Meeting of the Parliament

Meeting date: Thursday, November 15, 2018

Official Report 1007KB pdf

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Physical Activity, Diet and Healthy Weight

The next item of business is a debate on motion S5M-14749, in the name of Joe FitzPatrick, on physical activity, diet and healthy weight. I ask members who wish to speak in the debate to press their request-to-speak buttons. As members are aware, time for the debate is already short, so I ask opening speakers not to go over the time that has been allocated to them. I call Joe FitzPatrick to move the motion and speak to it for up to—and no more than—13 minutes.

15:10  

This Government has made it clear that it wants a fairer Scotland where everyone thrives. In moving the motion, I make the point that our overall aim is to improve the health of the nation, and preventing ill health and reducing health inequalities are central to achieving that.

In June, we published a set of six interlinked public health priorities, each with prevention and early intervention at its core. They cover places and communities; the early years; mental wellbeing; alcohol, tobacco and drugs; poverty; and healthy weight and physical activity. Those priorities, which were agreed between the Government and the Convention of Scottish Local Authorities, are the most important issues to focus on, over the next decade, to improve the health of the people of Scotland.

Today I will outline the step changes that the Government is taking to meet one of those public health priorities: a Scotland where we all eat well and have a healthy weight and level of physical activity. In July, we published two complementary delivery plans that set out what needs to be done to achieve that priority. We recognise that the plans sit alongside a wide range of Government policy and action. Each delivery plan has stretching ambitions: we want to cut physical inactivity in adults and teenagers by 15 per cent by 2030, in line with the new global goal that was set out by the World Health Organization; we want to halve childhood obesity by 2030; and we want to significantly reduce diet-related health inequalities.

We have set a high bar, and rightly so. The scale of the challenge is huge and the inequalities remain persistently wide. The ambitions are underpinned by clear and comprehensive plans. I welcome support from across the chamber in addressing those twin challenges. We need to take decisive action, including restricting junk food promotions and helping more women and girls to get involved in sport and physical activities.

Let us remind ourselves why we need to act so urgently. We all know that being physically active is one of the best things that we can do for our overall physical and mental wellbeing. An active lifestyle can help to prevent heart disease, strokes, type 2 diabetes, musculoskeletal conditions and a number of cancers, but it is about more than that. Physical activity has a unique power to inspire and motivate us. It can also play a crucial role in tackling social isolation and developing confidence. In short, being active is about all of us enjoying healthy lives and being connected to our communities and our environment.

Overall levels of physical activity in Scotland remain steady, while other developing countries show decline. Given its many benefits, we want to go further and see those levels increase.

The case for change is even more stark when it comes to diet and healthy weight. We should be in no doubt about the scale of the challenge. We are consistently failing to meet our dietary goals: 65 per cent of adults are overweight or obese and over a quarter—26 per cent—of children are at risk of being overweight or obese. That is a shocking statistic, particularly given that overweight children are more likely to become overweight adults, with all the health inequality that that brings.

Obesity is the second-biggest preventable cause of cancer after smoking. It is the most significant risk factor for type 2 diabetes and it can also increase the risk of lots of conditions, including cardiovascular diseases and arthritis. If we can bring down the rates of obesity and drive up the rates of physical activity, we can prevent the burden of health harms on our children, on adults and on the national health service, and the people of Scotland will live longer, healthier and happier lives.

Both plans have three core priorities. They seek to address health inequalities by supporting everyone to have active lifestyles and healthy diets, they recognise the importance of collective leadership and broad ownership nationally and locally, across the public, private, third and community sectors, and they prioritise cross-portfolio approaches to ensure that policies across the Government—not just in the health portfolio—support the changes that are needed. Let me turn to the detail in each of the plans.

In July, I launched “A More Active Scotland: Scotland’s Physical Activity Delivery Plan”, which sets out a range of 90 actions that we and our delivery partners are taking to encourage and support people in Scotland to be more active more often. Partnership working is a central theme. Our plan follows the publication of the WHO’s “Global action plan on physical activity 2018–2030”. The WHO plan sets the challenges that countries around the world face in helping people to get and stay active. It highlights how so many aspects of modern life, including transport, technology and changes in work and leisure activities lead us towards inactivity. The WHO plan makes it clear that a whole-system approach is crucial to success. That means working across policy boundaries to improve education, transport, health, planning and sport sectors, among others.

I am extremely pleased that the WHO has welcomed our delivery plan and that it sees Scotland as being ahead of the game in responding to its global action plan.

In Edinburgh, the Scottish National Party and Labour Party controlled city council is looking to hike up prices for local groups that undertake sports in sports clubs. Does the minister think that will help to achieve the desired outcomes of his delivery plan?

Local government is one of our partners in what we are trying to do. I was pleased when City of Edinburgh Council said that it would look again at those matters. I understand that that is still happening.

The delivery action plan shows the actions in which physical activity and sport can transform the lives of people of all ages and demographics. The actions in the plan include rolling out the daily mile across the country, doubling active travel budgets to £80 million to encourage walking and cycling for recreation and travel, increasing support for participation in sport by women and girls, giving £1 million for changing lives through sport and physical activity, and increasing funding support for older people who are in care settings to remain physically active. That is an important point in the amendment that Mr Cole-Hamilton will speak to later.

That is just a snapshot of the actions that we are taking and we will continue to work with academics and practitioners to learn from the evidence and shared experience of what works on the ground.

Physical activity is one factor in maintaining a healthy weight, but it is only one factor. In July—a busy month for me, as I was just in post—I also launched our diet and healthy weight delivery plan, “A Healthier Future”. It sets out a wide-ranging approach to tackling the nation’s weight problem.

Obesity is complex, but our aim is simple. We want to make it much easier for everyone across Scotland to eat well and be a healthy weight. The delivery plan has more than 60 actions, but today I will focus on three core priorities: transforming the food environment, giving children the best start in life and preventing type 2 diabetes.

On transforming the food environment, particularly promotions, as a nation, we consume too much food and drink that has little or no nutritional benefit and contributes calories or salt to our diet. These so-called discretionary foods include snacks such as crisps, sweets and chocolate. Half the sugar that is consumed in Scotland comes from that sort of food, so it is clear that we need to eat less of it.

It is, however, difficult to make healthier choices when we are constantly being bombarded with messages that encourage us to impulse-buy such foods and overconsume them. We want to change that. We are looking to restrict the in-store marketing and promotion of discretionary foods so that they cannot be sold on multibuy promotions or placed at checkouts, for example.

The consultation is already under way on a comprehensive set of proposals on which we would welcome feedback. As with all big public health interventions, we know that we need to take the public with us. The latest Food Standards Scotland data shows that around half of the public support restricting the promotion of unhealthy products, but we are not complacent. We will continue to make the case for change so that the consumer feels empowered to make healthier choices.

Transforming the food environment involves much more than that. For example, we are also supporting Scottish small and medium-sized enterprises to reformulate products and remove calories. We are urging the United Kingdom Government to ban the broadcast of advertising of high fat, sugar and salt foods before the 9 pm watershed. Food Standards Scotland will shortly publish its consultation on how restaurants, cafes, delivery services and others can support healthier eating by, for example, better calorie labelling.

Our ambition to halve childhood obesity gives our plan a strong preventative focus. Of course, all the changes to the food environment that I have talked about should improve the diets of children and their families, but there is much more that we can and must do. Early childhood and what happens before children are born are critical to the establishment of good nutrition and healthy eating. We will support parents pre-conception and in the early years on everything from pregnancy nutrition to breastfeeding and weaning. We will serve healthier food to children in early years settings at school, we will target services for families who need them where the child’s weight is a concern and we will continue to support children and families through school and the teenage years.

Although our overarching aim is to prevent children from becoming overweight or obese in the first place, we nevertheless recognise the current reality that being overweight or obese has become the norm for adults in Scotland. Along with that come the associated health harms and the significant pressures that they put on health services. Each year, we spend around 9 per cent of our total health expenditure on treating type 2 diabetes—a condition that is closely related to people being overweight and obesity. However, there is growing evidence that, with significant and sustained changes to diet and lifestyle, a diagnosis of type 2 diabetes can be reversed. That is why our third priority is our significant investment of £42 million over five years to tackle type 2 diabetes. In the summer, I also published a prevention framework that sets clear expectations of health boards and their partners to provide services to support those who have or are at risk of what are often avoidable conditions.

We can all unite on the issue in the worlds of health, communities and wellbeing. Politicians, policy makers, community leaders and medical professionals can unite around a programme of action that will add years to the healthy life expectancy of people in Scotland. Since July, we have already achieved a great deal with strong commitment from a wide range of local and national partners, but this is just the start. We need to continue to build leadership and momentum across the system. Such is the scale and nature of the problem that we want to ensure that we have the strongest possible plan of action for Scotland and for future generations, which means that we must continue to learn from others and evolve our thinking.

I therefore welcome our debate today and the tone of the amendments. I confirm that we will support the Conservatives’ amendment, which is in line with the strategies, and the Liberal Democrats’ amendment, which reflects a commitment that we have given and makes sense in the context. Unfortunately, we are unable to support the Labour amendment because it would remove reference to the two delivery plans. The asks in the Green Party amendment relate to budget matters, which we will come to later, but it is a good try.

I thank everyone for the constructive way in which I know that they intend to take part in the debate.

Will you formally move your motion, please, minister?

I moved it in my very first sentence.

