is what we do to tackle obesity. I welcome the minister's speech, much of which represented a continuation of the policy that the previous Executive engaged in over the past number of years. Perhaps the most positive contribution to the debate—I am not saying that other contributions were not positive—came from Michael Matheson, who combined a number of issues to challenge our understanding of the phenomenon, which is taking place not just in Scotland but across the developed world.
In considering how we deal with companies and organisations that sell packaged food, I do not think that a voluntary understanding is sufficient. We need to identify where we can intervene to address the issues surrounding products that are high in fat and in sugar. I hope that we can get some consistency on that issue across the parties.
The BMA report identified two issues, which Michael Matheson and others have emphasised. One is the quality of nutrition—particularly for youngsters in schools, where the quality of nutrition needs to be changed for the long term. Combined with that, we need to promote different forms of exercise for people who have very active lifestyles and those whose lifestyles are changed at a different level. That point has been made by one or two members. Given that the economic cost—never mind the social and personal cost—will be too immense for future taxpayers, we have a responsibility here and now to try to address the issue.
Finally, I want to touch on what I think are the important issues for which the Government should take responsibility, although I recognise from yesterday's debates on policy formulation that, when things are going well, the First Minister and his Cabinet colleagues claim that that is due to their intervention. I believe that there are three areas on which we need to do much more work. First, we need to do much more on the commitment to PE in schools, provided by quality PE teachers. Secondly, we need a radical shift—I take some responsibility, having been a minister in some of the relevant portfolios—to ensure that we do much more to provide a range of quality sports facilities. Thirdly, and most important, we need to consider how our most disadvantaged communities can be helped to sustain a level of self-confidence that enables individuals to take personal responsibility, to which the Conservatives have alluded. We need to do that by working alongside agencies and organisations to make a real difference. If we do that, we might not have the statistics that, on current trends, will confront us in 2050.
In trying to address the issues, partnership at Scottish, UK and European levels will be required across a range of areas. That is the real challenge facing any Minister for Public Health.
I appreciate that obesity is an issue that people do not like to talk about, but this afternoon's debate has been extremely interesting. Many valid points have been raised, especially by Nigel Don, whose speech I enjoyed, and by Frank McAveety.
I have no intention of reiterating all the points that have already been made, but I will touch on a couple. For many, obesity is a matter of embarrassment rather one that they do not care about. The obesity action plan that the Scottish Government launched in June is therefore a welcome step in tackling the problem in Scotland.
The action plan is a long-term practical strategy, and the most appropriate way to move forward. With £56 million of funding over the next three years, the SNP Government is helping to create a healthier Scotland. By tackling obesity in Scotland, we are striving to alleviate some of the strain on the NHS caused by chronic illnesses and the associated costs of treating the consequences of obesity.
We have already heard that the estimated cost of obesity to the NHS in 2003 was £171 million, a sum that I am sure every member in the chamber agrees could be easily redistributed to other areas of the health service. It is a positive move, therefore, that the Government is devoting £19 million—nearly half the available resources—to the early years. We cannot ignore the importance of education in forming our opinions and mindset when it comes to a healthy lifestyle.
In my adult years, I have been careful about what I eat. I still enjoy a fish supper or a burger from time to time, but I have never succumbed to the joy of a deep-fried Mars bar or a deep-fried pizza in batter—the thought is quite revolting. In the run-up to becoming a father, I became even more aware about the food that my wife and I ate. That awareness has continued since then, as we want to ensure that we and our daughter are as healthy as we possibly can be.
The early years programme to improve the nutrition of women of childbearing age, pregnant women and children under five in disadvantaged areas will have longer-term benefits for people's health as well as the health of the NHS in Scotland. Improving nutrition and educating people about the benefits of healthier eating, particularly for pregnant women and children under five, will be successful in the longer term. By promoting healthy living from an early age, in relation to both alternative food choices and fitness options, we hope that the future of Scotland will be heading in the right direction.
A further curse of obesity is diabetes. Last night, I attended the launch of the "Scottish Vision Strategy"—the document that I have here—at the meeting of the cross-party group on visual impairment. Shona Robison and James Kelly were also there. The strategy has been developed by a wide alliance of health and social care bodies, voluntary organisations, eye care professionals, Government representatives and service users. I encourage all members in the chamber to obtain a copy of the document from the Royal National Institute of Blind People, because it is interesting reading. The strategy is important because diabetes can lead to sight loss. It states:
"our rate for type 1 or 2 diabetes is increasing by roughly 7% annually".
