“Healthy citizens are the greatest asset any country can have.”
Winston Churchill
Supported by
Supported by
nesta Impact
on Urban
Health
Cover illustration by Howard McWilliam
ISBN: 978-1-916699-31-1
Executive Summary
This is intended as a how-to (and how-not-to) manual for current and future politicians.
It contains the wisdom of three former prime ministers, one deputy prime minister, ten former health secretaries, and six other former and serving politicians, all of whom have dealt first hand with the vexed politics of obesity, food and health.
We have both spent our respective careers trying to improve the UK's food system, often working closely with politicians from each of the major parties. It has at times been exasperating, watching one government after another struggle to grasp this agenda fast enough, often leaving office just as their confidence and clarity peaks. On the other hand, a campaigner's job is in many ways much easier than a politician's. We only have to be experts in our field, whereas they are expected to know and solve everything, all at once, while under continuous political and media fire.
We decided to interview the key political figures of the past three decades about why the politics of food are so fraught. We wanted to understand the messy, behind-the-scenes compromises, the logistical frustrations and psychological and cultural barriers that get in the way of improving the food system. And perhaps even more importantly, we wanted to know what it takes to lift those barriers, and push through meaningful change.
The politicians we interviewed described all of this, and more, with admirable candour. All 20 interviewees agreed that government had not done enough to tackle the problem of food-related ill health. Many expressed personal regret that they had not done more during their own time in power. But they were also optimistic about what might be possible, and full of ideas and advice for their successors.
Everyone we spoke to, across the political spectrum, thought food-related ill health was a huge problem for the UK. Almost 60 per cent of the calories eaten in this country come from highly-processed food – the majority of which is bad for our health. Cleverly marketed (often at children), convenient and above all cheap, this kind of food-like product has come to completely dominate the consumer landscape.
As a result, unhealthy diets and obesity are leading causes of disability, disease and early death in the UK.
This is a particularly acute problem for people on low incomes. Per calorie, healthy foods are more than twice as expensive as unhealthy foods. Adults in the most deprived areas are more than twice as likely to suffer from a diet-related condition, such as type-2 diabetes or cardiovascular disease, compared to those in the least deprived areas. Children from the poorest decile are 2.5 times more likely to suffer from tooth decay than their richer peers, as well as being both heavier and significantly shorter.
On top of the private anguish created by this illness and early death, there are the public costs. The taxpayer has to pick up the bill for our unhealthy food system. “One pound in every three of government spending is on the NHS,” as former Conservative prime minister Boris Johnson observed. As well as putting an intolerable strain on public spending, food-related disease is also a major factor in the UK's stagnant economy. A record 2.8 million people are currently out of work with long-term illness, most of them with conditions that are either caused or exacerbated by poor nutrition. Unhealthy diets are estimated to cost the UK £268 billion per year.
Like a slow-motion disaster, this tide of illness has engulfed us gradually. Politicians, seeing it coming, have tried to avert it. Since the early 1990s, governments of various political hues have published 14 different obesity strategies, containing almost 700 individual policy suggestions. Yet in that time the proportion of adults living with obesity has doubled.
Why this impotence? Because even the best ideas are only effective when properly implemented. The vast majority of the food-related health policies of the past three decades have been abandoned, derailed, watered down, delayed into extinction, lost in the system or forgotten altogether. They didn't work because they were never given the chance to work. Politics got in the way of policy.
But it doesn't have to be that way. There are, as we shall see, some examples of
“I think it's becoming a very significant problem. Rates of obesity are climbing in the UK and we know it not only impacts people's health and wellbeing, but also NHS capacity, national welfare payments and the economy more widely."
Sir Tony Blair, former Labour prime minister
“Obesity is a massive problem in our world today. If you had to rank issues Britain faces, chronic disease is right up there – and obesity is a significant driver of so many of our biggest killers.”
Lord David Cameron, former Conservative prime minister
“Well, one pound in every three of government spending is on the NHS and there's no doubt at all that people's life expectancy has been greatly shortened by obesity."
Boris Johnson, former Conservative prime minister
where political dexterity, foresight and cooperation have brought about meaningful and lasting changes in the food system. We need more of those.
Unlike most reports, this one contains no policy recommendations. Instead, it is all about how to make the politics work.
Between them, our interviewees identified four major political obstacles to tackling food-related ill health. These are:
- That any political attempt to influence how people eat is attacked by libertarians in Westminster and the media as interfering, joyless and ‘nanny statist'. Although the public does not tend to share this view, the attacks are ferocious enough to generate considerable political anxiety. We discuss this phenomenon in Chapter One: Merrie England versus the Nanny State.
- That the government faces a conflict of interest in its relationship with industry, oscillating between champion and regulator. Most politicians recognise that the rise of food-related ill health has been commercially driven. But they often feel unable to legislate, because of industry lobbying and fears about the impact on businesses and the wider economy. We explore this challenge in Chapter Two: Mixing Business with Politics.
- That, because it has overwhelmed us gradually, the problem of food-related disease has never made it to the top of the political agenda. With so many other pressing issues in the 24-hour news cycle, this one has not received the necessary focus and energy. We describe this problem in Chapter Three: The Struggle to Juggle.
- That because the food system is such a complex, multifaceted and sprawling issue, tackling it can feel like a political game of Whack-A-Mole. Multiple actions are required – with consequences that are not always predictable – and responsibility is spread across multiple government departments. This makes it extremely difficult to create the collaborative momentum required to force through change. We discuss this in Chapter Four: Whack-A-Policy.
As well as interrogating what goes wrong behind the scenes, we also wanted to understand what it takes to make things go right. It is difficult to get meaningful policies over the line – but not impossible. Some notable legislation has made it through Parliament in recent decades, including the ban on junk food advertising on children's television that came into force in 2007; a similar advertising ban across all Transport for London sites in 2019; and the introduction of Universal Infant Free School Meals in England in 2014.
But perhaps the most successful has been the Soft Drinks Industry Levy, which came into force in 2018. We interviewed former Conservative chancellor George Osborne about how he overcame determined opposition to manoeuvre this legislation into place, and the particular factors that have made it such a robust and effective policy. (See page 21.)
We asked all our interviewees what it takes to devise and implement policies, and what advice they would give to the next generation of politicians. The two sets of answers did not always align – political theory sometimes proving less useful than dextrous realpolitik. We did, however, identify four essential ingredients for success, which we describe in Chapter Five: Ingredients for Success. These are:
- Deploy a compelling argument
A powerful, persuasive story is a political superpower. Combine an abundance of evidence with careful framing, and use existing or well-researched policy ideas to make an irrefutable case. No need to reinvent the wheel – there are effective policy solutions ready to go.
- Build a movement
The public doesn't need much persuading: it already wants strong government action on the food industry, and help to access healthy food. But marshalling support both inside and outside Westminster is crucial for getting the right policies in place and fully implemented. Nothing worth achieving can be achieved alone.
- Enlist the prime minister
Food-related ill health should be a prime ministerial priority. The prime minister has the power to unify government around a common goal, pushing it to the top of the agenda and authorising multiple departments to pull the necessary levers. (At a local level, the same is true of regional mayors.)
- Be bold, act fast, no regrets
Changing policy is hard, particularly on food-related matters. But if you move fast and aim high you can leave a
“What's the point of occupying Number 11 Downing Street, or indeed Number 10 Downing Street if you're not doing something with it?"
George Osborne, former Conservative chancellor
“[This] agenda is really, really, really ripe now."
Sir Nick Clegg, former Liberal Democrat deputy prime minister
“There's a point where it reaches a tipping point where the thing just becomes so enormous and so impactful that you've got to act. You get to that burning platform moment and I suspect that's where we are [on food-related ill health]."
Alan Milburn, former Labour health secretary
"Stop faffing around, just get on with it."
Seema Kennedy, former Conservative minister for public health
clear legacy, with measurable rewards reaped in single parliamentary terms. Our interviewees urged their successors not to leave office wishing they had done more.
The politicians we spoke to, although weathered by experience, were far from defeatist. On the contrary, they all believed that the next generation of parliamentarians could, and should, transform this country's food system, reverse the tide of sickness, address food-related inequalities and improve the nation's health. We hope this report will inspire today's policy-makers to push faster and further, using the insights of those who have gone before.
Who we spoke to, and what we asked them
We approached all former UK prime ministers and health secretaries who served between 1990 (when the first national obesity-reduction targets were being developed) and 2022, as well as other particularly relevant senior politicians.
The table overleaf sets out who we asked to speak to, in order of their relevant time in office. Pink indicates who we interviewed, white indicates who we did not (either they declined, we received no response, or they are deceased). Three interviews were conducted in person, 13 on video or via a phone call, and four in writing.
We asked interviewees a series of semi-structured questions, including how big a problem they think food-related ill health is today; what barriers they faced trying to take action in government on this agenda; how they overcame the barriers; and what advice they would give future politicians trying to tackle food-related ill health.
We have published tables with key quotes in Appendix B and the interview transcripts in an annex on the Nesta website and on the UK data service. We hope that making them publicly available will be useful to future researchers, as well as enabling the reader to see quotes in context. The transcripts also make for fascinating reading in their own right.
The transcripts were analysed using a standard qualitative thematic analysis. Detailed methods are provided in Appendix A.
Dr Dolly van Tulleken and Henry Dimbleby
The names of those interviewed are highlighted on the table overleaf.