Did you? I was not listening closely enough. I am very sorry.

I move,

That the Parliament welcomes the publication of two new delivery plans for Scotland, which set out ambitious actions to increase levels of physical activity and to improve diet and healthy weight; recognises the important contribution that physical activity, diet and healthy weight make to health and wellbeing, including that obesity and an unhealthy diet are linked to harms, including type 2 diabetes, heart disease, stroke, musculoskeletal conditions and cancer; endorses a vision for a Scotland where people eat well, have a healthy weight and are physically active, as articulated in the nation’s new public health priorities; acknowledges the shared responsibility across all of society to help achieve this vision, including across national and local government as well as the public, private, third and community sectors; supports ambitions to reduce physical inactivity in adults and adolescents by 15% by 2030 and to halve childhood obesity by 2030; commends the commitment in both delivery plans to tackle health inequalities, and maintains support for proposals to restrict the promotion and marketing of food and drink that is high in fat, sugar or salt with little to no nutritional benefit where they are sold to the public.

I call Brian Whittle to move amendment S5M-14749.1 and to speak to it for no more than eight minutes, please.

15:23  

I welcome the opportunity to open on behalf of the Scottish Conservatives and thank the Scottish Government for the opportunity to debate this important topic. The fact that we have physical activity and nutrition on the parliamentary agenda is very welcome. The Parliament is, at last, beginning to recognise that there is a major health issue in Scotland that we can affect.

We will support the Government’s motion, but in doing so we recognise that this should be the start of a conversation and that much more action could and should be taken to make the impact that we all know is necessary. That is the thrust of the Scottish Conservatives’ amendment.

The preventative agenda is rooted in good nutrition, physical activity and inclusivity. Over a year ago, the Scottish Conservatives called for any moneys that are raised from the sugar tax to be allocated to a programme to keep schools open during the school holidays to offer activity hubs with healthy meals included, because we know that health inequalities and food bank usage spike during the school holidays. The Labour amendment is too restrictive, as it would prevent other possibilities such as whole days of activities. We recognise the direction of travel, but we cannot support the amendment.

Given that I am the convener of the cross-party group on arthritis and musculoskeletal conditions, members will not be surprised to hear that I support the Lib Dem amendment.

Although we are hugely sympathetic to the Green amendment and certainly want to pursue such a policy, we are reticent about putting a figure on it at this time, so we cannot support the amendment.

The conversation has to change. We must stop focusing so intently on the symptoms and conditions that arise as a result of poor lifestyle choices and focus on Scotland’s need for a better relationship with food, drink and physical activity. That argument leads us to issues such as ease of access and the need for an understanding of good nutrition, physical activity and the environment in which it takes place. If we begin to break down the barriers to inclusion, we will be able to have a much more positive conversation.

There are many levers available to the Scottish Government that would not require huge budgetary commitments but could have significant and long-lasting impacts. The educational environment should be a key battleground in delivering a healthier future for Scotland, from nursery education right through to higher education.

When we consider physical and nutritional education, we need to look not only at the learning environment but at how we ensure that that learning can be applied. Physical education is about how to be physically active and about why we should be physically active. We then need to ensure that that learning can be applied outside the school day. Connecting physical education with extracurricular activity and a community offer is, therefore, paramount.

Similarly, it is not enough to learn about nutrition in theory; pupils must be given the opportunity to apply that learning in practice. Increasing the home economics offer would be a good start, along with improving the quality of school meals. If pupils are allowed input into their school meal menu, that affords their buy-in. Pupils might even be allowed access to the school kitchen, as happens in Japan and Copenhagen among other places.

Will the minister explain to me why we export so much high-quality Scottish produce and import lower-grade, cheaper produce through the Scotland Excel public procurement contract? That does not make sense to me.

We also need to look at the environment that is adjacent to schools. The planning departments need to be cognisant of where we give licences for fast food restaurants. We must prevent food vans from parking close to schools, and we should consider the age at which we allow our children to leave the school premises. I have no problem with fast food, but I have a huge issue with its becoming the staple diet. On Monday, I drove past a school in Kilmarnock at lunch time and noticed three food vans parked at the school gates, with pupils queuing at all of them.

East Ayrshire is the gold standard when it comes to locally procured food and the quality of the food that is served, so we need to understand what drives pupils’ behaviour. The food vans simply being there is a big factor. Surely, a simple solution is obvious—we must change the environment and involve our school pupils in the development of school menus.

The approach should apply from pre-school—or pre-birth as the minister said—all the way through life. It can start with an active play framework in nursery schools, perhaps including a vegetable patch in the grounds that is tended by the children. Such an active, inclusive and educational approach would speak directly to attainment. Early intervention directly tackles the situation in which some children are, on reaching primary school age, already two years behind in their learning.

If we are to achieve our aim, we must consider how we can deliver such step changes, because if there is no delivery mechanism, we are nothing more than a talking shop. I have always said that we must first look after the health of our healthcare professionals. How can we expect them to deliver the message when their own working environment is a barrier to their adopting a healthy, active lifestyle? We must also free up our teachers’ time, to allow them to deliver education as they are trained and able to. It is through teachers that a paradigm shift in culture can be achieved.

The third sector has a huge part to play in this agenda. We are all aware of the value that the sector delivers to our communities. How third sector bodies are funded and aligned must be reviewed to ensure that they deliver what they are capable of delivering.

We must also consider how we would cater for an increase in physical activity nationally. Dr Frank Dick, the former director of coaching at UK Athletics and chair of the European Athletics Coaches Association, wrote a paper on offering upskilling to people who are approaching retirement, to enable them to continue to use their lifetime of experience and skills in the third sector should they wish to do so. I agree with him that those people are a largely untapped resource that we should be promoting both for their continued health and for the wellbeing of those with whom they would be working.

There is also the possibility of developing people in younger age groups who are interested in being involved, but perhaps not as sportspeople. Pupils in the later years of school who are afforded the opportunity to gain a coaching qualification can find that activity both empowering and engaging.

I have always believed in education as the solution to health and welfare. We have to create an environment in which all of us, irrespective of background or personal circumstance, have access to education in its wider context, be that in or outside the classroom. I believe that the school estate must be utilised much more effectively. It makes no sense for pupils to have to go home and then somewhere else to participate in sporting activity when the easiest place for them to access quality opportunities is where they are at the end of the school day. We must fish where the fish are.

We support the Government’s motion and thank it for bringing the debate to the chamber, but we recognise that the motion tackles only one element of a more complicated system. Now that we are in the starting blocks, let us have no false starts. The Scottish Conservatives look forward to working with the Government to develop a strategy to tackle what I believe is the most important issue that Scotland faces today.

I move amendment S5M-14749.1, to insert at end:

“, and calls on the Scottish Government to recognise that the three pillars of basic health are physical activity, nutrition and inclusivity and for it to provide the methodology required to achieve more ambitious targets.”

15:31  

I welcome this afternoon’s debate. Obesity is a modern-day public health crisis that would have been unrecognisable to Scots who lived through rationing in the second world war or to those who lived a century before that, when parishes from Shetland to Selkirk had to set up poorhouses. I share the view of Martin Cohen of the University of Hertfordshire, who has stated:

“Obesity is invariably presented as a diet issue for”

dieticians,

“whereas social inequality is deemed the domain of sociologists and economists. Put another way, even as the inequality gap becomes more and more obvious there’s been a medicalisation of a social problem. Yet obesity is not just a matter for”

dieticians;

“rather, it is a product of social inequality and requires a collective social response.”

As we know—indeed, the minister said as much in his remarks—obesity has been on the rise for decades. It is no wonder, as changes to our lifestyles have had inescapable repercussions for our diets. The increasingly fast pace of life has meant that we are more likely to buy quick and easy meals, frequently trading nutritious food for efficiency, and that shift in our eating habits has inevitably led to our taking in more sugar, salt and fat than we need.

To compound the problem, the busyness of life means that fewer and fewer of us are active enough to burn off the calories, causing what scientists call obesogenic environments. In 2016, it was estimated that only 64 per cent of those aged over 16 reached their recommended amount of physical activity each week. The result is a country with one of the worst records in the Organisation for Economic Co-operation and Development, with two thirds of Scottish adults classed as being overweight and, even more worrying, almost a third of children at risk of becoming overweight.

We all know that the consequences of endemic obesity are severe. For individuals, being overweight comes with numerous increased chronic health risks and reduces life expectancy by, on average, at least three years. In that respect, I commend the work of Cancer Research UK and Obesity Action Scotland, which are working hard to raise awareness, both in here and with the public, of the link between being overweight and developing cancers.

As one of the co-chairs of the cross-party group on diabetes—I think that my colleagues are in the chamber—I am glad that the motion refers to type 2 diabetes. Being obese or overweight is a significant contributing factor to developing type 2, and, with our obesity crisis, it is unfortunately no surprise that figures on the disease make for bleak reading. I looked at the up-to-date figures on diabetes just last night for a dinner that I was chairing, which a number of colleagues attended. In Scotland, 260,000 people have been diagnosed with type 2 diabetes, but what is really concerning is the fact that a further half a million people in Scotland are at risk of developing the condition.

Members will be familiar with this fact, but I will restate it: a diagnosis of type 2 diabetes can bring with it serious complications, including the risk of blindness and amputation. Besides the clear and grave impact that it has on an individual’s quality of life, this growing disease also provides just one example of the strain that obesity places on our national health service resources. The minister will be aware of the finances surrounding this. The NHS spends almost £1 billion on tackling diabetes, 80 per cent of which goes on managing avoidable complications. I therefore very much welcome the Government’s proposal to invest in weight management programmes with long-term goals.