That is an alarming rate. Thankfully, following its eye care review, the Scottish Government has given £2.6 million to health boards and partners to implement the key recommendations. That will, I hope, catch anyone with diabetes at an earlier stage, help them keep their sight and turn around their general health.
I mentioned the embarrassment of obesity. To be second in the world to the USA—to have a silver medal in obesity—is an embarrassment to Scotland, especially as we are a wealthy nation. The action plan is an opportunity to tackle the problem head on, and I am sure that there will be improvements in the future. Tackling obesity is a much wider issue, and has much greater benefits for people's wellbeing, than just getting someone to shed a few pounds, stones or kilos. The steps that the Government is taking are extremely welcome, and I fully endorse the obesity action plan.
Today's debate has been of good quality and consensual; it is a good way to start the new term.
As a politician—I am sure that other members will share this experience—the one time when I lose weight in a big way is during elections. The trouble is that, between elections, I put it back on. As I walked up Dundas Street this morning, it occurred to me that I have put on weight over the summer—I was feeling it somewhat by the time I reached the top. That takes us back to Nigel Don's notion that we are not doing enough exercise. As an aside, the trouble is that, as I go down Dundas Street of an evening, there is a street called Henderson Row to the left, on which is a purveyor of fried fish and fried potatoes that I find difficult to pass.
Shame.
Shame indeed. I share Mr McAveety's trouble on that front. That brings me to my colleague Ross Finnie's thoughts on the fact that what is required is a cultural change.
I thank the minister for her speech. I think that we all support her intention. If I understood her correctly, she acknowledges the foundation that the previous Executive put in place, on which the present Government is building. The first question that I pose to the minister is one that I have asked in the chamber many times before—I apologise to colleagues for that. We talk about getting two hours of PE in schools, but what about youngsters who loathe PE, as I did, and are naturally utterly unsporty and not PE-minded? The answer is walking, dance and other forms of exercise. I say to the minister that, although the matter is being addressed, she must watch out for the kids who fall through the gap.
Ross Finnie, like Michael Matheson, put his finger on the fact that there is a huge correlation between areas of deprivation and the incidence of obesity. That must be recognised. Ross Finnie also mentioned the need for good food labelling, be it with or without traffic lights. We heard about the difference between Boots and Marks and Spencer in relation to sandwiches. I will return to the issue, but I say to the minister that it would be useful if it was addressed.
As an aside, I discussed with my colleague Ross Finnie what the Latin is for fitness of body and fitness of mind. There is a distinct link, and education professionals know that well.
It was good to hear from Mary Scanlon of our former colleague—to some of us, anyway—Lord James Douglas-Hamilton. That brings me to my second point, which involves my constituency. Mary Scanlon is probably right to say that the position in Shetland is not as bad as has been suggested due to the excellent sports and leisure facilities that the islands have. That is in contrast to my constituency. I am sorry to say it again, but at the time of local government reorganisation, Caithness District Council had not invested in facilities whereas Inverness District Council had done so. That is why there is an uneven spread of facilities. However, I am in correspondence with the minister on the matter and I am grateful for the constructive approach that is being taken. Again, the point flags up the interconnected nature of what the minister is quite correctly trying to achieve and what is being done on other fronts.
I commend Nigel Don for a most thoughtful speech. His point about putting money into science is absolutely right, because if we do not keep ahead of the science we might not take full advantage of the opportunities that are presented to us.
Margo MacDonald echoed the point about the correlation between poverty and inequality and obesity and made some most interesting comments about taxes on fat, salt and sugar. She and others also raised the issue of cooking in schools. I have had representations from some schools in my constituency about the lack of progress that is being made, or even the backward steps that are being taken, in relation to that matter. She is entirely correct—cooking in schools is not what it was. The knowledge of cooking that our grandmothers and great-grandmothers had has largely gone, and we are all to blame for that. The minister must take that into account as well. The point is connected to the fact that, as far as we can, we should purchase food locally. That would also support our farmers and crofters.
Further to Ross Finnie's point about labelling, it has always occurred to me that supermarkets could do a lot more by giving healthy recipes on the back of some of their products. The things that we cut out of newspapers could also be delivered by supermarkets. There are cookbooks on sale in most supermarkets, but should supermarkets not also suggest healthy recipes that use their products? The minister could think about that idea, which was suggested to me by constituents; I hope that she will meet the supermarkets.