| Party |
Year |
Prime Minister |
Health Secretary |
Other positions |
Key Obesity and Food-Related Health Strategies |
| Conservative |
1990 |
Sir John Major |
Lord William Waldegrave |
|
Health of the Nation Green Paper |
| Conservative |
1991 |
Sir John Major |
Lord William Waldegrave |
|
Health of the Nation Green Paper |
| Conservative |
1992 |
Sir John Major |
Lord William Waldegrave |
|
Health of the Nation Green Paper |
| Conservative |
1993 |
Sir John Major |
Baroness Virginia Bottomley |
|
Health of the Nation White Paper |
| Conservative |
1994 |
Sir John Major |
Baroness Virginia Bottomley |
|
Health of the Nation White Paper |
| Conservative |
1995 |
Sir John Major |
Stephen Dorrell |
|
|
| Conservative |
1996 |
Sir John Major |
Stephen Dorrell |
|
|
| Labour |
1997 |
Sir Tony Blair |
Frank Dobson (deceased) |
|
|
| Labour |
1998 |
Sir Tony Blair |
Frank Dobson (deceased) |
|
|
| Labour |
1999 |
Sir Tony Blair |
Alan Milburn |
Lord William Hague, Leader of the Opposition (1997-2001) |
Saving Lives: Our Healthier Nation White Paper |
| Labour |
2000 |
Sir Tony Blair |
Alan Milburn |
Lord William Hague, Leader of the Opposition (1997-2001) |
Reducing Health Inequalities |
| Labour |
2001 |
Sir Tony Blair |
Alan Milburn |
Lord William Hague, Leader of the Opposition (1997-2001) |
|
| Labour |
2002 |
Sir Tony Blair |
Lord John Reid |
|
|
| Labour |
2003 |
Sir Tony Blair |
Lord John Reid |
Melanie Johnson, Minister for Public Health (2003-2005) |
Choosing Health: Making Healthy Choices Easier White Paper |
| Labour |
2004 |
Sir Tony Blair |
Lord John Reid |
Melanie Johnson, Minister for Public Health (2003-2005) |
Choosing Health: Making Healthy Choices Easier White Paper |
| Labour |
2005 |
Sir Tony Blair |
Patricia Hewitt |
|
Choosing A Better Diet: A Food and Health Action Plan |
| Labour |
2006 |
Sir Tony Blair |
Patricia Hewitt |
|
Choosing Activity: A Physical Activity Action Plan |
| Labour |
2007 |
Gordon Brown |
Alan Johnson |
|
|
| Labour |
2008 |
Gordon Brown |
Alan Johnson |
Boris Johnson, Mayor of London (2008-2016) |
Healthy Weight, Healthy Lives Food Matters Strategy |
| Conservative |
2009 |
|
Andy Burnham |
|
|
| Coalition |
2010 |
Lord David Cameron |
Lord Andrew Lansley |
Sir Nick Clegg, Deputy Prime Minister (2010-2015) |
|
| Coalition |
2011 |
Lord David Cameron |
Lord Andrew Lansley |
Sir Nick Clegg, Deputy Prime Minister (2010-2015) |
|
| Coalition |
2012 |
Lord David Cameron |
Jeremy Hunt |
George Osborne, Chancellor of the Exchequer (2010-2016) |
School Food Plan |
| Coalition |
2013 |
Lord David Cameron |
Jeremy Hunt |
George Osborne, Chancellor of the Exchequer (2010-2016) |
School Food Plan |
| Coalition |
2014 |
Lord David Cameron |
Jeremy Hunt |
George Osborne, Chancellor of the Exchequer (2010-2016) |
School Food Plan |
| Coalition |
2015 |
Lord David Cameron |
Jeremy Hunt |
George Osborne, Chancellor of the Exchequer (2010-2016) |
School Food Plan |
| Conservative |
2016 |
Baroness Theresa May |
Matt Hancock |
Michael Gove, Secretary of State for Education (2010-2014) and for Environment, Food & Rural Affairs (2017-2019) |
Childhood Obesity: A Plan for Action |
| Conservative |
2017 |
Baroness Theresa May |
Matt Hancock |
Michael Gove, Secretary of State for Education (2010-2014) and for Environment, Food & Rural Affairs (2017-2019) |
Childhood Obesity: A Plan for Action |
| Conservative |
2018 |
Baroness Theresa May |
Matt Hancock |
Michael Gove, Secretary of State for Education (2010-2014) and for Environment, Food & Rural Affairs (2017-2019) |
Childhood Obesity: A Plan for Action, Chapter 2 |
| Conservative |
2019 |
Boris Johnson |
Matt Hancock |
Sadiq Khan, Mayor of London (2016-present) |
Chilhdood Obesity: A Plan for Action, Chapter 3 |
| Conservative |
2020 |
Boris Johnson |
|
Sadiq Khan, Mayor of London (2016-present) |
Tackling Obesity: Empowering Adults and Children to Live Healthier Lives |
| Conservative |
2021 |
Boris Johnson |
Sir Sajid Javid |
Andy Burnham, Mayor of Greater Manchester (2017-present) |
National Food Strategy Part One |
| Conservative |
2022 |
Liz Truss |
Steve Barclay |
Dame Thérèse Coffey, Minister for Public Health (2019) |
National Food Strategy Part Two |
| Conservative |
|
|
|
Jo Churchill, Minister for Public Health (2019-2021) |
|
Chapter 1: Merrie England versus the Nanny State
“There is and always will be a strain in the Conservative Party or in English life, of Merrie England, John Bull, you know, 'Don't deprive me of my pleasures in life.'"
Michael Gove, former Conservative secretary of state for education, and for the environment, food and rural affairs
Any politician, from left or right, who gets involved with public health policy will soon find themselves dodging 'nanny state' accusations. This phrase is one of the most effective insults in the political lexicon: instant shorthand for a dour, prissy, illiberal style of government. Casting a politician in the role of Nanny reduces their complex ideas and arguments to pure bossiness: “Because I know best.”
The looming shadow of Nanny has, for decades, served as the single most powerful rhetorical deterrent against effective public health policies. It taps into an ancient vanity – the notion of the English as a particularly 'freedom-loving' nation – and is closely tied to the presumption that diet and weight are issues of personal responsibility alone.
Politicians are sometimes torn between their libertarian instincts and the knowledge that diet-related ill health is much too big a problem to fix at an individual level. Former Conservative prime minister Boris Johnson, for example, told us. “I think the government has to do something to try and deal with it. We can't be indifferent to these levels of suffering.” But he admitted: “I think that it is very difficult for a libertarian Tory to come up with the right policies.”
Johnson himself pondered the 'personal responsibility' argument. "Look, why do people overeat? It's because they're eating their feelings, right," he suggested. “The Archbishop of Canterbury and religious leaders should try to fill what is obviously an aching spiritual void in people's lives that drives them to gorge themselves”.
In reality, the UK's slide into obesity is directly correlated with the commercial transformation of the food system over the past 70 years, which in turn was caused by industrial farming and the mass manufacturing of cheap, highly calorific food products. In that time, the proportion of the population living with obesity has gone from less than one per cent to around 30 percent. A problem of this scale is clearly systemic, and cannot simply be attributed to or solved by – individual willpower. But the idea of free will is alluring, and it is easy to characterise any government interventions on food as an attack on personal choice.
This argument derives extra spice from the uneasy intersections of class and privilege. The cliché is always that middle-class ruling elites are telling working-class people what to do, and threatening to take away their few remaining pleasures. As former Labour health secretary Patricia Hewitt recalled: “Here was I, a middle-class, feminist woman with a southern constituency. And there was John [Reid], the working-class Glaswegian, who was adamant that people needed to be able to go to the pub after work and enjoy a pint and a fag and a bag of crisps."
Sir Nick Clegg, former deputy prime minister, expressed bewilderment at “this myth that somehow fresh nutritional produce is a sort of middle-class thing... It's super weird, it just doesn't exist in other societies." He pointed to other countries where access to good, fresh food is considered the norm for people of all backgrounds and income levels. “I say this partly as someone who is married to a Spaniard from a poor rural village of 3,500 people, in the middle of Spain, where GDP per capita is a fraction of what it is in the UK. And yet everybody eats better than many people do in the UK.”
“Here was I, a middle-class, feminist woman with a southern constituency. And there was John, the working-class Glaswegian, who was adamant that people needed to be able to go to the pub after work and enjoy a pint and a fag and a bag of crisps."
Patricia Hewitt, former Labour health secretary
“I can't remember where our party conference was in 1991 but I remember going to a fringe meeting of some Conservative body or other and being shouted at: 'Health fascist!”
Lord William Waldegrave, former Conservative health secretary
“It's bound up with this weird thing we have about class [in Britain]... this myth that somehow fresh nutritional produce is a, sort of, middle class thing, it's super weird, it just doesn't exist in other societies."
Sir Nick Clegg, former Liberal Democrat deputy prime minister
Our interviewees identified two main sources of ‘nanny state' rhetoric: the right-wing media (in particular The Sun, the Daily Mail, The Spectator and the political website Guido Fawkes); and libertarian colleagues in Westminster. It was clear from our conversations how much difficulty this line of attack created for anyone trying to bring in new policies. While some politicians found it only a mild irritant, others were exhausted by the need to make the same argument again and again. As former Labour health secretary Alan Milburn put it: "Somebody asked me the other day, and it wasn't a positive question, what the hell I did every day as the Health Secretary. My answer was: ‘I had an argument; every day, I had an argument.”
The 'nanny state' accusation is blunt and easily landed, whereas the complex reality of food-related ill health requires some explaining. By the time you have done the subject justice, your audience may have lost interest. In the words of former Conservative leader Lord William Hague, “Most of the time in politics, when you're explaining, you're losing."
For example, Boris Johnson's proposal in 2020 to ban ‘Buy one, get one free’ (BOGOF) promotions on junk food attracted opposition from both inside and outside Westminster, on the grounds that it would increase the price of food. In reality, BOGOFs are designed to encourage impulse purchases - so they actually lead to people buying more than they had originally intended. This is a well-established marketing strategy, which retailers use because they know how effective it is for increasing sales. But explaining this proved too subtle and counter-intuitive (surely free food must be a bargain?) to allay political fears.
Ideological opposition can prove especially hard to manage when it comes from within Whitehall. Nick Clegg recalled the difficulty he had when trying to introduce the Coalition government's 2014 Universal Infant Free School Meals policy, which met with fierce resistance from some government advisors. “[Dominic Cummings] was a sort of one-man wrecking ball... He just kind of waged war on the policy. It's incredibly time-consuming and disruptive [and it allows] the normal chorus of braying attack dogs in the right-wing press to have a go and call it ‘nanny state.”
Politicians are more vulnerable to dissuasion when they are beleaguered or facing some kind of crisis. For example, in 2022, when Boris Johnson was losing support among his party's MPs, a small group who were opposed to his anti-obesity policies forced a delay in the proposed ban on advertising junk food online and on TV before 9pm. (Its start date was moved from 2022 to 2024, and subsequently to 2025.) “There was a lot of personal pressure on the Prime Minister in Parliament, in the media and elsewhere, and I think that he was more in a mood to compromise with his backbenchers," explained Johnson's former health secretary, Sir Sajid Javid. Johnson himself told us: "It was one of the things that backbenchers would use to attack me."
Several of our interviewees identified a contradiction in the libertarian argument against anti-obesity policies. As William Hague explained, “Most Conservatives still say they believe in a smaller state, but there is very little prospect of a smaller state if we spend ever-escalating amounts on dealing with unnecessary ill health." Taking action to reduce the burden on the NHS, and therefore the taxpayer, could be seen as more ‘conservative' than leaving public health in the grip of destructive market forces. For this reason, Lord William Waldegrave, who served as health secretary under Lady Margaret Thatcher, warned against assuming she would have opposed anti-obesity policies. “If it was science-based, she would go with it.” Indeed, in Thatcher's 2002 book Statecraft, she observed: “Far from starving, more and more of the world is threatened by the ill effects of obesity.”
Likewise, the argument that any intervention on food must be bad for business, and therefore the economy, ignores the fact that economic prosperity is dependent on a healthy nation. Food-related ill health is now proving a major drag on productivity in the UK. “The impact on the economy has been underappreciated for some time, but is starting to draw more attention,” noted former Labour prime minister Sir Tony Blair. "We need to view health as a national asset and create an environment where healthy choices are the easiest and more accessible."
One of the most interventionist anti-obesity policies of recent decades – the Soft Drinks Industry Levy, which put a tax on the sugar used in manufacturing soft drinks – was implemented in 2018 by the coalition government led by former Conservative prime minister Lord David Cameron. “It had the right impact,” Cameron told us. "Manufacturers have changed their formulas. People's intake from soft drinks has reduced. There is even evidence that the tax has been followed by a drop in the number of older primary-aged children living with obesity." And crucially, “as we showed, you can do it without upending industries or damaging the economy”.
“Other than maybe Australia, there is literally no democracy on the planet that is as sort of addled by the vested interest in the newspaper industry as we are."
Sir Nick Clegg, former Liberal Democrat deputy prime minister
"The only people who ever get involved in these debates, making them more difficult, it's the libertarian wing. Sometimes they're on our side of the house, sometimes they're on the other side of the house. The ‘nanny state' kind of idea that you shouldn't be lecturing people."
Alan Johnson, former Labour health secretary
"Most of the time in politics, when you're explaining, you're losing."