I mentioned to the member last night, in discussing preventable health issues, that I read in a magazine that parental physical activity has a huge impact on the metabolic rate of children. When we are talking about prevention, we need to be cognisant of what the parents are doing pre-birth.

I bow to the member’s experience. He makes a very good point that was reinforced at the diabetes dinner last night.

I agree with what the Government has done on weight management, but any tangible improvement is likely to be short lived unless we take a preventative approach. Evidence-based action is absolutely crucial. It is important to know that what we are doing is working.

Diabetes Scotland has raised a concern with me about the budget cuts to the teams that are currently collecting clinical data. Those cuts could undermine the assessment of the programme. Perhaps the minister will address that in his closing speech.

I am conscious of the time, Presiding Officer.

It is good to see that the Government is seriously considering how we can restrict the advertising and promotion of food that is high in fat, sugar and salt. The key to such an approach will be not just to restrict the availability of unhealthy foods but to make the option of a balanced diet much more practical.

The key issue is that, although this challenge may look modern, under the surface the root problems are the same old story, which is that poverty, social deprivation and inequality are significant contributors to people being overweight. It is the least well-off people who are most at risk. For example, a quarter of children who live in the most deprived areas are at risk of obesity, compared to only 17 per cent in the least-deprived areas. We have major health inequality.

I agree with Brian Whittle about the need to use the planning system to ensure that community spaces encourage physical activity by being welcoming and safe.

The key to tackling obesity is to see it not just as a problem for individuals and families but as a social problem similar to educational underachievement or criminality. Poverty, not individual choices, is the driver of the problem. Therefore, only fundamental societal change that fights inequality will cut the Gordian knot of systematic overindulgence.

I move amendment S5M-14749.3, to leave out from “commends the commitment” to “health inequalities” and insert:

“notes with concern the deprivation gap in levels of physical activity and considers that, regardless of background or ability to pay, physical activities should be accessible for all; recognises the impact that poverty has on the ability of families to provide healthy meals; commends the Club 365 initiative from North Lanarkshire Council and calls for this to be rolled out across the country to end holiday hunger; believes that further action should be taken to tackle food insecurity and make healthy food options more affordable”.

15:47  

I would like to thank the many organisations that have provided briefings for this afternoon’s debate. I, too, am glad to discuss the systemic change that we need, so that people can live more active, healthier lives. I am also glad to see a range of amendments that present different but complementary ideas, to help us achieve that.

It is fair to say that a real challenge confronts us. The proportion of people in Scotland who meet guidelines for physical activity has not much changed since 2012. Just about two thirds of us manage moderate levels of physical activity for two and a half hours a week. Although the overall proportion of adults who are overweight or obese appears not to have increased since 2008, there has not been the positive reduction that we all want.

Over the past decade, we have certainly learned that public health messages that are focused on individual behaviours tend to fail—and to fail people on lower incomes in particular, as David Stewart stressed. They can also cause unintended harm by stigmatising some behaviours and some bodies.

When discussing the social determinants of health, Professor Michael Marmot often reminds us of the alternative health messages that we could be giving people. Instead of telling people to follow a balanced diet and to keep active, we might advise them not to be poor, and if they cannot avoid that, then to try

“not to be too poor for long”,

and not to

“live in a deprived area”,

or

“work in a stressful, low-paid manual job.”

That kind of parody indicates just how much of our health is determined by factors that we, as individuals, can do little to control. Yet, in 2018, we are a long way from seeing public health campaigns on our trains and buses announcing that poverty is a risk factor for poor health.

I agree with what the member is saying, but does she agree that, sometimes, healthier food can be cheaper than takeaway food, which is expensive, and that an education process is required in that regard?

The member makes an interesting point, but we also have to remember that in some parts of our more deprived communities we have what are described as food deserts, where it is simply impossible to access fresh fruit and vegetables at the affordable price that the rest of us enjoy.

It is clear that we need to begin to use regulation to tackle our obesogenic environment, and to make meaningful investment in our infrastructure. Most of the amendments reflect that focus.

The amendment in my name concentrates on the urgent need to improve spending on walking and cycling. It is helpful that spending has doubled, but £80 million is still a small proportion of our overall transport budget at just 3 to 4 per cent. Greens have a long-standing policy that active travel should get at least 10 per cent of the transport budget and we want to see spending brought up to at least £25 per head, putting us on par with the spending levels of the Netherlands, which is one of the most cycle-friendly countries in the world. I will address the minister’s remarks on finance when I make my closing speech, but in Utrecht, for example, cycling is the dominant form of transport, with 51 per cent of everyday journeys made by bike. That approach would begin to redress the lack of investment in everyday local transport for the third of people who do not have access to a car. It would also tackle two of the biggest barriers to becoming physically active: cost and time.

The increase in the active travel budget for 2018-19 is welcome and has been effective in generating more activity in local communities to deliver walking and cycling infrastructure. However, local authorities—particularly those with large urban areas—are still indicating a desire for more match funding than can be accessed currently. Increasing the active travel budget from the current level of £15 per head to £25 per head—as called for in the Green amendment—could trigger the transformational change in cycling infrastructure that could make Scotland a mass participation cycling nation, with long-distance and recreational trips safe, simple, convenient and frequent.

We need a stronger focus on cycling infrastructure, but while we work on that, we could build on popular, successful approaches, such as the cycle-to-work scheme. We could roll out cycle-to-college and cycle-to-uni schemes, which would give students better access to bike ownership through interest-free bike loans that are integrated into student funding. That would give all students an opportunity to start the semester with a bike of their choice and plan healthier, cheaper travel to lectures and classes.

Getting into healthy habits when we leave school for work, college or university can have a positive impact for decades and I would like to see more support for young people going through such important transitions. Expanding the daily mile programme is the only measure in the physical activity delivery plan that mentions colleges and universities specifically. That is a missed opportunity.

I am glad to see that the Scottish Further and Higher Education Funding Council will be developing a new approach to diet and weight for staff and students.

I strongly support the emphasis that the Labour Party amendment places on the need to tackle holiday hunger. The Greens are strong advocates of the universal provision of free school meals beyond primary 3. Brian Whittle touched on the need for better school kitchens and dining facilities. I was pleased to welcome the Copenhagen House of Food to Parliament years ago. That is a truly inspirational model that is well worth examining.

We also have to protect children and young people from the very worst aspects of an unhealthy food industry. We have to restrict irresponsible promotions on very unhealthy food—we really must get to grips with that.

I move amendment S5M-14749.4, after second “2030” insert:

“; recognises the positive impact that walking and cycling have on health; welcomes the doubling of active travel funding in 2018-19 but notes that active travel remains a tiny proportion of Scotland’s overall transport budget; calls for further urgent increases to bring active travel expenditure up to at least £25 per capita”.

15:43  

On days such as this, when there are tectonic shifts in politics, both at Westminster and across Europe, it is possible that outside observers might see debates like this one as somewhat prosaic. However, the debate is not at all prosaic. It is right that we come back to such topics, which are almost seasonal fixtures. We are all charged with obtaining progress on obesity.

I am grateful to the Government for lodging such a conciliatory motion and I will be happy to support all the parties’ amendments at decision time.

It is right that we return to the issue, because it offers us common ground. We share the same aims and objectives and we will not lose sight of the challenge that lies ahead. That challenge visits us in our constituency surgeries every week when we hear of health or ability complaints.

Large swathes of our population are locked into a trajectory—a vicious cycle—that reduces the orbit of people’s social universe, harms their mental health and, ultimately, cuts short their life expectancy.

Debates such as this one can be acts of contrition. Since this Parliament was first convened, we have sought to end the reality that people here eat more and are less active than those in most other countries. Whether through the confluence of our culture or through particular brands of social inequality, that is a nut that we are yet to crack.

I do not seek to ascribe any blame to any Administration or political viewpoint for the situation. I recognise that, for a multiplicity of reasons, an unhealthy lifestyle is woven into the fabric of our country’s make-up. How we unpick that will define the measure of our efforts in this area for years to come.

The challenge is huge. We know that, after cancer, being overweight is the second-biggest risk to health and cause of early death. Despite that reality, only a quarter of our fellow Scots are aware of the link. The scale is eye watering. If 65 per cent of adults and 29 per cent of children contracted a potentially fatal virus, that would trigger the emergency mobilisation of the World Health Organization and an international aid response.

The costs of obesity and inactivity to our society are equally large. Those costs are estimated to be upwards of £4 billion. As the minister said, our response has to be to find whole-nation and whole-place solutions. That could be by reducing the 110 tonnes of sugar that our population ingests every day through reformulation, product awareness and information.

The debate is about promoting activity, including active travel. I am very happy to support Alison Johnstone’s amendment, which I will speak to again during my closing speech. It is also about how we teach our children and make them aware of what a healthy, adequate lifestyle looks like.

The debate is also about recognising the links—they have been drawn several times—between obesity and inactivity, social isolation and social exclusion, and between obesity, inactivity, poverty and social deprivation. That is very much the thrust of my amendment.

Again, it seems prosaic to talk about a falls strategy, but the fear of falling reduces the orbit of people’s social universe. We need to recognise that and, collectively, do something to address it.