I end with two contrasting examples from my constituency. South primary school in Wick pursues an enlightened policy of getting youngsters to eat fruit and vegetables. It has a healthy tuck shop and provides free healthy food to many of the children. Wick high school, which I have already mentioned today, is in a shocking state and many of its sports facilities are not used in the way they could be used. That is surely counterproductive to all that is being achieved.
I am grateful that the Government has accepted Ross Finnie's amendment, which seeks the introduction of a system of measurement and regular reporting. We have had a good debate and I thank all those who spoke in it. I greatly enjoyed what I heard.
Well, here we are again at the beginning of a new term. Despite all the changes that have happened and the chatter of new prefects and teachers, this is a familiar gathering of health—if not healthy—front benchers.
I offer—I think—my commiserations to Ross Finnie. I want it to be known that over the summer I was keen to offer my overt support for him to whomever I met when I was running around campaigning against obesity, whether or not they asked for my opinion on the leadership contest of Scotland's fourth party. I hope that that is not what did for Mr Finnie, but the nation's loss is about to be the health club's gain.
I also offer commiserations to Margaret Curran, with whom I now share an unexpected reference point: we have both been defeated in Westminster parliamentary by-elections in Glasgow. To be fair to myself, I was probably not expected to win my contest in the winter of 1982 in Glasgow Queen's Park—which is, incidentally, the last Glasgow seat to have been represented by a sitting Prime Minister, the Conservative Andrew Bonar Law. By 1982 times had changed, but who could have imagined that they would have lived to see the time when, only a generation later, things would have changed so fundamentally that Baillieston's best would be rejected by her own?
We have not lodged an amendment to the motion, because we are prepared to support its ambition and content. However, I have observed in previous debates a gnawing concern that our NHS should be seen by all who access it without fear or favour as an insurance policy that demands no responsible action on the part of all who benefit from it. If any of us went out leaving the doors and windows of our home open, we would hardly be surprised if our insurance company said, "Too bad" when we reported that our home had subsequently been ransacked. However, no such sanction can exist within our NHS. In the final analysis, it is there when we need it.
What do we do to avoid every lifestyle choice, however irresponsible, becoming a subsequent demand on the taxpayer? How do we plan to mitigate the horrendous future cost predictions for the economy and the NHS of poor lifestyle choices?
I accept—and indeed have supported in previous debates—many of the arguments about the inequalities in our communities and agree that they underpin this debate. I also accept that, for some, genetic factors are very real. However, we should be concerned when The Times quotes Mr John Hamilton, who lives in the Calton area of Glasgow and drinks six bottles of cider a day, as saying:
"Low life expectancy does not worry me."
There are many real health issues and addictions. However, one does not catch obesity on the train and children do not catch it from one another. According to one practical definition, obesity results from a persistent imbalance between energy intake and energy expenditure. As a result, it is not enough for the World Health Organization to state that
"obesity is not caused by moral failure on the part of individuals but by the excess availability of high-fat and high-sugar foods".
Andrew Lansley was correct when he said in his recent and quite excellent speech:
"Tell people that biology and the environment causes obesity and they are offered the one thing we have to avoid: an excuse …That doesn't mean"
that we
"ignore the environmental factors. On the contrary, we have to deal with them, actively and urgently. But"
we
"do feel, strongly, that"
even
"as we do so, we should also focus on how people can and should take responsibility for their lifestyle and health".
Margaret Curran asked about the part that nudge politics play in all of this; I have to say that I am more of a "Nudge, nudge, matron" man on these issues—no double entendre is too unsubtle. However, I point out that Elaine Smith made up quotations from Andrew Lansley that are not in his speech, the full extract of which I have with me. Moreover, Frank McAveety invented conclusions from it that my previous quotation sought to address.
If the member is concerned about behaviour and conduct, does he think that illegal and illicit drug use at university is inappropriate for someone who then seeks to take on a full-time political career?
This from a man who, in a previous parliamentary session, advised the chamber that he was at a meeting when he was in fact eating pie, beans and chips. Let us not go there.
For us, personal responsibility is the issue that is missing from the motion. We agree with the actions in the Government's plan; indeed, some build on initiatives that stretch back to the previous Westminster Conservative Government. However we want to complement those actions with messages and practical support that encourage people to take personal responsibility.