Lord William Hague, former Conservative leader
Fear of the 'nanny state' is most pronounced in Westminster and the media. In the wider population, the insult has less resonance: indeed, polls suggest high levels of public support for government interventions that improve access to healthier, affordable food. For example, 68 per cent of the public agree with the statement that “It is the government's job to make sure that everyone has affordable healthy food options available to them.” David Cameron made a similar point, telling us: “We need to get away from the binary thinking on obesity. Nudging consumers alone is not enough. You also need to give the companies a shove, so those consumers can make better choices."
Moreover – as with previous ‘nanny state' policies, such as the introduction of seatbelts in cars – any public resistance tends to fall away once new rules are in place and proving to be useful. In the words of Sajid Javid: "Once you've done it... it's hard to see how anyone's going to go shopping and say 'Oh my god, I went into a Marks & Spencer's in Birmingham and it was bloody awful because I couldn't reach my chocolate as soon as I got to the till.' No one's going to say that right? Everyone's going to think ‘Like, what was the fuss about?”
"Once you've done it... it's hard to see how anyone's going to go shopping... and say 'Oh my god, I went into a Marks & Spencer's in Birmingham and it was bloody awful because I couldn't reach my chocolate as soon as I got to the till.' No one's going to say that right? Everyone's going to think 'Like, what was the fuss about?”
Sir Sajid Javid, former Conservative health secretary
“I can't recall anything that particularly distressed me ... Just being called Nanny Bottomley; it can't even be described as a war wound."
Baroness Virginia Bottomley, former Conservative health secretary
"The public have moved to a completely different position about what they want the State to be doing ... which is that the State is going to be much more interventionist ... So I'd be less worried about the whole nanny state."
Alan Milburn, former Labour health secretary
Key findings
- 'Nanny state' rhetoric, both in the media and within Westminster, has proved a powerful deterrent against government interventions in the food system.
- Libertarians want a smaller, leaner state, but that is impossible while diet-related ill health imposes constantly escalating costs on the NHS and the wider economy.
- The public is less bothered than the political commentariat by the idea of the 'nanny state'.
- Once new policies are in place, and proving effective, opposition quickly fades away.
Chapter 2
Mixing Business with Politics
From one angle, the obesity crisis can be seen as a success story. It demonstrates the extraordinary power and effectiveness of capitalism. The purpose of business is to make money, and successful businesses give customers what they want. And what humans want – at least, what our evolutionary appetite prompts us to crave – is sugary, fatty food, dense with calories, because this would have been a rare treat for our Neolithic ancestors.
The government's relationship with the food industry is complicated, oscillating between regulator and champion. Industry bosses enjoy direct access to senior politicians, including the prime minister. This is not in itself suspect. Both sides need to understand and work with each other. The food industry is one of the UK's biggest employers, and food security is a fundamental responsibility of government. During the Covid-19 pandemic, for example, politicians, civil servants and industry bosses were able to move fast, together, to minimise disruption and ensure the nation got fed.
Over the past 70 years, new methods of agriculture and manufacturing have made it cheap and easy to produce such food at scale. Manufacturers have learned how to make and market edible products that are 'hyper-palatable', meaning they are deliberately moreish. These foods are often low in fibre and water, which means they don't fill us up quickly, so we end up eating more of them.
But food companies have a vested interest in blocking, diluting or disrupting any legislation that might interfere with trade or profit margins. The same is true of other businesses, such as advertising agencies or broadcasting networks, which derive some of their income from the food industry.
The retail landscape has been gradually flooded with food that is designed to be irresistible, but which makes us ill and overweight. (The two are not necessarily synonymous: it is perfectly possible, for example, for someone of a ‘healthy' weight to develop type 2 diabetes as a result of poor diet.) Any political attempts to hold back this commercial tide have been much too modest for the scale of the problem. “It was too little, too weak in the face of the availability, the cheapness, the tastiness, the ease of junk food", admitted Patricia Hewitt, former Labour health secretary.
Politicians, too, are often wary of doing anything that might put a spoke in the capitalist machinery, lest it should damage the economy or hamper growth. The politicians we spoke to acknowledged that this nervousness combined with determined lobbying by food companies often resulted in food-related policies being watered down or blocked altogether.
The politicians said:
“There were very strong things going the other way, of course, deep societal things like the shift to fast-food and less home cooking... and huge industries surrounding those various burgeoning fast-food things”.
Lord William Waldegrave,
former Conservative health secretary
"[We] can directly see the causal link between the unhealthy food environment that has grown with the rapidly increasing rates of obesity that we see in young children, teens and adults."
Sir Tony Blair, former Labour
prime minister
“It was too little, too weak in the face of the availability, the cheapness, the tastiness, the ease of junk food."
Patricia Hewitt, former Labour
health secretary
The lobbying they described was sometimes direct (meetings between politicians and industry representatives), but often indirect and unofficial, coming from worried backbenchers, civil servants or colleagues in other departments. For example, an MP with a big food manufacturer in their constituency might argue strenuously against any policy that they believed could put jobs in jeopardy. The same would be true of ministers or civil servants with departmental responsibility for a relevant industry.
“[Future governments] are going to be as lobbied by the food industry as we were and the people before us were and the people before them were."
Jo Churchill, former
Conservative minister for
public health
“The biggest one that I recall was commercial television... They lobbied me hard about those things, because I was quite persuaded about [the post-watershed ban] but there was a very real impact on what was then becoming an increasingly fragile broadcasting landscape."
Andy Burnham, Mayor of
Greater Manchester and former
Labour health secretary
“MPs will be influenced by businesses in their constituency or trade associations that they know well saying, you know, regulation in this area is just going to put back this industry or threaten the jobs in your constituency. Of course, that has some influence on the political system."
Lord William Hague, former
Conservative leader
“So my experience is they [the food industry] is very, very strong lobbyists," Jo Churchill, former Conservative minister for public health, told us. “You have departmentally, either civil servants or individual ministers who have been lobbied by the likes of KFC or McDonald's or Burger King or whoever, Coca-Cola, Pepsi. They call it 'public affairs', however, not lobbying! You often see them at the table at events." Boris Johnson also acknowledged: "Big sugar would be quite... I think they were using backbench feelings about freedom to try and get some of this stuff watered down."
Lord Andrew Lansley told us that compliance with European Union legislation provided another excuse for inaction, even after Britain left the EU. “Industry is still walking in the door saying, 'If you make us have a different product, we can't sell it abroad. We have one production line for Europe. Don't think that you can legislate for the United Kingdom alone.”
Our interviewees described facing a barrage of objections to any new food and health regulations. Both lobbyists and Westminster insiders tended to assume that whatever policy was under consideration would drive up the cost of food, reduce consumer choice, dampen healthy competition, cause job losses, annoy industry leaders, or be problematic, expensive and cumbersome to enforce. Former Conservative health secretary Michael Gove – who, during his time at the Department for Environment, Food & Rural Affairs, was responsible for both food and farming – summed up the hectoring tone: “Why do you want to undermine a commercial success in this country? British sugar is a huge success... why would you want to have not a single sugar beet grown in East Anglia and people losing their jobs in Docklands?"
The overwhelming concern of most politicians is the economy, with growth being the ultimate objective, so such arguments carry a lot of weight. In some cases, our interviewees felt that pro-business sentiment made it impossible even to explore potential legislation. “I did think it would be so much simpler if we just set a target for salt or sugar and said, in five or ten years' time, that will be compulsory," recalled Patricia Hewitt. “But I also knew there was no point pursuing that line. Being pro-business was absolutely critical to creating New Labour."
This points to an inherent conflict of interest within government. It must facilitate and celebrate large food corporations because of their immediate contribution to the economy, while simultaneously looking for ways to clean up the negative (and increasingly unaffordable) health consequences of the products these companies sell.
Sometimes this conflict plays out within individual political careers. Jeremy Hunt, who served as the UK's longest-standing health secretary (2012–18), told us: “I wish in particular we had made more progress with kids' obesity, where most people are less sensitive to the 'nanny state' arguments”. Yet in 2023, when he was Chancellor of the Exchequer, Hunt tweeted that it was “brilliant news” that PepsiCo UK was making its largest investment in Britain for 25 years, which the company said would lead to an 11,000-tonne annual expansion in the production of snacks in the UK per year. This is not an indictment of Hunt's character - it simply reflects the competing interests within the political system.
“When we introduced stricter regulations on the advertising of unhealthy foods to children the food industry were strongly opposed at the time, arguing that it would impact profits, harm the economy and infringe their commercial freedoms – but we did it anyway because it was the right thing to do.”
Sir Tony Blair, former Labour
prime minister
“[Treasury] say, ‘Ooh, no, no, no, no, no, no, no, if there's regulation then that will reduce the production capacity of the economy.”
Michael Gove, former
Conservative secretary of
state for education, and for the
environment, food and rural
affairs
“There's been a tendency to try and focus on more voluntary arrangements, which by definition don't really have much teeth."
Sir Sajid Javid, former
Conservative health secretary
Because of the difficulty of pushing through legislation, governments of the past 30 years have tended to favour voluntary regulation. But even this has often been met, behind the scenes, with resistance from the food industry. Alan Johnson, the former Labour health secretary who introduced the voluntary ‘traffic light' system of food labelling, recalled doing battle with the then-boss of Tesco. “I remember a long late-night conversation with Terry Leahy, trying to convince him. In the end, we got consensus around what system should be used with a bit of help from the prime minister.”
Such was the paralysis generated by industry lobbying that, in at least one case, it proved easier to cut industry out of the discussion altogether. George Osborne, former Conservative chancellor, told us he prevented the Soft Drinks Industry Levy from being weakened, blocked or delayed by vested interests by the simple expedient of keeping it a secret. “What we couldn't do is go and directly ask the industry, as we often would, ‘What's the best way to make this work?” he explained. “Because otherwise it gets kind of destroyed by the lobbying." (It's worth noting that Osborne felt that opposition would come from the right-wing media as well as drinks companies. “I remember The Sun newspaper was totally against it, and in those days the newspapers were more powerful.”) Keeping it secret gave Osborne and his colleagues the space to work on the details of their ambitious new fiscal lever before announcing it. (See box on page 21.)
"We took the piss out of David Cameron, one of his early PMQs, he was new. He was up against Tony Blair and he said something about, it's wrong that chocolate should be near the tills. Do you remember? The supermarket. He was absolutely right."
Alan Johnson, former Labour
health secretary
“I know the industry has set themselves up as the sort of villain in all this, but they did respond and worked very well with us and did reformulate their drinks, and so I say thank you very much to them.”
George Osborne, former
Conservative Chancellor
“When I first instructed TfL to bring these plans forward, there was concern that it would impact on our advertising revenue and that companies would completely stop advertising on the TfL estate. But one of the most successful things about the ad ban, from my perspective, is that this did not happen.”
Sadiq Khan, Labour Mayor of
London
Yet several interviewees noted that – once new regulation had been approved – food companies adapted quickly, implementing changes with surprisingly little fuss. “I know the industry has set themselves up as the sort of villain in all this, but they did respond and worked very well with us and did reformulate their drinks,” said George Osborne. “And so I say thank you very much to them.” Former Conservative health secretary William Waldegrave agreed, saying: “The Unilevers and so on of this world didn't really mind what you did as long as you gave them clear information and a little bit of time to adjust.”