Social isolation and inactivity are definitely bedfellows. This year, 65,000 Scots will spend Christmas alone, and 200,000 Scots go four days or more without contact with another human being. That has an undeniable impact on physical and mental health. The 19th century French writer Balzac said:

“Solitude is fine but you need someone to tell that solitude is fine.”

We cannot magic social connections for those people out of thin air, but we can reduce the barriers to their doing that for themselves.

In 2017, I chaired a meeting of the Scottish older people’s assembly in this very room. At one point, I asked assembly members what they were most frightened of. I expected them to mention criminality, disease or frailty, but, universally, the number 1 thing that frightened them the most was falling. That is because they know that a fall could reduce the size of their social universe and that life expectancy after a hip fracture is dramatically reduced.

I am sure that, day in and day out, every member has people who come to their surgery and say that they have no confidence in the pavements or the street corners in their communities—the accident hotspots that we all know something about. My amendment calls on the Scottish Government to build on the 2014 falls framework, which looks at falls reduction and early intervention in medical settings; to expand that work in our local communities; and to work with sport and leisure trusts and local authorities to identify accident blackspots. As the nights draw in and the frost starts to bite, it is at this time of year, more than at any other, that people elect to stay at home rather than take the risk of going out and falling in their communities. If we can get the right approach, we can get them back out into their communities and social networks, and into opportunities for physical activity, which we have heard about this afternoon.

I take great pleasure in moving my amendment, and I look forward to supporting all the other amendments. I move amendment S5M-14749.2, to insert at end:

“, and reaffirms the call, which the Parliament agreed in the debate on motion S5M-04324 on 2 March 2017, for the Scottish Government to bring forward a national falls strategy, which it believes will help give people confidence in the physical landscape around them to enable a more active lifestyle.”

15:49  

The Scottish Government motion that we are debating today sets out the benefits of improved physical activity and healthy eating. A healthier lifestyle can benefit overall health and wellbeing and, my goodness, as a nation we need to have this debate.

Levels of type 2 diabetes—as we have already heard from David Stewart—heart disease and other illnesses, including many types of cancer associated with obesity, are stubbornly high in Scotland and they have been that way for years. That puts a strain on our hard-pressed national health service, other public services and economy, and it is something that we could well do without. That is why I very much welcomed the Scottish Government’s “A Healthier Future: Scotland’s Diet & Healthy Weight Delivery Plan” that was published earlier this year.

Some great work is going on across Scotland to address those issues, and I want to use some of my time in the debate to highlight some of the remarkable initiatives and fantastic organisations that are operating in my constituency and contributing positively towards the Government’s plan.

It is, of course, true to say that Stirling has some of the most beautiful and stunning landscape that exists anywhere in this wonderful country of ours. It is home to an impressive array of Munros, Corbetts, Grahams and Donalds, as well as spectacular lochs. Because of that inspiring landscape, it is an attractive and popular place for hikers, hillwalkers, kayakers and cyclists—the perfect setting to promote a healthy outdoor and active lifestyle.

Stirling is also the home of the now internationally recognised daily mile, which was pioneered at St Ninians primary school from 2012 and was the brainchild of the then headteacher, Elaine Wyllie. The scheme ensures that all pupils walk, jog or run a mile each day, in addition to the usual physical exercise that they undertake. A study by Stirling, Edinburgh and the Highlands and Islands universities has shown clear evidence that the daily mile approach can help to combat problems not only in Scotland, but globally. I understand that over 3,500 schools in more than 30 countries around the world now take part in that remarkable initiative. What a success story it is, which began in St Ninians in the city of Stirling. Not all is gloom and doom in this area, although it is very challenging—we know that.

Earlier this year, the Scottish Government said that it wanted Scotland to be the first daily mile nation, with nurseries, colleges, universities and workplaces joining more than 800 primary schools to take part regularly. As the minister said, the Scottish Government’s aim is to cut physical inactivity in adults and teenagers by 15 per cent by 2030. That equates to about a quarter of a million more people becoming active. Perhaps, in his summing up, the minister will say a bit more about how that ambition can be realised and reached.

I will say a few words about nextbike in Stirling, which is a highly innovative bike share scheme. Nextbike now provides 160 bikes across 23 bike stations in the city of Stirling, which are available 24/7. It is yet another advertisement for how we can have that active lifestyle.

I turn to healthy eating, and on that matter we are being watched very carefully by Philip Sim of the BBC. He has just tweeted:

“MSPs are debating diet and healthy weight on macaroni cheese day in the canteen. So everyone is making speeches about eating well, mere hours after half the people in the building gorged themselves on pasta, chips and garlic bread.”

Will the member take an intervention?

Only if the member is going to serve me macaroni and cheese.

I am curious, now that Bruce Crawford has raised the matter: did he have macaroni cheese for lunch?

Excuse me, Mr Crawford; I put on record that I did not take chips.

I did not have it, but only because I did not spot that it was on. It is one of my favourites. There is a place for it. We should not decry that as not being a good food; the issue is how we go about finding a balance in what we eat.

Members will be aware of the Food Assembly and its shock announcement that it would pull out of the UK earlier this year. That was a concerning time for all involved in food assemblies. I am glad to say that Stirling Food Assembly is still working hard to promote and sell fresh local produce. I was delighted when the organisers announced that they would be staying put in Stirling. They hold pick-up markets in Stirling high school and I understand that the Stirling Food Assembly now has more than 2,000 members.

I do not have any time left, but I want to pay tribute to the work that the Royal Highland Education Trust does in working with food producers and the agriculture industry to educate children about where their food comes from, which is so important.

15:54  

I warmly congratulate the member who has just spoken, not just because of the wonderful Munros in Stirlingshire, which I have had the privilege of climbing—some of them several times—but because Stirlingshire has led the way with many good-news stories when it comes to educating our youngsters on health.

The first Education, Lifelong Learning and Culture Committee inquiry that I took part in when I was elected was on whether we should introduce free school meals in primary 1 to 3. Aside from all the politics of that debate—and there were plenty of them; in fact, they are still going on—there was some fascinating evidence from around the country, south of the border and other countries about what interventions had helped the very youngest people to eat more healthily. One piece of evidence that stood out for me was the marked improvement when schools encouraged pupils and parents to get involved in the setting of menus, and when those menus made good use of locally sourced food. Brian Whittle referred to initiatives in Japan and Denmark, where pupils are able to help in the school kitchen.

The evidence since then has been striking in relation to rural schools, where food is very much part of the farming community that surrounds those schools. There is a lesson to be learned from the recent story in The Press and Journal about the school cook at Broadford primary school, who has been nominated for two awards for her outstanding work in promoting healthy eating at the school and inspiring pupils to further educate themselves on nutrition.

The evidence that we took at the Education, Lifelong Learning and Culture Committee has stuck with me throughout my time as an elected member, especially when I consider school meals that are less than satisfactory. It is sometimes argued that it is more expensive to prepare healthy meals because there is less scope for mass purchasing, and therefore less scope for economies of scale when it comes to preparing and transporting food. I wholly refute that view, although I accept that many school kitchens are not always suitable for the kind of meal preparation that we need in modern schools. It is important for us all to think about that when it comes to procurement.

Does the member agree that as well as improving food in school canteens, we need to educate children about the journey that the foodstuffs that they ingest at lunch time have been on to get to their plate?

Absolutely—I agree. That is all part of the educational journey for youngsters. However, the key thing is that we must ensure that there is an improvement in the quality of the food that is being delivered to children for lunch and, in some cases, breakfast.

Members who have spoken in the debate have said that it is a damning indictment of Scotland’s health that we have the lowest life expectancy not only in the United Kingdom but in western Europe. A 2017 Audit Scotland report found that many key trends indicated that overall health in Scotland is not improving in the way that we would like. That is why, as the Conservative spokesperson on education, I feel that we must focus on the diet and nutrition aspects of the motion.

I think that we all welcome the fact that one of the key outcomes in the diet and healthy weight plan is the emphasis that is placed on children having the best start in life by eating well and having a healthy weight. Apart from anything else, children who have that healthy early start do much better at school, irrespective of where they come from and their income background.

The “Scottish Conservative Healthy Lifestyle Strategy”, which was published by Brian Whittle last year, was founded on the belief that issues such as health, education, planning and housing have cross-party and cross-portfolio relevance and that policy must be based on three key, interconnected pillars: nutrition, the educational environment and physical activity. Education in particular is very much the solution to improving health and welfare, irrespective of who we are.

15:59  

I very much welcome the fact that Philip Sim is watching the debate, because I know how much he enjoys my contributions. I say to Bruce Crawford that, in 1945, the ration for cheese was 2 ounces a week, so there would be little prospect of having macaroni cheese very often. Indeed, research that was done in 1939, at the beginning of the war, showed that one could live and thrive on 1 pound of meat a week, a quarter of a pint of milk a day, 4 ounces of margarine and as much potatoes, vegetables and bread as one could eat.

Will the member give way?

That is all that people need to survive, although the experiment reported that there was a substantial increase in flatulence. Speaking of which, I will give way to David Stewart.

What was the member’s experience of living through the Boer war?

I am never bored by any debate on the subject of food.