I hope that the member will tell me who is this Andrew Lansley who everybody talks about.
On a more serious note, if we can put on cigarette packets warnings such as, "This will damage your health" or, "This will kill you" or whatever, can we put on the appropriate foods a warning such as, "This will make you very fat"?
I was going to come to the point that Ross Finnie made. I do not know whether he does the shopping, but I do. I am afraid that the only pastime my mother had when I was an infant was taking me to the shops, so I am well used to going around them.
Although labelling has a role to play in telling people about the content of food, if someone buys a double cream, deep pan, New York vanilla cheesecake, what do they think that they are buying? If they buy an extra large size of double thick chocolate mousse, what do they think that they are buying? If they buy a cake in a box, what do they think is inside it? If they buy a meal that is rich in a cream sauce, what else do they think is in there? Labelling has a role to play and we should encourage it, but we are kidding ourselves on if we think that labelling alone will change people's eating habits.
However tempting it is, the Scottish Parliament must not take on the sole responsibility for the lifestyle choices of our fellow Scots. All who can do so must choose for themselves. Certainly we must promote and encourage the healthy choice options, but, for the sake of our country and future sustainability of our health service, we must get individuals to respond and change the culture in Scotland, which sees us languish as the earth's next-to-most-obese nation after the Americans.
We are not beyond taking a little action ourselves. I know perfectly well that I am somewhat larger and less fit than I should be. I hesitate to set a target to remedy that, because politicians inevitably fail to achieve the targets that they set, but I intend to try to remedy it. Perhaps we could all take our inspiration from a BBC news feature that claimed that climbing stairs can prolong life. In the study, the use of lifts was banned, which led to better fitness, less body fat, trimmer waistlines and a drop in blood pressure. Perhaps the minister could campaign for a ban on using lifts in the Scottish Parliament, except for those who are frail or sick, or those who are past the point of no return—best categorised in here as those who are also peers of the realm.
We cannot just preach; we have to practise too. Therein lies the problem: we are too comfortable with sloth. Our addiction to obesity is deep-seated in modern times and is Scotland wide. To tackle it we need to do everything in the motion and more besides. It needs the commitment of all individuals in a sustained, national effort.
I thank the minister for her words about the work of the previous Government. The action plan reflects the fact that progress is being made.
I say to Jackson Carlaw that there is a distinction between what the Government can achieve—which may be limited—and what the individual can achieve, and the concept of responsibility as it has been promoted by Conservatives in the past. For example, that concept was promoted by hiding away the Black report on inequalities, which also dealt with diet. The individual's responsibility was used as an excuse for inaction—that is how it might be perceived. Of course individuals have to take some responsibility for their own care, but that should not be the main focus of our attention.
Do we have a problem? As all speakers today have said, undoubtedly there is a problem. Margo MacDonald referred to the European situation. The EU report of the international obesity task force indicated that 22 million children were overweight and 5 million were obese, and the numbers are rising. As both Nigel Don and Michael Matheson said, it is about not just the figures but the trend. For the most part, the trends are going in the wrong direction. That is our concern. The causes clearly are complex, as most speakers have highlighted.
Elaine Smith, Margo MacDonald and James Kelly said that deprivation and poverty contribute to obesity. For women, the connection between deprivation and obesity is clear, although it is less well understood in the case of men. Nevertheless, deprivation is important. A number of members made the point that if someone is poor, the foods that they buy tend to be less good for them. Good food is sometimes considered to be more expensive. Inequalities undoubtedly play a part in obesity, as do the diet that we eat and the exercise that we take.
A number of members referred to the consequences listed in the BMA report, so I will not list them all again. The important point is to recognise that, because of current trends, there is likely to be a great increase in, for example, the incidence of type 2 diabetes, and a growing number of people will be affected by complications and problems relating to cardiovascular disease and cancer, which are two of the three priorities for this and the previous Government.
Should we take a general or a targeted approach? It is clear that, without the knowledge of what we should actually be doing, it is important that we try to target things better. As Professor Mike Lean indicated—and as Michael Matheson mentioned—the balance must lean towards diet. Diet is more important than exercise, although exercise clearly plays a part. As the action plan indicates, we need to increase the consumption of fruit, vegetables, cereal and oily fish, and we need to reduce the intake of salt, fats and simple, as opposed to complex, sugars.