What bosses disliked most was uncertainty. The worst-case scenario was for a government to announce or introduce a regulation, only to implement it in a muddle or abandon it altogether. “The chief executives would say... ‘What we don't want is, you change your mind, right? So we've got to re-format our stores, we've got to move things around, that costs money, and if you're going to do it, do it, but don't keep delaying it. Don't keep changing it, because that's more and more costs,” recalled Sajid Javid, former Conservative health secretary. “So you're making what from their perspective is a bad situation even worse, and I was sympathetic to that. I thought it was a very reasonable point.”
In recent years, some companies have gone public in their calls for mandatory regulation. For example, in 2023, Danone UK & Ireland's president, James Mayer, told the media, “The UK food industry's efforts to improve the health profile of its products have not moved fast enough. We've reached a point where meaningful intervention from the government is a necessary course of action.”
Our conversations revealed a paradox of realpolitik. The policies that met with least resistance, and were therefore easiest to implement, were the voluntary ones, such as voluntary labelling and reformulation of food. But these were also the least effective, and the most likely to be abandoned or changed out of recognition. By contrast, mandatory regulation was extremely hard to get over the line, but much more effective and less vulnerable once in place.
“Every prime minister since then has talked about... getting rid of [the Soft Drinks Industry Levy] and then backed off," observed George Osborne. “So it's now quite entrenched.” He added: “The lasting things in politics are often the difficult things, that on the surface seem unpopular, but there's a general acceptance in the country that they need to be done.”
Key findings
- Government has a complicated relationship with the food industry, serving as both champion and regulator.
- Industry lobbying can be direct or indirect. Politicians themselves often take the side of food companies over public health, because they are worried about inadvertently damaging the economy.
- Resistance to new policies is so intense and destructive that politicians have resorted to devising them in secret.
- Voluntary policies attract less opposition and are easier to introduce, but often prove ineffective. Mandatory legislation is harder to bring in, but much more robust and effective.
- The food industry fights hard against new legislation, but adapts quickly once it's in place. Mandatory legislation is in some ways preferable for businesses, because it creates certainty and a level playing field: as long as everyone has to follow the same rules, no company has a competitive advantage.
The Soft Drinks Industry Levy:
A case study in making the politics work
Affectionately known as ‘Sidl' by its admirers in the world of food policy, the Soft Drinks Industry Levy (SDIL) was announced in the 2016 Spring Budget of the then-chancellor George Osborne, and implemented two years later. This legislation placed a graduated tax on the amount of sugar used in the manufacture of soft drinks, and since its implementation has proved one of the most effective public health policies of recent decades.
of 21 per cent in the number of children admitted to hospital with severe asthma. Its effectiveness has led to growing enthusiasm – not least among some of our interviewees – for the idea of imposing a similar tax on the manufacture of food products and some previously exempt drinks.
But when George Osborne first started exploring the idea of a ‘sugar tax', he knew it would be politically dangerous. “Any tax on food or [non-alcoholic] drink is hugely, hugely controversial and virtually no one in Britain has ever pulled it off," he told us. Osborne had already had his fingers burned once, when his attempt to add VAT to some hot takeaway foods (the so-called 'pasty tax') ended in ignominy and reversal.
Manufacturers swiftly adapted their recipes to minimise their extra costs. As well as raising over £300 million in annual tax revenue, the SDIL is credited with halving the amount of added sugar consumed in soft drinks by children in the UK. (In adults, it has cut consumption by one third.) This is easily enough to make a significant difference to both bodyweight and dental decay – both of which are particularly acute problems for children in low-income families. The SDIL is also thought to have contributed to a surprise drop Any tax that raises the cost of food for consumers has the potential to be both electorally disastrous and regressive, since the extra cost falls disproportionately on the poorest people. So Obsorne realised he would have to devise a tax that incentivised companies to change their recipes instead. “There was already Coke Light or Coke Zero, so it wasn't as if you were asking for something impossible.”
Michael Gove recalled that the case for a government tax on sugary soft drinks was made in part by Camilla Cavendish, then director of the Number 10 Policy Unit, who had been charged with formulating David Cameron's childhood obesity strategy. (“There may be other heroes and heroines who are part of the story, but that's my recollection”, Gove added.)
Osborne told us that, although he faced strong resistance from some political advisors and fellow ministers, he was emboldened by a change in the public mood, led by campaigners such as Jamie Oliver. “There was a growing chorus of voices saying we should do something about sugar in drinks, and there were various health charities and the leadership of the NHS.” The tipping point came when Osborne managed to get David Cameron on board. “I just sat down with him and said, 'Look, there's all this evidence, it's a big landmark thing we could do. I think we're both skilled enough politicians, we can sell it. Let's go for it.”
completely. Milk-based drinks and fruit juices were exempt, because of concerns about unintended consequences and negative public perception. And industry was given two years to prepare before the levy was brought into force in 2018.
Crucially, all this was done in near-total secrecy, to prevent interference by manufacturers, political colleagues or the press. ("The Treasury is pretty good at keeping things confidential,” Osborne commented.) Making the levy part of the Budget meant it didn't have to go through ‘write round' – the process of cross-departmental consultation which, as we shall see in Chapter Four, often kills off new policy ideas.
In designing the levy, Osborne and his team of civil servants were careful to ensure that drinks manufacturers had enough headroom to make reformulation possible. The levy had two tiers, for flexibility: companies could choose to reduce the sugar in their recipes just enough to avoid paying the higher levy rate, or enough to avoid the levy Before the policy was announced, Osborne lined up Jamie Oliver to muster public support behind it. But perhaps most importantly, he had the courage of his own convictions, which made it easier to defend the policy himself. “I would say it could easily have gone wrong with the sugar tax, and we knew that... But it was worth it. It was worth risking, trying."
Chapter 3
The Struggle to Juggle
Being in high office is quite the circus act, requiring ministers to walk a political tightrope while juggling multiple competing priorities. As former deputy prime minister Nick Clegg explained, politicians have much less agency than is generally assumed: “They have to pretend that they know what they're doing and they're in control, and they're not. They're not. They're constantly being buffeted left, right and centre.”
The politicians said:
"You simply can't do everything at once.”
Patricia Hewitt, former Labour
health secretary
“When I first became Prime Minister in 1997, obesity and food-related ill health were not as high on the policy agenda as they are today.”
Sir Tony Blair, former Labour
prime minister
“I was Secretary of State for Health, not the Secretary of State for the Health Service, and that sometimes gets lost in the political debate.”
Lord William Waldegrave,
former Conservative health
secretary
Some of the issues faced by our interviewees were predictable and ongoing (NHS funding), while others seemed to come out of the blue (the Covid-19 pandemic or the 2008 financial crash). Ministers talked a lot about not having had enough resources, or hours in the day, to get through their jam-packed red boxes. Even those who had worked in more junior government roles with more narrow responsibilities described facing an endless list of policy problems to solve.
Many of our interviewees said they had been advised early on to identify one or two issues they really cared about, and stick to them. (Although even these were often elbowed aside by the events of the day.) "You can't do everything all at once," said Alan Milburn, former Labour health secretary. “So where are you going to cut the cake? Where are you going to place your bets?" Everyone we spoke to believed that obesity was a major national problem that required government action. “Obesity is a colossal issue for the country,” said former Conservative health secretary Matt Hancock. “It's having a massive impact on the cost of healthcare, and the NHS is unaffordable for the nation unless we can stay healthier in the first place."
“Not all my advisors were in favour of doing anything about it, in fact they weren't, so, absolutely not, no way we could... don't even touch it, but I thought that was short-sighted."
Boris Johnson, former
Conservative prime minister
and mayor of London
“You have to think, in an election especially, that it's taking air time from something else you could be talking about that could be more sort of impactful in terms of votes.”
Sir Sajid Javid, former
Conservative health secretary
“I think we'd spent so much time on smoking and were so worried that... let's see if that works first, smoking at work and all that. There's a big step to take. Let's not be fighting on too many [public health issues]."
Alan Johnson, former Labour
health secretary
Former Conservative prime minister Boris Johnson told us he became convinced of the need for action during the Covid-19 pandemic, when the poor overall health of the nation became painfully clear: “Covid was hitting Britain particularly badly because we were so fat." While in intensive care himself, recovering from a near-fatal Covid infection, Johnson “noticed it was all middle-aged men and quite fat, a bit like me, and I came out of that thinking, ‘Crikey, we've got to sort this out.”
Yet in Downing Street, Johnson had run up against Whitehall resistance. “Not all my advisors were in favour of doing anything about it,” he recalled. "In fact they [said] absolutely not, no way we could... don't even touch it, but I thought that was short-sighted. I think governments need to try to tackle it.”
The proliferation of government reports and strategies on obesity was identified not as a sign of determination, but of inaction. Publishing a new report might generate positive headlines, and give the appearance of a job in hand, but policies were seldom seen through to full implementation. “Many think a press notice is an implementation plan,” noted former Conservative health secretary Baroness Virginia Bottomley. “But there's a vast difference between a press notice or a White Paper or Green Paper and an implementation plan delivering results."
cross government, obesity has tended to be seen as a long-term, ‘important but not urgent' issue. The focus of politicians was usually on what they saw as more immediate problems, either out of necessity – dealing with an unfolding crisis, say – or to secure short-term gains that might win over voters. “You have to think, in an election especially, that it's taking air time from something else you could be talking about that could be more impactful in terms of votes,” said former Conservative health secretary Sajid Javid.
Our interviewees also described having limited 'political capital' to spend. They could only fight a certain number of fights before accruing too many enemies, and sustaining too many losses, to be effective. They risked losing influence, or even their position. Obesity policies were thought to require particularly high levels of political capital, because of the need to do battle with libertarians, the food industry and colleagues with vested interests in their department or constituency.
ever reached her) said, 'You can't stop people advertising Tony the Tiger.' A health secretary only has so much political capital with No 10, and on that occasion I went with the flow – saving my capital to negotiate a £20 billion increase in the NHS budget later on.”
This story also illustrates the strange fact that unhealthy diets – despite being one of the biggest causes of avoidable disease and death in the UK – aren't even a top priority within the Department of Health. In politics, the NHS always takes precedence over public health. It's not hard to work out why: long waiting lists and overcrowded emergency departments are punishable at the ballot box. The money for treatment comes from the same pot as the money for prevention. Most of the time, long-term prudence - trying to bring down the number of people falling ill in the first place – gets sacrificed to immediate need.
Jeremy Hunt, former Conservative health secretary, told us about a perfect storm in which a planned anti-obesity policy was derailed by events, industry lobbying, libertarian rhetoric and the need to preserve political capital. “The week we planned to announce [David Cameron's] obesity strategy, Theresa May became Prime Minister... We had to go back to square one because her advisers (I am not sure if it Interviewees pointed out that putting more resources into preventative measures would eventually reduce overall health expenditure. But that truism is easily lost amid the pressures of NHS funding crises, the 24-hour news cycle and election campaigns. It also suffers from being a repeated refrain across many different government departments, especially around the time of the annual Budget. As former chancellor George Obsorne put it: “This argument – ‘But yeah, but it'll pay itself back in the long run' – is literally what everyone says in every single area of public policy."
Alan Johnson, former Labour health secretary, recalled how hard he had to fight within Whitehall to get funding for the public health campaign Change4Life, launched in 2009. “[It] was going to cost £75 million. Not insignificant when you've got this bit [of the government] saying we could use that to build more hospitals, or we could use that to tackle healthcare acquired infections. So there were internal issues."