Realistically, for many of us, food has become a hobby rather than a way of living our lives. I am a little older than every other member in the chamber at the moment, apart from one. I see that members are looking the wrong way—he is over there on the Conservative benches. I remember the ending of sugar rationing in February 1953, when I was six years old. The ration for sweeties at that point was 11g a day. To translate that into something meaningful in today’s terms, that means that people could have in total one Mars bar every five days and nothing more—that was it. The sugar content of the 1953 ration was the equivalent of one can of Coke every three days.

We were actually a great deal healthier when our food intake was controlled by the state. I do not advocate a return to that, but that illustrates how much of our food intake is optional or voluntary and unnecessary. I and others of my generation probably have less of a sweet tooth, and I hope that that is reflected in my health. I am about a kilogram over the weight that I should be, although I am working on it. My heartbeat and respiration rate are okay. I had my blood pressure tested here in the Parliament just last week, and I am within the acceptable limits—I am below 140 and the difference between systolic and diastolic is about 60. However, that is not true of everybody in our society, and people suffer because of that.

On exercise, we do not all have to be Brian Whittle, who is a world-class athlete. I am nowhere near that, and I have never been near his historic achievements, but at least I and all of us can walk in our normal days. My watch tells me that I have walked 2.5 miles today. From looking at my diary, I expect to do about 4.5 miles tomorrow. I normally walk around 20 to 30 miles a week, just simply doing my normal business and avoiding taking taxis. That is a great help to my personal physical and mental wellbeing. Walking is a great activity to undertake if we want to think through the issues that we have.

Diabetes is one major consequence of our being overweight. To again return to the period after the war, type 2 diabetes in particular barely existed then, and type 1 was uncommon. However, we need to be cautious about that, because the diagnostic tools were pretty poor, so I suspect that there was a huge amount of undiagnosed diabetes. According to my father, basically it was diagnosed by smelling acetone on the patient’s breath. However, by the time that that could be done, people were severely diabetic and their life was at severe risk.

Sport in schools is not what it used to be. I went to a very large school and on the peak day, a Saturday, a grand total of 490 pupils would participate in competitive sport in the rugby, football, hockey and cross-country teams. That is not the case today. The restoration of sport in our schools would definitely help.

I very much welcome the debate and the focus on being healthy, taking exercise and good food.

16:04  

I draw attention to my declaration in the register of members’ interests of my position as chair of the Hibernian Community Foundation, which I intend to mention later.

I am pleased to have the opportunity to contribute to the debate. We have heard lots of statistics from all speakers to illustrate the seriousness of the problem that we have with activity, diet and obesity. David Stewart told us that 65 per cent of adults in Scotland are defined as being overweight. That means that being overweight in Scotland is now the norm. Almost one third of adults are classified as being obese. That tells us that Stewart Stevenson is not the norm, but we probably knew that before we started.

It is important to recognise, as speakers have mentioned and the Scottish Government’s research shows, that issues relating to unhealthy and unbalanced diets often begin in childhood. The 2016 Scottish health survey revealed that 29 per cent of children in Scotland were at risk of being overweight and 14 per cent were at risk of obesity. In primary school, during those formative early years of education, it is crucial that we teach children the benefits of both physical exercise and maintaining a balanced diet.

Would the member like to know that I was recently at the Rowatt Institute, which has found that a child’s taste buds are formed by the twelfth week of pregnancy?

That certainly illustrates that some of those things are set very early in life.

Mr Crawford made a good point about this not all being doom and gloom. We have made some progress, and he gave the good example of the daily mile, which has been shown in recent research to be not always daily and not always a mile, but still extremely effective in raising health and activity levels in our schools.

It is not the only example. There is also the active schools programme, which goes back further and which in 2017-18 involved 309,000 young people making almost 7.5 million visits to active schools activity sessions. In my constituency of East Lothian, the programme is an enormous success. Therefore, initiatives have been taken that are having a positive impact.

That is true not just on the activity side but on the diet side as well. In my constituency, good programmes are run in our primary schools by the roots and fruits food collective or fundamental foods, working with young children and showing them how to cook, how to use foods and how to make better diet choices when they get older.

That feeds into the quality of the food provided in our school meals and the availability of free school meals—a number of speakers have mentioned school meals. One important aspect is their being available only during term time. That is why in the Labour amendment we mentioned the important initiative in North Lanarkshire, the 365 Club, which provides free school meals throughout the year.

There are other approaches. In East Lothian, we have lunch clubs in the school holidays in both Tranent and Prestonpans, and those are initiatives that we need to encourage.

Perhaps some of the strongest initiatives combine both things. That is why I want to mention the Go Fitba’ programme, which the Hibs Community Foundation is currently running in Edinburgh and East Lothian. Youngsters in primary schools are given the chance of an hour’s football activity, followed by a session on good nutrition and cooking, and then they sit down for a meal together.

The foundation is not just about children. We have also been responsible for delivering the football fans in training project to more than 560 men and 80 women. The programme is delivered by most of the major football clubs in Scotland and research by the University of Glasgow has shown not only that it encourages weight loss during the 12-week programme, but that the weight loss is still in place some 12 months later. It is an almost uniquely successful programme.

There are programmes that work and we know what we can do, but perhaps the most important thing is to support diverse approaches, because we are obliged to address the problem, and what works for some people will not work for others.

16:10  

Like others, I welcome this afternoon’s debate. Obesity is a serious issue that needs to be addressed.

As has already been mentioned, the Scottish Government motion states:

“obesity and an unhealthy diet are linked to harms, including type 2 diabetes, heart disease, stroke, musculoskeletal conditions and cancer”.

As a nurse, I am directly aware of those issues and have direct working experience of patients who live with those conditions. I spent 25 years of my career in the operating room, much of the time—in both Los Angeles and Dumfries—involved in surgery for patients with complications related to type 2 diabetes and obesity. Many of those surgeries were not pleasant for either the patient or the staff. They included some of the worst cases of embolectomy, wound debridement and amputation of limbs, as well as other operations.

Tackling those issues and promoting physical activity, healthy diet and healthy weight—all of which contribute to optimum physical health and wellbeing—requires a multistrategy approach. It is important to highlight that all the amendments that have been lodged are different, which underlines the fact that a multistrand approach is required.

The Scottish Government has outlined the delivery of ambitious actions in areas such as increasing levels of physical activity and improving diet and healthy weight, and it is important that we use a multistrand approach to achieve those aims.

I agree that improved mobility—potentially through appropriate weight loss—can lead to improved confidence in guarding against falls. I also agree with Alex Cole-Hamilton’s words regarding older people’s fears about falling—as has been highlighted, it is a major fear. I have looked after many post hip fracture patients and know that rehabilitation can sometimes take a long time.

I agree with the part of the Scottish Government’s motion that,

“acknowledges the shared responsibility across all of society to help achieve this vision, including across national and local government as well as the public, private, third and community sectors.”

I will pay a little attention to that. Many across our communities choose to engage and participate in, and support others through, social prescribing programmes. Before I joined the Health and Sport Committee, the Minister for Mental Health, Clare Haughey, briefed me in the quickest of conversations about what social prescribing was all about. Since then, I have been exploring the many ways in which social prescribing can help—whether in the form of walking football, walking netball or tai chi.

We know that it is not necessary to increase the heart rate to lose weight; simply an increase in physical activity can contribute to weight loss. The “Fixing Dad” programme, which I have mentioned in the chamber before, created by Anthony and Ian Whittington, helped their dad to lose seven stone—that is about 44kg. They helped their dad to lose so much weight by supporting him in a socially prescribed and family-engaged way so that Geoff could get on his bike. I welcome the work that Anthony and Ian have done. Perhaps the Scottish Government could review some of the merits of and evidence from the “Fixing Dad” model of social prescribing.

Today’s debate is about the contribution that physical activity, diet and healthy weight make to health and wellbeing. I highlight the recent research published by the Scottish Government that explores the link between food, environment and the planning system. The Scottish Government consultation paper, “A Healthier Future”, identifies Scotland’s obesity rates as being among the highest in the developed world. The consultation, which ran from October 2017 to January 2018, included more than 30 proposed actions to improve the Scottish diet and lifestyle and reduce public health harm.

Improving the food environment is critical to that aim. The consultation document makes it clear that a wide range of regulatory and other actions are needed to make healthier choices easier wherever we eat. The points that stood out for me include the fact that having access to outlets that sell healthy food near schools was noted to decrease the odds of someone being overweight or obese and that the closer a person lives to a fast food outlet, the more likely they are to be obese. How health relates to planning is an issue that the Health and Sport Committee took evidence on.

In addition, I love the easy suggestions for how people can increase their physical activity, which include simple steps such as getting off the bus one stop ahead of their destination. Simple suggestions can sometimes be the easiest way to achieve big gains.

I would like to highlight one of the actions that I took locally—

I do not know whether you have time; you will need to be very swift.

I will put that up on my social media.

Who needs a Parliament?

I welcome the debate, and I look forward to the Scottish Government engaging with third sector organisations and members across the chamber to allow us to create a healthier nation.

16:15  

Sadly, the fact that we, as a nation, have a problem with diet and exercise should come as no surprise to members. Study after study and case after case have confirmed that to be the truth. The fact that two new delivery plans have been published today is to be welcomed. However, we must not kid ourselves that they will be some sort of a magic wand that will provide the solution to all our problems; another day, another Government strategy. Members should not get me wrong—the ambition is laudable, but I cannot in good conscience say that we are making good progress.