Surprisingly, the plan does not cover alcohol—it is merely alluded to, and it is not dealt with under diet. We have been clear about the massive growth in the alcohol problem in Scotland, which involves calorie intake as well as other aspects. Managing alcohol is important in this context. Frank McAveety and Mary Scanlon, who mentioned labelling, referred to alcohol. Alcoholic drinks need to be labelled with regard to calories so that people know how much they are taking in.
Our diet is important. The previous Government concentrated on children eating fruit and vegetables and learning habits early, with the P1 to P3 programme and the provision of fruit at nurseries. I found it most rewarding when I went to a nursery school and saw young children eating fruit. The parents came in and saw some of the fruit that had not been eaten and asked, "What is that?" It was a kiwi fruit. They took it, and said, "Actually, that's very nice." People do develop good habits.
Despite the despair, doom and gloom that all members who have spoken in the debate have referred to—while not quite reaching the point of assassination, to refer to Ian McKee's typically eloquent speech—I wish to highlight an area in which we are doing a little better: Scotland is high up in the charts for children eating fruit and vegetables. Unfortunately, only about 24 per cent of them are reaching the target, but that comes right at the top end of the list for the European Union. We have made some progress up the charts, which indicates that what we do here can have an effect. I refer to the hungry for success programme, the active schools programme and to what Ian McKee, Margo MacDonald and Jamie Stone said about teaching school pupils about nutrition and cooking. All those things are important and form part of the whole.
On the educational process, curriculum crowding, to which Ross Finnie referred, is important. If we turn out citizens who are going to die younger than the current generation, that means that the educational process is failing. Tackling the problem must be given a much greater priority.
I welcome the priority for mothers—prenatally, antenatally and postnatally—and women at the pre-conception stage, because helping them to understand nutrition is of considerable importance. I welcome the emphasis on breastfeeding, although I hope that the minister will answer the question about targets, which was raised by Elaine Smith, who has done considerable work in that area. Breastfeeding is important for a healthy diet and the start that children get in life.
If diet and intake are important, so is exercise. Why? Not just because it balances calorie intake to a modest degree—which I accept is less important—but because of the mental wellbeing that exercise creates. If people feel better about themselves, they might not comfort eat or eat food in the way that was described so graphically by Stuart McMillan and other members who mentioned deep-fried Mars bars and pizzas and so on, which people sometimes eat as comfort food. Improving mental wellbeing is helpful.
The exercise side must be developed by, for example, having more cycle routes and opportunities for walking. The policy of free access to swimming facilities, which was in the SNP manifesto, needs to be followed through. All those things need to be developed. As Jamie Stone said, we must ensure that sport does not mean just rugby, football, lacrosse and hockey—or even physical education; it must be what people want to do in the way of exercise. The why dance programme for adolescent girls is a good example of what should be done. We need to understand what people want.
The Scottish centre for healthy working lives is mentioned in the action plan. We need employers to give much more consideration not just to workplace canteens but to opportunities for their workforce to exercise in the workplace. Investment in developing such opportunities would not be unselfish, because workers' productivity would increase.
I welcome the action plan and the debate, the consensual nature of which demonstrates the Parliament's intentions. We will make progress.
We have had a good debate that has been consensual, with perhaps one or two exceptions. I will try to respond to all the points that members made—if I do not do so in my speech, I will write to the relevant members.
Margaret Curran raised a number of issues. On free fruit, we have tried to ensure that we consider the evidence on where our efforts should lie, so that we refine our activity. Many members mentioned health inequality, which is the reason why we are focusing on children and expectant mothers in the most deprived communities and giving them priority through the healthy start scheme and other programmes. Of course, health boards have some latitude in what they do, which can include supporting the community initiatives to which Margaret Curran referred. I hope that I have given the member some comfort in that regard.
As I said in my opening speech, we will come back to the Parliament with more detail on PE provision. Suffice it to say—for the moment—that Learning and Teaching Scotland will shortly publish new guidance for schools on health and wellbeing under the curriculum for excellence, which will include outcomes that are related to physical activity and regular, high-quality PE. We expect schools to continue to work towards the provision of at least two hours a week of good-quality PE for each child.
I was asked when the report on free school meals would be published. The answer is soon. I assure members that they will not have to wait too long for it.