William Waldegrave summed up the problem thus: “I was Secretary of State for Health, not the Secretary of State for the Health Service, and that sometimes gets lost in the political debate.”
Key findings
- Cabinet ministers have giant to-do lists, and diet-related ill health is seen as an issue that is important but not urgent.
- Because food-related health policies attract so much opposition, they use up a lot of 'political capital'.
- Spending more on preventative public health would save the taxpayer money in the long run. But immediate funding for the NHS always takes priority.
- Government reports are no substitute for full policy implementation.
Chapter 4
Whack-A-Policy
Faced with a problem as messy and complicated as the food system, there is always a temptation to throw up one's hands in despair. It can feel like a political game of Whack-a-Mole, with new issues popping up all the time. Or, in the words of Alan Milburn, former Labour health secretary: "It's so complex, it's so difficult, it's so upstream, how do you get your arms wrapped around it?"
The politicians said:
“It's so complex, it's so difficult, it's so upstream, how do you get your arms wrapped around it?"
Alan Milburn, former Labour
health secretary
“Tackling obesity is a job for more than just the Department of Health. In this case, Treasury and Health ministers worked together to create a pragmatic, workable solution. This in fact is a job for the whole of government – Education, Business, Science, DEFRA, Work and Pensions so many departments have a role to play in changing what we teach, the industries we back, the food we eat and the choices we incentivise.”
Lord David Cameron, former
Conservative prime minister
There is no single department in charge of improving the nation's diet. Instead, responsibility is scattered across government. The Treasury is responsible for taxes on food and drink; the Department for Environment, Food & Rural Affairs is in charge of agricultural policy; the Department for Digital, Culture, Media & Sport decides which foods can be advertised when and how; the Department for Education is responsible for school meals; and the Department of Health and Social Care has to clean up the mess.
The 'siloed' nature of government departments, so antithetical to tackling complex problems like obesity, was a recurring theme of our interviews. “Government by and large operates reasonably well when it's operating in vertical silos,” Alan Milburn explained. “Education does its thing, Health does its thing, you pull the levers and something, not always what you want, but something happens. What it's not set up to do is to deal with the horizontal challenges, and the problem today... is that the big challenges are all horizontal, of which this [obesity and diet-related ill health] is one.”
"The ability to get stuff through write round was virtually impossible in an area like this."
Jo Churchill, former
Conservative minister for
public health
“Other secretaries of state aren't going to sit there thinking “This is my priority" and I can understand that”
Sir Sajid Javid, former
Conservative health secretary
“I worked with MAFF [The Ministry of Agriculture, Fisheries and Food] who had sponsorship of the food industry and the food industry were understandably wary of the whole matter.”
Baroness Virginia Bottomley,
former Conservative health
secretary
Politicians described two main barriers to cross-departmental cooperation. First, that most departments don't consider obesity to be their particular responsibility (and if they did, it was low on their list of priorities); and second, that different departments were often protecting or representing rival interests, such as food manufacturers or the advertising industry.
Collective agreement across the relevant cabinet committees and departments is required for most government policies. This is the purpose of the ‘write round' process, where new legislation is circulated around departments before being publicly announced. Our interviewees identified write round as a moment of acute peril, when a policy is likely to be dismembered or killed off altogether by objections from all sides. “When you have multiple influencers in multiple departments, the ability to get stuff through write round was virtually impossible,” said Jo Churchill, former Conservative minister for public health.
Michael Gove, who served as secretary of state for both education and for the environment, food and rural affairs under the Conservatives, said that fear of unintended consequences often put a brake on progress. With something as complex as the food system, it requires multiple policy levers to be pulled by several departments to make a difference – and the
effect of each can be dismayingly hard
to predict. "Do I subsidise this or do I tax
it? Do I ban or do I mandate it? Now
within that, there are systems, and with-
in those systems, there are actors that re-
spond to incentives. But if you're looking
at something like food, just like the envi-
ronment, because it's a system, you've got
to think, how will one intervention in one
area manifest itself in others?"
The danger of unintended consequenc-
es is real. Jo Churchill remembered a
previous experiment with encouraging
food manufacturers to reformulate their
recipes: “For example in yogurts, they
replaced fat with starch. That's not nec-
essarily a great substitute in my view, and
reformulation amusingly led to out-of-
home desserts going up by some 30% in
calories." Similarly, the ban on junk food
advertising on children's television in-
troduced in 2007 by Tony Blair's Labour
government actually led to an increase
in the total volume of junk food adverts
shown throughout the day. Industry is
good at adapting to policies, often too fast
for the government to keep up.
Some interviewees felt that it would have
been easier to get new food-related health
policies over the line if the evidence had
been stronger and more consistent.
Nutritional science, they pointed out,
keeps changing: not a bad thing in itself,
since it suggests that important work is
still being done, but politically unhelp-
ful. Politicians do not want to risk losing
credibility by introducing a policy based
on science that is later disproved or su-
perseded. "Remember that in those days,
the NHS believed, or certainly told people,
that it was fat that made you fat," noted
"If you're stepping into new
terrain, the fallacy is you've
got to operate on the basis of
evidence-based policy. But
almost by definition, if you're
stepping into new terrain
there is no evidence.”
Alan Milburn, former Labour
health secretary
"People often feel that, not
only on food but a whole range
of issues, they've been given
advice by governments that
turns out to be incorrect later.
That fashions change, that
they don't really know who to
trust, and politicians aren't
exactly top of the table of who
to trust. Credibility is a very
big barrier."
Lord William Hague, former
Conservative leader
“Although I will continue to
make it a policy priority, there
is no guarantee that the next
Mayor - whoever they may be
will do the same.”
Sadiq Khan, Labour Mayor of
London
Patricia Hewitt, former Labour health sec-
retary. “I was beginning to understand,
actually from personal experience, that
it was sugar that made you fat... I think
the NHS was, and is still, a bit behind the
science."
On the other hand, Alan Milburn point-
ed out that it's not always possible to wait
for iron-clad evidence before taking ac-
tion – especially when dealing with new,
complex or as-yet-unsolved problems: “If
you're stepping into new terrain, the fal-
lacy is you've got to operate on the basis
of evidence-based policy. But almost by
definition, if you're stepping into new ter-
rain there is no evidence."
However, a well-designed policy can
sometimes produce measurable results
within a single parliamentary term. This
means that, as well as being able to gath-
er the missing evidence, politicians have
something good to show their voters.
Sadiq Khan, currently serving his third
term as Mayor of London, banned junk
food advertising across Transport for
London in 2019. “Research shows it's been
linked to 94,867 fewer cases of obesity,
2,857 cases of diabetes prevented or de-
layed, and 1,915 fewer cases of cardiovas-
cular disease,” he told us. “The London
School of Hygiene and Tropical Medicine
has also found that the ban has contrib-
uted to a 1,000-calorie decrease in un-
healthy purchases in Londoners' weekly
household shops."
Former Conservative leader William
Hague argued that anti-obesity policies
could be a real vote-winner. “The human
body heals itself very well if you allow it
to. [This is a policy area where] the bene-
fits are individual, almost immediate, and
would start to be substantial within the
lifetime of a five-year parliament. That is
my advice."
Enforcing such policies does require de-
tailed planning. When interviewees talked
about policies that had been fully imple-
mented, including Universal Infant Free
School Meals in England (implemented
2014) and the Soft Drinks Industry Levy
(implemented 2018), they described me-
ticulous efforts to anticipate and solve
problems in advance. These efforts were
led by politicians, civil servants and lead-
ers in the relevant sectors: proof of what
effective cooperation can do.
The importance of pragmatism was
emphasised by many interviewees.
For example, not trying to do everything
all at once, but instead seeing through one
or two key policies. This is especially im-
portant because political appointments
are so often abruptly cut short, whether
because of cabinet reshuffles or changes
of government.
Frequent changes of ministerial staff re-
sulted in policies being delayed, weakened
or scrapped. Civil servants were some-
times reluctant to pursue policies that
might be ditched by the next minister in
line. “I feel sorry at times for the civil serv-
ants," said Jo Churchill. “Especially the ex-
cellent ones, because they push and push
and push and push a policy – and then,
no control, change of minister, change of
government, world event and then down
it goes again.”
While he was health secretary, Alan
Milburn published a 10-year plan for
his department, in an attempt to estab-
lish a long-term vision. But this back-
fired when he was criticised for being
“presumptuous”.
Yet we did find examples where policy ideas
had survived multiple changes of person-
nel, and indeed governments. In fact, as we
will see in the next chapter, building on a
predecessor's work is one of the most effec-
tive ways to bring about meaningful change.
Key findings
- Responsibility for food policy is scattered across multiple government
departments, making it hard to coordinate political action.
- Reshuffles and elections mean frequent changes of personnel, and there-
fore lost momentum.
- The 'write round' process – during which new policies are scrutinised by
all relevant government departments – is a key moment of political peril.
- Politicians want clearer evidence to support food-related health policies.
But when dealing with new or urgent problems, it is not always possible
to wait for the evidence.
- Well-designed anti-obesity policies can produce measurable impacts
within a single Parliamentary term.
Chapter 5 Ingredients for Success
"Change begins with an argument."
Alan Milburn, former Labour health secretary
Surprising though it may seem, the politi-
cians we spoke to were not at all defeatist
about tackling obesity and food-related ill
health. On the contrary, they were brim-
ming with optimism, ideas and advice for
future governments. All 20 interviewees
agreed that not enough had been done to
tackle the problem, and that politicians
can and should do more.
“The truth is, I can tell you now how to do
it," declared Alan Milburn, former Labour
health secretary. “It's hard, it's fucking
hard, but the truth is there's a series of
levers that you can pull, ding-ding-ding-
ding-ding, and it's quite mechanistic in
one sense... You've got to get the levers
operating in sync, and in some cases there
are levers that have now been extracted
that need to be re-introduced; but none-
theless, it's subject to leverage."
Former Conservative chancellor George
Osborne was more optimistic still, per-
haps because of the success of his own
‘sugar tax' on soft drinks. “It seems to
me this is an area where it's quite sim-
ple to deliver practical improvements in
a measurably short period of time,” he
told us. “At least one component of this
what we allow people to eat, or what we
incentivise food companies to produce
seems to be something that's a relatively
straightforward lever to pull, compared
to many other issues.”
There is no shortage of good policy ideas
(or 'levers') in this field. The question is,
how to make sure these policies get im-
plemented, on time and in full? Between
them, our interviewees came up with four
essential ingredients for success.
1. Deploy a compelling argument
A politician's greatest weapon is a well-
shaped argument. This was one of the
clearest messages that came out of our
interviews. Evidence and policy ideas, al-
though vital, are not sufficient. You need to
be able to tell a persuasive story: one that
inspires others to join your cause. Seema
Kennedy, former Conservative minister for
public health, observed that deft “story-
telling" is always more effective than “just
data about diabetes and heart attacks".
Through our interviews we identified the
following components of an effective po-
litical argument:
Give the gift of hope
Change is possible, so make it part of a
positive mission of renewal. Combat fa-
talism by talking about specific things the
government can do to improve the na-
tion's health, and explaining how these
solutions work. As Alan Johnson, former
Labour health secretary, put it: “The first
thing you have to try and do politically is
to make sure that parliamentarians and
others understand that this is not wishful
thinking. That there is a solution to this
problem, that it's not too big to resolve.”