Last year under the SNP, life expectancy in Scotland fell for the first time in nearly four decades. That is not progress, and it is simply not acceptable. We need to fundamentally consider how we go about tackling the problem. One key pillar, which so far has been neglected by the Scottish Government, is the process of early intervention. We need to spend time working out why school kids prefer to go for a chip roll at lunch time rather than something healthier, and we need to work out how to tell them that the alternatives are better, because at the moment that message is not getting through.

Is the member seriously saying that the Scottish Government is entirely responsible for young people going to chip vans and fast food outlets and for the fact that the age at which people are dying is dropping? If he is seriously saying that that is entirely the Scottish Government’s fault, it is a ridiculous statement for him to make.

We expect the Government to take a lead on such matters and to demonstrate good practice.

We need to figure out how best to convince pupils that physical education is far better for them than updating their Instagram profile. Too many are losing out, and not nearly enough has been done to ensure that every pupil in Scotland has access to sufficient hours of PE in secondary school. I hope that that will be a key focus of ministers in the future, because the current situation, in which nearly 80 per cent of schoolchildren are not getting the right amount of physical activity every day, is not good enough.

It cannot be the case that the strategies and consultations that are put out by the Government are branded as narrowly focused or bewildering. There needs to be clarity of objective on a much smaller scale than is the case now, so that outside groups can understand the specific intentions behind each individual policy. Again, that is simply not the case at the moment—or, at least, not according to the chairman of the National Obesity Forum.

Parents and families have a role to play, too. Even the best food education cannot offset a situation in which parents are not providing healthy meals for their children. When more than 500 two to four-year-olds are referred to a weight management service in one three-year period, it is vital that parents take responsibility and heed the advice that is given. In addition, we need to have a food procurement agenda that puts fresh, locally sourced, nutritious food at the heart of our thinking across the board—in schools, hospitals and every local authority area in Scotland.

Let us not lose sight of the end goal and the opportunities that a healthier Scotland will bring. We can unlock billions of pounds in productivity for our economy and ensure that obesity and weight management do not continue to take hundreds of millions of pounds from our NHS—money that can be put to better use if progress is made on personal fitness and wellbeing.

We have had plenty of strategies, but not enough progress, with too much talking and not enough action. We know that we have a problem, so let us resolve to fix it before it is too late for a generation of Scots. The time for action is now, so let us not fall short.

16:20  

There has been a lot of agreement today—maybe slightly excepting the last speech—and I do not aim to be too different from what others have said.

I agree with many members that there are a number of factors involved in our citizens achieving a healthy weight. The individual citizen has a role and the public sector has a role—that is what we found with smoking and alcohol. That role can be legislation, taxation or education, but individuals also have to choose a more healthy lifestyle.

On physical activity, Brian Whittle did not disappoint with his emphasis on sport. I completely agree that sport has to be part of the answer. However, not everyone is into sport, and there are other ways to get the physical exercise that we all need. In yesterday’s debate on rail, I mentioned that I used the train seven times on Saturday, which involved a fair bit of walking because the train does not always go to exactly where a person wants to be. I agree very much with Alison Johnstone that we should put more into public transport, which would automatically help with physical exercise. I gave that example to show that we can be physically active without doing sport.

With regard to schools and young people, we have the double problem of parking at schools and youngsters who are not walking or cycling to school. East Lothian has trialled having exclusion zones for vehicles around schools, which therefore encourages more youngsters to walk and reduces the parking problem. I wonder whether we need to look at rolling that out nationally—Glasgow, for example, has been reluctant to go down that route.

Sport is the physical activity of choice for many people, and I am delighted about the investment in the east end of Glasgow, particularly in connection with the Commonwealth games: the Emirates arena, the Tollcross pool and the Glasgow Green hockey centre. Football remains the most popular sport for many people, but the cost of hiring pitches remains a problem—I identify with what Liz Smith said.

Does John Mason agree that, in our time, we could just put the jerseys down to have a game of football, but these days hiring 4G pitches is the norm? The cost of participation has gone up.

That is exactly the point; expectations have gone up, which is good and means that we do not have the blaes pitches as much, but the new pitches cost money. Glasgow City Council and Glasgow Life subsidise pitch hire, but it still remains a big challenge in poor areas where parents do not have spare cash for the kids to go to the football club—that also applies to athletics at the likes of Crownpoint, where Mr Whittle and I spent a pleasant evening recently.

Preventative spend has been an underlying theme of the debate. It is better to prevent people from getting obese in the first place, rather than waiting until they are and trying to fix it. That might mean spending more on subsidising football pitches, but the challenge is where to disinvest to free up the money. Should we cut hospital budgets in order to fund sports activity? What would happen if that meant less money for hospitals?

Diet is clearly a major factor, which we have focused on today. It is a question of what we eat and how much, as members have mentioned. The odd can of Irn Bru or bar of chocolate is okay, but the volumes that some people consume are the problem. Some restaurants are guilty on the question of portion size; even if the food is healthy, the portion size is sometimes far too big. In our canteen in the Parliament, we can be guilty of that.

I agree that there is also an issue with what people are eating and that we should be moving to promote healthier food. I maintain that some of our traditional meals are pretty healthy—for example, mince and tatties or stew—and they do not have to be that expensive, although I take Alison Johnstone’s point that they are not always available cheaply locally. Generally speaking, mince and tatties for four will probably cost less than four fish suppers. However, an issue is that traditional cooking skills have been on the decline so there is a need for education in that regard.

Obesity stigma is a tricky area. On the one hand, we are saying that obesity is not a good thing, so we do not want to say at the same time that it is okay to be obese, but I agree that we need to tackle discrimination in employment and potentially related mental health problems.

I fear that there are no easy answers, but I agree with the overall theme that, just as we have tackled smoking and alcohol, we need to tackle obesity.

16:25  

The debate has not been the pedestrian one that it could have been. There has been a lively and vibrant set of contributions from across the chamber and I have been struck by the level of consensus that has been achieved. I thank Joe FitzPatrick for setting the tone and am grateful for his inclusive approach to the debate, which is typical of his approach as minister in the time that I have worked with him.

I associate myself with the priority areas that the minister identified: supporting active lifestyles and healthy diets; leadership across all sector; and linking Government policy across portfolios. It is very easy, in the dark vaults of Government, for people to work in isolation, but we cannot afford to be complacent on an issue as important as this. He was right to reference the fact that WHO has said that Scotland needs a whole-system approach and we see the measure of that in the plans that are being taken forward.

The minister was rightly intervened on by Miles Briggs, who mentioned price hikes in our nation’s capital, and I hope that he will continue to put pressure on his colleague, council leader Adam McVey, to walk back any plans to increase the cost of physical activity in Edinburgh.

On transforming the food environment, focusing on children and young people and type 2 diabetes, we need to work to capture the range of interventions that we have at our disposal. When it comes to children and young people, and this speaks very much to my values as a former youth worker, it is not just about looking to expand the daily mile. In particular for children who are disengaged from school, who are arguably most likely to have the hardest health outcomes, we need to work to redress the systemic erosion of youth work that has happened across the country in recent years and find means of boxing clever by making activity available to the children who need it most.

Brian Whittle, who knows a thing or two about physical activity, as he never tires of telling us, offered some forensic analysis of what happens at school, which was a theme that was picked up by Liz Smith. Both members addressed the fundamental and undeniable link between diet and educational attainment. It is not rocket science.

Will the member take an intervention?

I will, because I was mean.

The member will be glad to know that I will not be mean back. I talked about the way in which we discuss this issue. I like to talk about nutrition—I do not like to talk about diet because, in my view, “diet” is “die” with a “t” on the end. We need to talk more about nutrition.

The point is well made and speaks to the fact that nomenclature—how we describe things—matters here.

I enjoy serving with David Stewart on the Health and Sport Committee; he knows a lot about this issue and he cares a lot about it. He was quite right to identify the overmedicalisation of some of these problems at the expense of the fundamental recognition that a lot of them are social problems. They are symptoms of wider social problems, whether that is social exclusion, poverty or any of a range of other inequalities that exist. It was an important point to make. I congratulate him on the diabetes dinner that he held last night—I am sorry that I could not attend, as 260,000 of our fellow Scots are currently suffering from type 2 diabetes.

I associate myself with Alison Johnstone’s point about active travel. Active travel really matters; it matters in my constituency, where we have two of the most polluted thoroughfares in the whole of Scotland. One of the points in the five-point plan that I have identified is about investing heavily in active travel, so I am happy to support Alison Johnstone’s important point about active travel.

In an exchange with John Mason, Alison Johnstone also talked about the existence of what are called “food deserts”. It is very easy to say that you can cook a meal from scratch cheaply and effectively if you have the means, but that is of no use to people who live 2.5 miles away from the nearest fresh fruit and vegetables.

Moving on to Bruce Crawford’s excellent contribution, for full disclosure, I say that I had the mac and cheese. I went for the skinny fries though; I think that counts.

We talked about the natural capital that we as a country have at our disposal for physical activity. We should never tire of reminding ourselves of the beautiful country that we live in and the asset that it represents.

Liz Smith is another contributor who is significantly more active than I am. I am glad that she took my intervention, because I think that it is important that our kids understand how the food that they eat in their schools and homes gets to their plate. That will start a lifelong interest that will pay health dividends.

I will not talk about Stewart Stevenson and the night that I ended up in the same Thai restaurant as him. He clearly used most of his ration book on what I saw him consume that night.