Ross Finnie made important points on, for example, food labelling. He and a number of other members talked about engagement with retailers and manufacturers, which is important. I and other ministers, in particular the Cabinet Secretary for Rural Affairs and the Environment, Richard Lochhead, have had regular engagement with supermarkets and others. Food and drink policy will be critical in that regard. I attended a meeting of the food and drink leadership forum, at which a diverse range of interests was represented. The health agenda is central to its work. The policy is about considering how we might better use land in Scotland to produce healthy, local, sustainable food, which will not just improve people's health but help our farmers, manufacturers and retailers—that is all part of the package. I hope that I have given members a flavour of what will emerge from the food and drink policy.
Through the active schools programme, children have access to a wide range of activities, including dance, which I hope will encourage them to partake in physical activity. It is not about the cross-country running that I remember being forced to do on a cold winter's day. We have moved beyond that. We must ensure that there are good choices for people. We are on the case.
Mary Scanlon made important points. I agree that the sample in the Dr Foster Research study was small and that the report should be treated with caution. She made an important point about pathways into support. The counterweight programme offers a clear pathway through GPs, who will refer people to experts who can work with them on their weight management programme.
Mary Scanlon also asked about school nurse training. The pilot programmes in three health board areas will not only harness existing skills among staff but develop and shape new roles, to ensure that we can offer effective care and support to children who require it, starting with our most deprived children. We are developing the model on that and we are ensuring that there are clear pathways.
When will the counterweight programme be available to people in all health board areas?
The roll-out of counterweight has followed two phases. It started with the keep well programme, and its roll-out is under way. Wave 2 commenced in April 2008 and wave 3 started in August 2008. Patients from 66 practices had access to counterweight, and 1,300 patients have been enrolled. The programme continues and is building up.
Mary Scanlon talked about outdoor education policy, which I know she is keen to have developed. Maureen Watt has, of course, agreed that outdoor education should be embedded in the curriculum. What matters is not just having five-day residential courses but the broader outdoor education policy. That work progresses as we speak, and we will keep Parliament updated through the channels to which I agreed in accepting the Labour amendment.
Nigel Don talked about engaging the commercial world—absolutely. I point him to the food and drink policy. The forthcoming supermarket summit offers the opportunity, which I assure members we will take, to engage with big and important players on many of the issues.
James Kelly mentioned investment in gym and sports facilities. Significant investment has been made. The Government has provided almost £3 billion in capital over the next three years, including an additional £115 million for 2008-09, to secure investment in schools and other local government infrastructure. Such funding will help to continue to secure investment in schools and in PE and sports facilities. Funding to sportscotland has also increased by 44 per cent, which local authorities can access to develop local sports facilities.
Michael Matheson talked about the bigger picture—absolutely. That is why the action plan is a down payment on how we tackle obesity. The obesity strategy, which will follow, is about the whole societal approach. However, I would like to think that the action plan has given a sense of how we will create sustainable towns, encourage the use of public transport and develop community initiatives to involve all the community in deconstructing the obesogenic environment. Testing of that in communities, along with help for individuals, gives a sense of the cross-Government approach. The issue concerns not only health and education services but the whole Government. That is why we are working across portfolios.
We encourage local authorities to see it as their role to promote public health, so that when they make planning or licensing decisions they wear their public health hats, too. That is important, particularly in tackling inequalities and in relation to the facilities in some of our deprived communities, which we need to change.
Elaine Smith raised a couple of issues, one of which was the breastfeeding target. The previous target was unclear, because it could include mixed feeding with infant formula. The difference is that the new target is exclusively for breastfeeding, which makes it clearer for us all to understand.
Margo MacDonald talked about poverty and inequality and about supporting important community initiatives—absolutely. The vending machines issue is important, as is the point about canteens, particularly in public sector workplaces. We are taking that forward, and the Scottish centre for healthy working lives is helping us. It is important for the public sector to take a lead. We have done much work in our hospitals and schools, but I would like that to spread throughout the public sector.
Ian McKee and Margo MacDonald talked about cooking classes. I remind members that we launched the cooking bus, which is a start. It goes round schools to supplement work that is taking place, engages pupils and their teachers in improving cooking skills and leaves a trained resource in schools to continue its work. That initiative has been important.
I am sorry if I have not covered every member's point. We have also to focus on the positive achievements, on which Richard Simpson made an important point. We have to create a vision of where we want to get to. When there is good news about increased fruit and veg intake, we should seize that information to paint a different, more positive, picture of our children. I thank all members for their contribution to the debate. I look forward to continuing the dialogue.