Expose the system
Eating habits are not accidental. They are
shaped not only by individual genes and
circumstances, but also by the consumer
landscape, clever marketing and advertis-
ing. We live in a world flooded with cheap,
unhealthy food that is deliberately designed
to be consumed in excess, and marketed
aggressively at children, thus establishing
lifelong habits. Once people understand how
the food system manipulates and exploits
their instinctive appetites, they don't like it.
Prioritise children
This makes sense nutritionally, since a good
diet early on can have life-long health ben-
efits. But it also makes sense politically, be-
cause the wellbeing of children is a priority
for voters. “In my experience, I think people
tend to care more about young people, and
children, in particular, than themselves,”
former Conservative health secretary Sajid
Javid told us. “That is why, for example, the
TV [junk food] advertising ban [before] the
watershed is... actually quite popular."
Emphasise fairness
Everyone deserves the opportunity to
be healthy, no matter what their back-
ground or where they live. Explaining the
link between food-related ill health and
deprivation can bring new converts to the
cause. Several of the politicians we spoke
to said it was this that had inspired them
to act: after all, they had gone into public
service to help those most in need. Nick
Clegg, former Liberal Democrat deputy
prime minister, recommended “a narra-
tive that says: kids in London have this,
kids in your neck of the woods should as
well. The whole fairness thing... I think is
a really powerful one."
Make connections with other political
issues
For example, free school meals have been
shown to improve educational attainment.
This sort of cross-disciplinary effect can
help win round colleagues who might oth-
erwise have little interest in the problem of
food-related ill health. Seema Kennedy told
us that former Conservative prime minis-
ter Theresa May “saw [obesity] very much
as a social justice issue”, partly because
of “the effects on educational outcomes”.
Put yourself in your opponent's shoes
Colleagues who might be sceptical of state
interventions in the food system can some-
times be persuaded when the argument is
reframed as a question of choice and free-
dom. For example, schemes that improve
access to healthy food do not restrict choice
but expand it. Likewise, it's hard to enjoy
your freedom without the benefit of good
health. Others drew inspiration from po-
litical history: William Waldegrave, former
Conservative health secretary, said: “My
strand of Conservatism goes back to the
first great public health acts in this country
[which] were actually passed by Disraeli's
government... and so on. So there's always
been that strand of Conservatism, which
I'm proud of.” (Disraeli, in fact, once stat-
ed: "The first consideration of a minister
should be the health of the people.")
The politicians said:
“It's about telling the story
internally. How do we tell the
story to the media? How do we
tell the story to the public? So
there probably is a job of work
to do around storytelling,
rather than just data about
diabetes and heart attacks.”
Seema Kennedy, former
Conservative minister for
public health
"Give the gift of clarity... give
the gift of permission... give
them the gift of hope."
Alan Milburn, former Labour
health secretary
"We had a lot of sessions
on it... there's a wonderful
woman who came in and
talked to us... There were a
series of... there were various
doctors and dieticians and so
on who... we had sessions.”
Boris Johnson, former
Conservative prime minister
and mayor of London
In shaping these arguments, it is impor-
tant to use the clearest and most com-
pelling evidence. This may come from
many different sources, including govern-
ment-commissioned reviews, academic
studies, data from implemented policies
and comparable work in other countries.
"It has to be third-party evidence. It has to
be real, scientific evidence with people that
have no axe to grind. And it has to come
from many different places, and sources,
and countries,” said William Hague, former
Conservative leader.
There is no shortage of good ideas ready to
be implemented, as several interviewees
noted. A huge amount of evidence-gath-
ering, data crunching and policy research
has already been done. “Well, they [incom-
ing politicians] don't need to reinvent the
wheel here in terms of policy,” said William
Hague, “because the elements are all there
in the National Food Strategy that Henry
Dimbleby set out. I'm not just saying that be-
cause he's part of your project, I think that's
true, and I've said that for a while. And, of
course, one could decide to vary certain el-
ements of that, but that's the menu, that's
the agenda that we're dealing with here.”
In addition to government-commis-
sioned reviews such as the National Food
Strategy, there is an array of high-qual-
ity reports that government can turn to
for policy ideas. These include the re-
cent House of Lords special inquiry re-
port 'Recipe for Health: A plan to fix our
broken food system'; the Food, Poverty,
Health and the Environment Committee's
'Hungry for Change: Fixing the Failures in
Food' report; and Nesta's own “blueprint
for halving obesity in the UK”. There are
also many government-proposed obesity
policies that have yet to be progressed or
have been approved by Parliament but
not yet brought into force.
Overall, the message from our interviewees
was clear: no need to reinvent the wheel.
Implement policies that are well-evidenced
and already proposed, or in the pipeline. “I
think just grasp the nettle, and start imple-
menting the policies,” said Seema Kennedy.
“We don't need any more research – it's all
there, just start putting it into place."
We need to view health as a
national asset and create an
environment where healthy
choices are the easiest and
most accessible.”
Sir Tony Blair, former Labour
prime minister
“It has to be third-party
evidence. It has to be real,
scientific evidence with people
that have no axe to grind.
And it has to come from many
different places, and sources,
and countries."
Lord William Hague, former
Conservative leader
“I think just grasp the nettle,
and start implementing the
policies. We don't need any
more research, it's all there,
just start putting it into place.
There's reams and reams of
data, it's all pointing one way,
and there are lots of practical
ways that you can attack it.”
Seema Kennedy, former
Conservative minister for
public health
Are weight-loss drugs the answer?
"One thing that really changed when
I was prime minister was the ad-
vent of appetite-suppressing drugs,"
Boris Johnson told us. “I remember
Patrick Vallance, the government's
Chief Scientific Advisor saying that he
thought that was where it would all go,
and I think he's been proved right."
The remarkable effectiveness of
drugs such as Wegovy, Ozempic and
Mounjaro has indeed caused much
excitement in Westminster, as else-
where. The political temptation is obvi-
ous. Instead of having to make difficult
and controversial interventions to im-
prove the food system, why not just sit
back and let the drugs take effect? Or as
George Osborne joked to us: “Anyway,
we're all going to be on Ozempic soon,
so maybe it doesn't matter.”
This proposition is genuinely appeal-
ing to those of a libertarian bent, who
believe food should be solely a per-
sonal matter. Appetite-suppressing
drugs seem to provide a literal injec-
tion of self-control. The irony that this
‘willpower' has to be pharmaceutically
induced is quickly brushed aside. As
Johnson put it: “Clearly, there's no sub-
stitute for individual decision-making
and will, and that's why I think appe-
tite suppressants are so important."
It is certainly true that these drugs
are proving a godsend for many peo-
ple with severe obesity or diabetes.
But they are not a sensible solution at
a population level. For one thing, they
don't actually work for a significant mi-
nority of people. They can also have un-
pleasant, and sometimes intolerable,
side effects.
Moreover, the cost to the NHS of putting
one third of the UK population (the cur-
rent proportion that is clinically obese)
on weight-loss drugs would be prohib-
itive. It is instructive to look across the
pond at America, where the economics
of diet-related disease are divided up
more visibly. Already, 12% of American
adults have reported using an appetite
suppressant, and the expectation is
that by the end of the decade, 30 million
US adults will be on one. Food com-
panies are braced for a decline in reve-
nues of up to 20 per cent, while the big
pharmaceutical companies are licking
their lips with glee.
Only health insurance companies
which have to pick up the costs either
way, whether to pay for these drugs or
to treat conditions caused by obesity
have a vested interest in improving the
overall food system. Many insurers are
now pioneering local schemes, such as
fruit and veg vouchers for people on
low incomes, to help people improve
their diets without recourse to drugs.
In the UK, the state is effectively a gi-
gantic health insurer. For reasons of
economic probity, therefore, it should
be doing everything possible to stop
the population from getting ill and
gaining weight in the first place.
2. Build a movement
“Politics being politics, you can achieve
anything if you let someone else take the
credit.
Michael Gove, former Conservative secretary of state for
education and for environment, food and rural affairs
No policy worth its salt can be implement-
ed alone. It requires collaboration – not just
across government departments (although
this is vital), but also between ministers
and civil servants, advisors and external
specialists, and perhaps also charities,
media campaigners and businesses.
Many of the politicians we spoke to
said that the impetus for change needs
to come from outside as well as inside
Westminster. Once an issue becomes
part of the wider zeitgeist, with voices
in the media calling for change, it be-
comes easier for the government to act.
As former Conservative education sec-
retary Michael Gove put it, public cam-
paigners can help create a “permissive
environment" for the introduction of new
policies.
Several interviewees mentioned the cam-
paigning work of celebrity chef Jamie
Oliver. “Jamie's School Dinners was such
a success... The significant media cover-
age, and the public's engagement, un-
derscored the urgency of the issue and
made it politically viable to allocate funds
and introduce new standards for school
meals,” Tony Blair explained. Another
former PM, David Cameron, agreed: “I
found Jamie Oliver, in particular, a huge-
ly persuasive and effective advocate for
the cause."
Famous campaigners can muster public
and media support more effectively than
any politician, as well as providing air
cover when policies come under attack.
George Osborne, former Conservative
chancellor, told us: “I phoned Jamie Oliver
and said ‘The moment I announce [the
Soft Drinks Industry Levy], I need you out
there publicly.’... He and others did come
out in force, and fought off an attempt by
the drinks industry to either get rid of it
or water it down."
Many of our interviewees pointed out
that voters don't actually need all that
much persuading on issues of food-re-
lated ill health. As polling shows, most
people already want the government to
introduce measures that make it easier
to access and afford nutritious food and
limit the marketing of unhealthy options.
“The public have moved to a completely
different position about what they want
the State to be doing,” Alan Milburn told
us, “which is that the State is going to be
much more interventionist, it's going to
be much more active and it's going to be
much more strategic than it was proba-
bly 25 years ago.” Milburn suggested that
this ideological shift has come about, in
part, because the voters can see the neg-
ative consequences of bad diet in their
own lives: “The public tend to be ahead
of the politicians because they're expe-
riencing it."
This in turn means that even staunchly
libertarian media outlets will sometimes
(though not often) lend their support to
public health interventions. Jeremy Hunt,
former Conservative health secretary, re-
membered: “At a private lunch with Paul
Dacre, who I expected to be very hostile
to anti-obesity measures I was introduc-
ing, he told me that when he polled Mail
readers [they said] eating too much sugar
was one of their biggest concerns. I sus-
pected that was not a natural ideological
position for him to take, but to his credit,
like all great newspaper editors, he stayed
close to his readers."
Even among the more hostile news out-
lets, media interest in health is strong.
Lord William Waldegrave, Conservative
health secretary under Margaret Thatcher
and John Major, observed: “The other
great story they [newspapers] love, apart
from the Royal Family, is always health
things."
The politicians said:
“Don't underestimate how
much people do realise this
is a problem and do want
rescuing from it."
Lord William Hague, former
Conservative leader
“There was this really clear
message from the public that
they wanted support to be
healthier... That message was
absolutely the foundation for
that public health green paper."
Patricia Hewitt, former Labour
health secretary
“I think the Left needs to be
careful not to be as, sort of,
politically moralising about it
as they tend to be, and the Right
needs to really overcome this
idea that it's not for people like
them... You want everyone from
the Daily Mail to The Guardian
to feel as strongly about this."
Sir Nick Clegg, former Liberal
Democrat deputy prime
minister
Public support for government action on food and health
- 68 per cent believe it's the government's job to make sure everyone has
access to affordable healthy food.