Iain Gray picked up on the school meals issue. I am delighted to say that we will support the Labour amendment, because it is absolutely right. Free schools meals are only available during term time and we need to recognise that that is a yawning gap, particularly during the summer months.

Before I finish, I want to thank Emma Harper. Her contributions to these debates are always very important. Her lived experience as a nurse lends a lot to the Health and Sport Committee, as it does to these debates. Her insight, particularly into hip fractures and support for a falls strategy, is welcome indeed.

Hippocrates said:

“let food be thy medicine and medicine be thy food”.

That is an ancient quote, but it is still apposite today. In my early days on the Health and Sport Committee, a leading clinician—I cannot remember who it was—said that the six best doctors that we have at our disposal in Scotland are sunlight, air, exercise, sleep, water and vegetables. I cannot think of a better way of summing up the preventative and proactive agenda that we are all forging together tonight.

16:32  

I agree with colleagues that this has been a positive and consensual debate—even though the Government and the Conservatives feel that they are unable to support my very reasonable amendment. I know that they both really want to; I think that we can get there.

It is important to discuss figures, even in our policy debates.

On the doubling of the active transport budget, what is not in that headline figure is the additional leverage through the money that comes from local government as part of the package. That actually delivers the £25 per head that Alison Johnstone asks for.

I appreciate that local government has a part to play, but it is key that Government shows real leadership on this important agenda. We could do much more, together with local government.

I welcome the fact that the minister spoke of the need to restrict the marketing of unhealthy food. The Scottish Greens welcome that, because we have a manifesto commitment to a levy on supermarkets in relation to the mass retailing of high-sugar and high-fat food. As the minister pointed out, there is public support for such restrictions, because we all pay for the outcomes when people do not eat healthily for a variety of reasons.

The minister also spoke of the need to change formulations and about the impact of diabetes on the NHS. David Stewart also spoke about how diabetes is costing the NHS and us £1 billion a year. Diabetes is worthy of its own debate. It is obesity related and relevant to all the issues that we are discussing in this debate. The debate is important because healthy life expectancy has stalled in this very wealthy country.

We will support the Conservative amendment because I welcome the fact that it acknowledges that inclusivity is key to good health. I also welcome the fact that Brian Whittle suggested that he has huge sympathy for our amendment. I look forward to discussing it with him at a later date and ensuring that we have support when it becomes a firm budget ask.

Brian Whittle also spoke of the fact that the school estate has a role to play. Nurseries and schools also have a role, as do we all—parents, teachers, the third sector, and so on.

Schools and their proximity to junk food are another thing that we need to discuss further. During apprenticeship week I went to visit the Breadwinner Bakery in my Lothian region, and when I came out of that really impressive visit, there was a queue of schoolchildren visiting a burger van in the industrial estate behind the school that I attended. There is work to do there. They were choosing to leave the school campus and go into the industrial estate setting to visit the van. I am absolutely certain that healthier options would have been available within the school grounds.

Volunteering is key to the delivery of physical education that we want to see. We want to make sure that it is affordable and that those who have skills to offer get the chance to offer them. Volunteering is good for the volunteer and good for those who benefit from the skills that they can offer. It is important to look at the cost of access to facilities, too.

David Stewart spoke about the obesogenic environment. Today I have sat in committee and sat in the chamber and tonight I will be sitting as I chair a two-hour public meeting held by Spokes—the Lothian cycling campaign. It is important that we have an opportunity to build activity into our days wherever that is possible. I now live six miles from Parliament, so I cycled in this morning and I will cycle home tonight, but we need to have a discussion about how we enable people to be active during the day, and we have a role to play in being the best role models that we can be.

Alex Cole-Hamilton’s on-going support for a firm look at falls and the impact that they have is welcome. If older people remain physically active, they are more likely to have the strength that will prevent them from falling, which will enable them to continue to be physically active.

I am glad that the diet and healthy weight strategy acknowledges the importance of breastfeeding, and I certainly agree that we need new specialist support for mothers and babies who have been breastfeeding for around 6 to 8 weeks, because we know that that is when rates tail off. I was dismayed by recent changes to breastfeeding support across the NHS Lothian area, where some much-needed and well-regarded drop-in support has been discontinued and, in effect, replaced by a triaged appointment-based system. I would appreciate an update from the minister on changes and priorities in that regard, particularly in Lothian.

Colleagues have mentioned this, but we must address the fact that the missing ingredient in so many of our plans and our best intentions to eat well and move more is the lack of time that we have in our days. As much as we want to, it can be difficult to find the time to cook with our families and friends, to shop often for fresh food in the middle of a busy week and to prioritise taking part in sports or meeting friends who play those sports when we are feeling overburdened and overstretched.

If we want to improve people’s diets and activity levels, we have to be honest about the value that we place on making sure that people have leisure time and the cash to enjoy it. Leisure time is fundamental to living healthily, but too many people—particularly those in high-stress, low-paid occupations—do not get enough of it. All too often, it seems that there is a tension between our working lives and living healthily. We can make changes to our communities, the food that we eat in our workplaces and the amount of time that we spend being physically active, but we need to ask whether we are getting the overall shape of our working week right. That may be a debate for another day.

I call on David Stewart to close for Labour. You have six minutes, Mr Stewart.

16:38  

As other members have said, this has been an excellent debate with well-argued contributions from across the chamber. There was a strong consensual spirit in the debate, which is why Labour will support the Scottish Government’s motion and all the amendments. I note that my spirit of co-operation has not been reciprocated by a couple of parties, but I believe that we should support sinners who repent.

As we have heard, more than a quarter of adults in Scotland are obese, and the Labour amendment particularly emphasises the health inequalities element. Members will be aware that being obese can increase the risk of individuals developing many potentially serious health conditions including type 2 diabetes and several types of cancer. The key point is that the risk of obesity varies across Scotland, with obesity being seen in 21 per cent of women who live in affluent areas compared with 37 per cent of women who live in deprived areas.

Iain Gray flagged up the key point in our amendment that holiday hunger for schoolchildren is a scandal that cannot be allowed to continue. The successful club 365 programme in North Lanarkshire feeds children who qualify for free school meals throughout the holidays. I hope that the relevant minister will confirm in their wind-up speech whether that can be rolled out across the country.

During the debate, Brian Whittle made sensible points about the need to look after the health of healthcare workers. That is extremely important. Not least, we should consider the flu vaccine proportions in each health board area. Brian Whittle also talked about the important role of third sector organisations, and I think that we all agree with his point about using the school estate better for sporting activities after hours, which seems very sensible.

Alison Johnstone made strong points about health inequality. I agree with her general point that we should increase the walking and cycling budget. That would be a sensible development.

Alex Cole-Hamilton made a good speech, in which he made a key point about the great challenge that we face, because being overweight is the second most important avoidable cause of cancer. He, too, stressed the importance of active travel and talked about the links with poverty and social isolation.

Bruce Crawford made a good speech too. He is a fantastic advocate for his Stirling constituency. I flag up the important daily mile initiative, which originated in a school in his area. I was astounded to learn that 3,500 schools across the world have copied that excellent initiative.

Liz Smith said that one of the first debates in which she became involved in the Parliament was the debate about free school meals. I strongly agree with her about the importance of locally sourced food and making learning about nutrition part of educational activity.

Stewart Stevenson always takes a wide historical sweep. He did not answer my question about his role in the Boer war, but I am sure that I will find out about that at some stage. He made an interesting point about the ending of sugar rationing and the relatively low incidence of diabetes during the war, because people were consuming less fat and sugar.

Iain Gray, whom I have already mentioned, talked about the active schools programme. As a fellow football fan—although I do not support his team—I am interested in what Hibernian Community Foundation is doing, and I will raise the matter with my colleagues at Inverness Caledonian Thistle Football Club when I see them—I hope at the weekend.

I agree with what Emma Harper said about the fixing dad programme. I saw a presentation on the programme at a cross-party group meeting. I would like the Scottish Government to support the roll-out of a strong element of social prescribing across the piece.

John Mason made good points about the important levers that the Parliament has. Given the important impact of the smoking ban on public health, parliamentarians should consider what other public health solutions we can develop, particularly in the context of public transport and preventative spend.

Time is short, so I must conclude. Health inequality is at the root of this debate. Poverty, social deprivation and inequality are significant contributions to being overweight, and the least well-off are most at risk. Why should someone’s postcode determine their life expectancy? As Martin Luther King said:

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Thank you. For one dreadful moment, I thought that Stewart Stevenson was going to intervene to explain his role in the Boer war. Mercifully, we were spared that.

16:43  

This has been a good and useful debate. I say to Alison Johnstone that I hope that one day we will have a Conservative-Green coalition in this Parliament, so she should not give up lodging amendments.

It is clear from all members’ speeches that improving people’s diet and increasing their physical activity are among the biggest health challenges that Scotland faces. The benefits to health of good diet and regular exercise are clear.

The health inequalities in Scotland in the current landscape are unacceptable. I think that all members who have spoken have highlighted that. We have the lowest life expectancy in the UK; in fact, we have lower life expectancy than most western European countries. That has been the case for too many years, and the health of the people of Scotland is not showing the signs of improvement that we all want. Two thirds of adults are overweight and almost a third are classed as obese. Even more worrying is that almost a third of children are at risk of being overweight or obese.