- 80 per cent support a ban on junk food advertising on TV and online to
kids.
- 68 per cent support the introduction of some form of tax on junk food,
provided the revenue is ring-fenced for improving child health and ac-
cess to healthy food.
- 76 per cent would like their local council to restrict junk-food advertising
near places where children congregate, e.g. schools and playgrounds.
Within Westminster, it takes a village to
raise a policy. “People think that cabinet
ministers are very powerful, and in some
ways they are, but you can't make a change
unless you have a movement of people
making the same case and amplifying your
argument," former Conservative health
secretary Matt Hancock told us. “You need
your troops if you want to make change."
Our interviewees were generally highly
complimentary about the civil servants
they had worked with, whose support
was critical in getting policies over the
line. Former Labour health secretary Alan
Johnson talked about “getting the right
civil servants onto this” being vital. The
least helpful civil servants were the more
nervous ones, who sometimes avoided
pursuing mandatory obesity policies for
fear that they might be too difficult to im-
plement or attract too much opposition
e.g. from industry and other government
departments.
Several interviewees mentioned how
useful it was to have the insights and
support of high-profile government ex-
perts, such as Chief Medical Officers Sir
Chris Whitty, Sir Liam Donaldson and Sir
Donald Acheson. Along with independent
advisors, these experts tended to be trust-
ed by the public, and could offer impartial
advice to politicians.
Marshalling support across party-politi-
cal divides was seen as vitally important,
to help create durable policies that could
survive changes of government. “I think
the Left needs to be careful not to be, sort
of, politically moralising about it as they
tend to be, and the Right needs to really
overcome this idea that it's not for people
like them," said Nick Clegg, former Liberal
Democrat deputy prime minister. “You
want everyone from the Daily Mail to The
Guardian to feel as strongly about this."
One underrated method of collaboration
is to build on the work of your predeces-
sors. Our interviewees were clear that
leaning into policies that were already in
place, or under consideration, was easier,
less disruptive and usually more effective
than starting from scratch. It also had the
great advantage of not enraging industry
bosses, who want consistency above all.
Several interviewees recommended that
new governments should act fast in order
to see the benefits of a policy within a
single parliamentary term. This is more
easily done if you adopt or push through
policies that have already been drafted
by the previous government. For exam-
ple, the current Labour government has
swiftly adopted the advertising ban on
junk food that was legislated for, but then
delayed, by the previous Conservative
government.
“At a private lunch with Paul
Dacre, who I expected to be very
hostile to anti-obesity measures
I was introducing – he told
me that when he polled Mail
readers [they said] eating too
much sugar was one of their
biggest concerns. I suspected
that was not a natural
ideological position for him to
take, but to his credit, like all
great newspaper editors, he
stayed close to his readers.”
Jeremy Hunt, former
Conservative health secretary
“As time went on though,
several shifts were taking place.
Awareness of the dangers of
unhealthy food was growing.
Attitudes were changing.
Industry was already moving
in the right direction, offering
healthier options. There was
also a greater sense of coherence
between those pressing for
action and what they were
calling for, and I found Jamie
Oliver, in particular, a hugely
persuasive and effective
advocate for the cause.”
Lord David Cameron, former
Conservative prime minister
3. Enlist the prime minister
The politicians said:
“If the prime minister isn't
onside, if the prime Minister
isn't enthusiastic about the
policy area, then one individual
Cabinet minister who's
determined enough can kill it.”
Matt Hancock, former
Conservative health secretary
“From my earliest days as
Prime Minister, I put obesity at
the heart of the public health
agenda... I was 100 per cent
behind tackling obesity."
Lord David Cameron, former
Conservative prime minister
“These things will only happen
if the prime minister of the day
decides that it is a priority, and
pursues it over many years.”
Lord William Hague, former
Conservative leader
A prime minister is like a conductor: he
or she is the only person who can bring all
the instruments of government together
in some kind of harmony. With an issue as
complex and multifaceted as food, the en-
gagement of the prime minister is crucial.
As former Conservative minister for pub-
lic health Jo Churchill put it, what matters
most is “who is interested, at what level”.
In the past, prime ministerial support
was often tacit rather than active. Those
of our interviewees who served in govern-
ments several decades ago remembered
being given considerable freedom to pur-
sue an agenda. William Waldegrave, who
was health secretary to both Margaret
Thatcher and John Major, said it was “a
time when government was pretty strong
on the whole”, and ministers had a lot of
power. However, the prime minister did
expect to remain informed. “One wouldn't
have done anything as big as this without
making sure that the cabinet and the prime
minister knew what you were doing.”
Virginia Bottomley, who also served as
health secretary under John Major, had
similar recollections: “This was a time
when there was almost entire delegation
to cabinet ministers. I would talk to John
Major about my portfolio of activities, but
he only wanted to know if there was an
issue on which he had to intervene, or
the 'no surprises rule'. It's so different
to today."
As politics has become more fractious and
unstable, ministers have found it increas-
ingly difficult to make headway without the
active involvement of their prime minis-
ter. "If the prime minister isn't onside, if
the prime minister isn't enthusiastic about
the policy area, then one individual cab-
inet minister who's determined enough
can kill it,” said the former Conservative
health secretary Matt Hancock.
The prime minister can force an issue to the
top of the government (and media) agenda,
resolve border disputes between depart-
ments, stiffen backbones, demand coop-
eration and clear a path for legislation. He
or she has the necessary clout to enlist the
other key power brokers in Whitehall, and
to pull multiple levers across government.
“If you want the whole of government to
engage with public health... the prime min-
ister and the head of the civil service have
to join in, and the Treasury have to allocate
specific resources,” noted Andrew Lansley,
former Conservative health secretary.
Any really big policy move for example,
introducing a tax to encourage food man-
ufacturers to make healthier products
would require both the prime minister and
the chancellor to put their shoulders to the
wheel. Fiscal policies such as taxes tend to
be controversial but highly effective. They
also have the great advantage of being con-
tained in the Budget, and therefore not
subject to 'write round' (see page 21.) As
we have seen, this was a major factor in
George Osborne being able to get the Soft
Drinks Industry Levy through Parliament.
Of course, prime ministers themselves
are impermanent. Jeremy Hunt stayed
in post as health secretary under two
Conservative prime ministers, and de-
scribed the chaos created by change at
“The prime minister's
endorsement of this strategy
was really important because
it was cross-government and
it's always difficult to get
cross-government issues really
moving because of the nature
of the beast bringing all these
different factions together.”
Alan Johnson, former Labour
health secretary
“One wouldn't have done
anything as big as this without
making sure that the cabinet
and the Prime Minister knew
what you were doing [and were]
behind you."
Lord William Waldegrave,
former Conservative health
secretary
“The occupants of Number 10
also make a difference."
Jeremy Hunt, former
Conservative health secretary
the top. An entire programme of obesity
policy ended up weakened, delayed and,
in part, scrapped when Theresa May suc-
ceeded David Cameron. (Later, it should
be said, May became much keener on
food-related health interventions. Her
government revived some of Cameron's
policy ideas, including a watershed ban
on junk-food advertising on TV – only to
see it kicked into the long grass by her
successors, Boris Johnson, Liz Truss and
Rishi Sunak. It has been revived by the
current prime minister, Keir Starmer,
with the ban set to be implemented in
October next year.)
Another difficulty arises when prime
ministers don't see eye to eye with
their chancellors. Patricia Hewitt recalled
how the power struggle at the top of New
Labour left her feeling torn between two
masters. “I was... in a somewhat awkward
position with the increasingly difficult
tensions between Tony Blair and Gordon
Brown. I was a Blairite and completely
committed to Tony Blair's public service
reforms. But it was Gordon who was really
committed to tackling health inequalities,
much more than Tony.”
Alan Johnson, who succeeded Hewitt as
health secretary, said his colleagues used
to refer to “the TB-GBs: things that Tony
had done that Gordon had expressed dis-
satisfaction with... If we had another con-
versation another time, we might talk
about the TB-GBs and how debilitating that
was to have kind of two emperors during
those years." But he also noted that, thanks
to Jamie Oliver's campaigning work, both
Blair and Brown were able to agree on the
importance of improving school meals.
Having the boss on board is vital at a re-
gional, as well as national, level. Mayoral
engagement makes all the difference.
Sadiq Khan, current Labour Mayor of
London, told us: “When I was writing my
2016 manifesto, I knew that I wanted to
include some key policies that looked to
use the powers of the mayor to address
the issue [of obesity] in London."
Once in office, Khan succeeded in intro-
ducing universal free school meals across
London primary schools, and banning
junk food advertising across all Transport
for London sites. “I have made it a political
and policy priority in my budgets," he told
us. But he added: “Although I will contin-
ue to make it a policy priority, there is no
guarantee that the next Mayor – whoever
they may be – will do the same."
The former prime ministers we spoke to
clearly felt that food-related ill health is
such a serious problem, with ramifica-
tions in so many areas of national life, that
it belonged in their inbox. “Addressing
obesity is not just a health initiative,” said
former Labour prime minister Tony Blair,
"it is a critical component of a broader
strategy to secure a prosperous and sus-
tainable future for the UK."
4. Be bold, act fast, no regrets
“The final lesson is that real change happens when you're bold – but that boldness must be underpinned by a deep understanding of the problem, and specific, targeted policies to address it. ”
Lord David Cameron, former Conservative prime minister
'Be bold' was one of the clearest instructions our interviewees had for their successors. Also: move fast, before you get bogged down; have a clear sense of what you want to achieve; and aim high. Tony Blair, former Labour prime minister, counselled: "Take bold, innovative steps, including shifting the focus of the NHS from cure to prevention, and stay committed to building a healthier, more resilient Britain as the health of our people is the foundation of our future prosperity.”
Many interviewees saw an opportunity to shift the emphasis away from personal responsibility and towards more systemic changes in the food system. The proper business of government, after all, is not to supervise personal choice, but to regulate industry and protect public health. Doing this will require a multi-pronged approach, including mandatory measures such as taxes and legislation. One interviewee said, off the record, “I think, broadly speaking, my instinct is that you'd wait forever if you want to wait for [industry] to do it voluntarily.”
There was a widespread feeling that, as the costs of food-related ill health become increasingly obvious and unsustainable, the political mood is shifting towards big interventions. “I think [this] agenda is really, really, really ripe now because there's clearly... an absolute longing for renewal,” said Nick Clegg, former Liberal Democrat deputy prime minister. “Position it in the context of an optimistic and forward-looking story about, ‘We are where we are, [but] we can be so much more.’”
The idea of taxes on unhealthy food and drink was considered politically promising. This may be partly because of the success of the Soft Drinks Industry Levy. Some interviewees felt that reformulation would be an effective way to create large-scale nutritional improvements, while also being less ‘nannying' than bans or restrictions. “I remember being on Question Time... [and] being surprised at how popular it was to talk about reformulation", recalled Andy Burnham, former Labour health secretary and current Mayor of Greater Manchester.
The politicians said:
“I think, broadly speaking, my instinct is that you'd wait forever if you want to wait for [industry] to do it voluntarily."
Interviewee, off the record
“In the end to do these things requires political courage and it requires Teflon-style leadership... leadership will involve conflict, it just will.”