Our record on health inequalities is most pronounced in the poorest communities that we represent. We need to work especially hard to address that. As David Stewart said, being overweight and obese significantly increases a person’s risk of developing type 2 diabetes, heart disease, musculoskeletal conditions and cancer. Obesity is the second biggest preventable cause of cancer, after smoking, and is on track to become the biggest preventable cause.

Type 2 diabetes accounts for a significant proportion of NHS Scotland’s drug costs, but it is preventable and reversible and people can, through exercise and living a healthier lifestyle, go into remission. Its cost to NHS Scotland is estimated to be up to £600 million a year, and the cost to Scottish society is estimated to be up to £4.6 billion a year, if we take into account the wider economic impact.

I agree with my colleague Brian Whittle—who would speak on the issue for hours, if he was given the opportunity—that improving Scotland’s attitude to eating well and having more regular exercise should be at the heart of what happens in our schools and society. As many members have said, it is our responsibility to teach our young people the important lessons of eating well, and to help them to develop good lifestyle habits to keep physically active. At the weekend, I attended the Hindu community’s Diwali celebrations in Edinburgh, and one of the values in the Hindu religion of which I was not aware is that every parent is equivalent to 100 teachers. That is something that we should take into account in the context of the subject of the debate.

In this year of young people, we must ensure that our school pupils have access to meals that are of the best nutritional value, and to physical activity. A number of members have already made the point, but I make no apology for raising once more the issue of access to our school estate. Despite having consistently highlighted the matter, I continue to see how limited the opportunities are for community groups to deliver after-school physical activities and clubs in my Lothian region.

It is also important to consider how every level of government in Scotland will look to prioritise the two new delivery plans. As I have stated, the City of Edinburgh Council proposed this summer to hike prices for sports halls and local groups in the capital. I believe that the proposal is totally counterproductive to what we are trying to achieve, and I am pleased that following my intervention and that of other Lothian MSP colleagues the council has postponed the increase until January. However, in the coming weeks and months, the minister—indeed, all of us—must make sure that we have a genuine joined-up approach throughout Scotland in order that we can truly make Scotland a healthier nation.

The expansion of weight management services that are tailored to individuals’ needs will make a real difference, because such services can massively reduce people’s chances of contracting the diseases that are associated with being overweight and obese. Resources and organisations must be available to build up the infrastructure around these services, and to ensure that they are tailored to individuals.

I recently learned of a partnership between Scottish Slimmers and a local general practice on the Isle of Skye that is helping patients with assisted weight loss. I hope that we see that kind of innovative approach being taken as a result of the delivery plans, and that there is a cultural shift in Scotland, with people having access to better-quality food and exercising more.

However, for that to happen, a holistic approach will be required. Scottish Conservatives have already supported the banning of multibuys that promote food that is of low nutritional value, and which actively encourage people to overpurchase and overconsume. We also support labelling on packaging that ensures that consumers can make informed decisions.

I was encouraged to learn in the debate that a record number of schools are receiving sportscotland awards, and that a record 309,000 young people attended active schools lessons. In my Lothian region, third-sector organisations including the West Lothian Youth Foundation are doing exceptional work in our communities. The foundation uses football to promote health development and education for people across West Lothian, and has a range of initiatives that encourage participation by and accessibility for all. In fact, it has tweeted to me during the debate to ask me to advertise its offer of free football games for 11 to 15-year-olds every Friday. For those who are interested—I suppose that this continues a theme that was highlighted by Bruce Crawford, Stewart Stevenson and Alex Cole-Hamilton—the games take place at Livingston Football Club’s Tony Macaroni arena tomorrow, if they have time to go. Charities and organisations like the foundation can make a real difference in our communities, so we should provide them with all possible support to make positive change.

Everyone in the chamber will agree that Scotland’s relationship with food and exercise needs to improve, and the Scottish Conservatives are committed to working with the Government and all parties across the chamber to make that happen.

However, I point out to SNP ministers and the Government that although strategies, action plans, working groups or the two delivery plans that are being discussed are welcome, they will, as Willie Rennie said at today’s First Minister’s question time, be worth as much as

“a piano in a pigsty”

if they do not deliver the change that we all want, and if they are not outcomes driven. If we can make sure that they are outcomes driven, the Government will have the support of Conservative members.

16:50  

I am delighted to close the debate on two interconnected issues that are vital not only to our individual health but to having a healthy nation. I am grateful to members across the chamber for the content and tone of the debate, and I will do my best to respond to some of the questions that were raised.

I will start with Mr Briggs’s comments, just because they are in my mind and I will forget otherwise—I have not written this down. Can we collectively agree that, from now on, we will drop the idea of pigsties and pianos? To answer his substantive point, the plans are outcome focused for the very reasons that he pointed to. None of the ministers in the health portfolio has much time for strategies and plans that do not have a purpose and that we do not follow through.

It is important to recognise—as members have done—that, although the issues that we are dealing with are complex and can be difficult, that is no reason not to tackle them. In the spirit of this debate, it cannot be beyond our collective wit to come up with real plans and initiatives that we can drive forward to make a difference. In previous health debates, we have said that one of the challenges for our health service is not simply to meet the health needs that people in Scotland currently have but to tackle the generations coming behind us, so that they do not face the same problems as the rest of us.

Let me turn to what members have said. I agreed with much of what Brian Whittle said, which does not often happen. It is important to talk about children’s input into the creation of school menus and to recognise that that is growing. In relation to the school estate, it is important to recognise that sports facilities in 79 per cent of primary schools and 98 per cent of secondary schools are available to the local community. However, there are difficulties with private finance initiative schools, which can restrict that access.

Mr Whittle and other members spoke about the issue of planning applications for fast food outlets near school gates. I agree that we are sending mixed messages if we are teaching children in school about better nutrition and better diet and we are asking them to be involved in that, but then the burger van is immediately outside the school gates. Therefore, we have committed to look at that in the review of planning policy and the national planning framework, which will begin after the Parliament has taken a view on the Planning (Scotland) Bill.

Mr Whittle’s important central point was about what drives people’s behaviours and how we can change the relationship that we have in Scotland with food, physical activity, nutrition and drink. That is the central point and, to be frank, it is the hardest problem to crack. I do not think that any of us has the ultimate answer to that question.

A number of steps have already been taken, which are having some results. For example, in the national health service in Scotland, the mandatory nutrition criteria for retail outlets require that 50 per cent of food items and 70 per cent of drinks offer a healthier choice. There are also limitations on what can be promoted. The recent evaluation of that initiative has shown that healthy food purchases from those outlets have increased from 11 per cent to 47 per cent and that healthy drink purchases from them have increased from 47 per cent to 76 per cent. There are levers that we can pull to help people to make healthier choices.

Does the cabinet secretary agree that how we frame the conversation will be hugely important? For example, I say to Bruce Crawford that there is nothing wrong with having mac and cheese, but he should have broccoli with it. I also say to Alex Cole-Hamilton that skinny fries are worse.

I agree. That speaks to a point that was made by both Alison Johnstone and Iain Gray in their own ways. Alison Johnstone made the important point that, when we have the conversation, we have to be very careful what we say about body image and ideal shape. Those are important issues for everyone, but particularly for young women. John Mason talked about not shaming people, and Iain Gray made the point that we need a diversity of approaches. That is very important.

When I was at school, I absolutely hated sport but I loved dancing. Now, in some of our schools, particularly in secondary schools, dancing is a physical activity option. Indeed, I joined in the dancing at my local secondary school. How we keep young people actively engaged in physical activity as they move into secondary schools is key.

I agree with much of David Stewart’s amendment, but I regret that we cannot support it because it deletes what we consider to be an important part of the Government’s motion. That is a pity.

I am glad that Mr Stewart raised the important point about type 2 diabetes, in which respect there is work going on. For example, there is an initiative in NHS Fife that, if it proves to be effective, we will look to roll out across the rest of the health service.

The point about holiday hunger was well made by Mr Stewart and others. Many initiatives on that are being undertaken by local authorities across the country, and they are gaining some momentum.

As I said, Alison Johnstone made an important point about body image. I welcome the fact that she recognises the increase in spending on active travel. The problem with the Green amendment is that it seeks to make budget decisions outside budget discussions. I know that Alison Johnstone and her party will pursue that particular point in the budget discussions with Mr Mackay.

We support the Liberal Democrat amendment. Alex Cole-Hamilton made an important point about the work on falls and fractures and the consequential impact on reducing social isolation and loneliness.

Liz Smith and others talked about the importance of school kitchens and menus, and so on.

Everyone touched on the point that what we need is a partnership. Of course, the Scottish Government has a responsibility to lead, but we need to do much of the work in partnership with local authorities, the health service, the third sector and the private sector.

Finally, many members highlighted the work that is being done in their constituencies and regions in schools, football clubs and the third sector. I point to the work that Cumnock Juniors Football Club has done to make a connection between schools and physical activity, focusing on people who are particularly inactive and on young women and girls.

We recognise that we are not going to solve all the issues over the course of one electoral cycle; therefore, sustaining the momentum over the long term is crucial. It is important that we continue the spirit and tone of the debate as we work together collectively not only to deliver the plans to which our motion refers but in being open to new ideas and initiatives that other members may want to introduce. I speak on behalf of my colleagues on both sides of me when I say that we are very open to having those conversations and to considering additional ideas about how we can move things forward.

The core point to which I return is—as Mr Whittle said—that we must change the individual and collective mindset about how we want to live a healthier life. Living longer is good, but living longer and more healthily is even better. I commend the motion to the Parliament.