Alan Milburn, former Labour health secretary
“I would do much more in this space, i.e. taxes on unhealthy inputs into food, whether it's sugar or high salt content,” said former Conservative chancellor George Osborne. “But I would have a couple of conditions: that, first of all, it's a tax not a ban, and there's a reformulation option open for the industry." Osborne felt that such a policy should not be framed primarily as a revenue-raising exercise. However, polls suggest that there would be considerable public support for ring-fencing revenues generated by taxes on particular styles of food production and using the money to support public health.[^25]
“We were pondering on [a sugar tax], but we were never really bold enough to do it."
Alan Johnson, former Labour health secretary
Any such tax would have to be very carefully designed and implemented to minimise unintended consequences. But if framed right, it could be both popular and effective. Interviewees were aware of the damaging effects of unhealthy, highly-processed food. "We all now know that ultra-high processed foods are specifically designed to appeal to the worst elements of our physiological nature... ultra-high processed food is a target glaring out to be tackled to improve people's diets,” said former Conservative health secretary Matt Hancock.
“I wish in particular we had made more progress with kids' obesity, where most people are less sensitive to the ‘nanny state' arguments."
Jeremy Hunt, former Conservative health secretary
Getting any new legislation through Parliament is tough, as we have seen. Former Conservative health secretary Baroness Virginia Bottomley told us it takes persistence, belief, tenacity, collaboration and “an appropriately thick skin". This quality of personal robustness was another recurring theme in our interviews. “In the end, to do these things requires political courage and it requires Teflon-style leadership,” said Alan Milburn, former Labour health secretary. “Leadership will involve conflict, it just will.”
“There is a lot more that government can and should do.”
Lord David Cameron, former Conservative prime minister
But our interviewees were clear that the struggle is worthwhile. There can be few legacies more important than improving the nation's health. Their shared message was: Don't leave office wishing you'd done more. Several people expressed regret that they had not done more themselves to counter diet-related ill health when they were in government. “Sugary drinks, what are we going to do about sugary drinks? We were pondering on this, but we were never really bold enough to do it,” remembered Alan Johnson, former Labour health secretary. “[Then] [David] Cameron did it, and I think that changed the mindset in government.”
“Take bold, innovative steps, including shifting the focus of the NHS from cure to prevention, and stay committed to building a healthier, more resilient Britain as the health of our people is the foundation of our future prosperity."
Sir Tony Blair, former Labour prime minister
Those interviewees who had successfully introduced anti-obesity policies felt a strong sense of achievement. “Evidence shows it's working," said Sadiq Khan, Mayor of London. “I am proud of the work we have delivered." George Osborne told us: “It's interesting, at the end of my six years as Chancellor, I look back on the sugar tax as one of the things I'm still proud of.”
“The main advice I would give to future administrations is to be brave and bold in their policies and their decisions, and to focus on building political consensus.”
Sadiq Khan, Labour Mayor of London
Being in government provides a unique and privileged opportunity to make lasting change in the world. “You're there to do things that last and, in your view anyway, make a permanent difference to the country," said George Osborne. “What's the point of occupying Number 11 Downing Street, or indeed Number 10 Downing Street, if you're not doing something with it?"
“What's the point of occupying Number 11 Downing Street, or indeed Number 10 Downing Street, if you're not doing something with it?"
George Osborne, former Conservative chancellor
Or as David Cameron put it: “The final lesson is that real change happens when you're bold."
Acknowledgements
Huge thanks to both Nesta[^33] and Impact on Urban Health[^34] for supporting this work financially and logistically. We could not have done it without you.
We are deeply grateful to all the politicians we interviewed for speaking to us so frankly, and for allowing us to publish the transcripts of our conversations. We hope that future readers will, like us, find these conversations honest, illuminating and even relatable.
Thank you also to Dr. Benjamin Hawkins, Dr. Katherine Cullerton and Dr. Charlotte Albury for providing expert advice and guidance.
Appendix A
Methods
We adopted a standard qualitative thematic analysis for this study.
The dataset comprises 20 semi-structured interviews with UK prime ministers, health secretaries and other relevant senior ministers, as well as two regional mayors, all of whom who were in post or government between 1990 (when the first government obesity-reduction targets were being developed) and 2022 (the government before this project started).
Interviews were conducted in person, on a call or in writing. Consent to record the interviews, and to publish the resulting transcripts, were obtained in advance. Interviews were recorded on a computer or dictaphone, and were transcribed verbatim by an external professional transcription company. The transcriptions were reviewed by the researcher teams and sent to interviewees to seek approval, check for accuracy and provide the opportunity to anonymise, remove or clarify any sections.
The two overarching research questions we sought to answer were: What barriers did senior politicians face in government when trying to pursue food-related health policies? And: What factors helped them overcome these? Our larger aim was to develop a political manual for current and future politicians on how to effectively navigate the politics of food-related health policy.
Our analysis involved nine analytical phases, which were inspired in part by psychologists Virginia Braun and Victoria Clarke's practical guide (2022) to thematic analysis.[^35] Our phasing included:
- Developing an initial a priori codebook
- Familiarisation with the data
- Initial coding, both a priori and in vivo
- Refining and finalising codebook
- Full coding
- Generating initial themes
- Developing and reviewing of themes
- Refining, defining and naming themes
- Writing up
We approached all former prime ministers and health secretaries who served between 1990 and 2022. Where a former prime minister and/or health secretary from a particular government declined to take part in an interview, we approached the relevant public health minister (where possible or appropriate) to help put together a rounded picture. Interviews were conducted between March and October 2024. Prior to each interview, participants were sent an information sheet detailing the aims of the research, the main questions that would be posed during the interview, and how the data would be used.
As with most thematic analysis approaches, our phases were iterative in practice. This was particularly important as our dataset took longer to obtain than planned.
– or have worked – in food-related health policy and research. We engaged in discussions to critically reflect on our personal perspectives and how they may have shaped our interpretation of the data. We aimed to prioritise what interview participants' told us, rather than prioritising our own interpretations of their words.
Before we began our analysis of the interview data, we researched existing academic and grey literature on the barriers to and facilitators of government nutrition policy. We identified five studies[^36] [^37] [^38] [^39] [^40] and developed an initial codebook to help organise and analyse our data based on their insights. Our codebook contained a list of codes (i.e. labels to make meaning from our data) with definitions and information about applying them. Multiple researchers independently coded a different sample of the interviews using a combination of the codebook and additional codes. The codebook was then discussed by the researchers and revised based on the initial coding. DvT then coded all the data with the revised codebook and another member of the research team blind-coded (coded without looking at DvT's coding first) a portion of the transcripts. Initial themes were then generated based on the coded data. The themes were discussed in relation to the dataset by the research team before being further developed and reviewed. Any differences in interpretation were discussed between the researchers and used for the purposes of helping draw out richer insights. Finally, we refined, defined and named our themes before writing up our analysis.
Limitations
Although we have drawn from academic methods to conduct this research, there are limitations and inconsistencies created by the human factor. For varying reasons, we were not able to speak to all of the politicians we had hoped to. Those we did speak to were often extremely busy, so the interviews were of varying length and took place in fits and starts over a seven-month period.
We would have loved to have broadened our scope to include more of the key figures involved in public health policy – including senior politicians in the devolved nations, and civil servants and advisors across the UK – but we lacked both the time and resources to do so. This report therefore offers only a partial insight into how policies get made, from the unique perspective of former prime ministers, health secretaries and other senior politicians.
We aimed to be as reflexive (i.e. self-aware and conscious of biases, experiences and perspectives) as possible given we all work
We asked our interviewees for permission to publish the full transcripts of our conversations, in the hope that they will be useful to other researchers and interested parties. We are extremely grateful to them for allowing us to do so.
Appendix B
Key quotes elicited by our interviews, grouped by issue
| Government |
Interviewee |
Position |
Obesity and food-related ill health today |
| Conservative: |
Lord William Waldegrave |
Secretary of State for Health, 1990–1992 |
“Amongst the health problems facing us, it is very high... it's probably today's equivalent of smoking in the 1950s and ‘60s.” |
| 1990-1997 |
Baroness Virginia Bottomley |
Secretary of State for Health, 1992-1995 |
“Obesity is an enormous issue.” |
|
Sir Tony Blair |
Prime Minister, 1997-2007 |
“I think it's becoming a very significant problem." |
| Labour: |
Lord William Hague |
Leader of the Opposition, 1997–2001 |
“I think it's a huge issue because it connects to so many of the other issues that are facing the country." |
| 1997-2010 |
Alan Milburn |
Secretary of State for Health, 1999-2002 |
“Our numbers are pretty alarming... so I would say it's a huge issue.” |
|
Patricia Hewitt |
Secretary of State for Health, 2005-2007 |
“They are a huge issue... No health service anywhere in the world can cope with the consequences of the degree of preventable ill health that we are now seeing.” |
|
Alan Johnson |
Secretary of State for Health, 2007-2009 |
“We described it back in my time as being akin to climate change, as important an issue as climate change. I think it is.” |
|
Andy Burnham |
Secretary of State for Health, 2009–2010) and Mayor of Greater Manchester, 2017–present |
"Well, it's a huge issue, isn't it? But I think it's more than obesity and poor diet. I think there is a sort of growing issue around irregular eating and the impact on people's mental health of not having food security.” |
| Coalition |
Lord David Cameron |
Prime Minister, 2010-2016 |
“Obesity is a massive problem in our world today. If you had to rank issues Britain faces, chronic disease is right up there – and obesity is a significant driver of so many of our biggest killers." |
| (Conservative |
Sir Nick Clegg |
Deputy Prime Minister, 2010–2015 |
“It is a growing and increasingly acute problem... the general trend seemed to me to be exceptionally concerning and alarming and has only got worse." |
| -Liberal |
George Osborne |
Chancellor of the Exchequer, 2010–2016 |
“I think it's a problem, but it's not unique to this country." |
| Democrat): |
Lord Andrew Lansley |
Secretary of State for Health, 2010-2105 |
"It's a pretty big problem.” |
| 2010-2015 |
Jeremy Hunt |
Secretary of State for Health, 2012-2018 |
“There is no doubt that obesity is a huge issue – both in itself and when compared to other countries." |
|
Michael Gove |
Secretary of State for Education, 2010-2014 and for the Environment, Food & Rural Affairs, 2017-2019 |
“I think it's the biggest unresolved public health issue." |
| Conservative: |
Boris Johnson |
Mayor of London, 2008-2016, and Prime Minister, 2019-2022 |
“Well, one pound in every three of government spending is on the NHS and there's no doubt at all that people's life expectancy has been greatly shortened by obesity.” |
| 2015-2024 |
Matt Hancock |
Secretary of State for Health, 2018-2021 |
“Obesity is a colossal issue for the country... But I would say it is the second biggest public health question after smoking.” |
|
Seema Kennedy |
Minister of State for Public Health, 2019 |
“I think after the ageing population... it's the biggest problem.” |
|
Sir Sajid Javid |
Secretary of State for Health, 2021-2022 |
“I think it's a huge challenge. It's going to be a major threat... I mean it already is, but it's a growing threat to the country in many ways.” |
|
Jo Churchill |
Public Health Minister, 2019-2021 |
“In my view it is probably the primary health issue that we have because it is so interrelated to absolutely everything else that affects both individual health, global health, and also productivity." |
|
Sadiq Khan |
Mayor of London, Labour, 2016–present |
“It's certainly one of the biggest health issues, and one of the biggest issues facing our children and young people too.” |
| Government | Interviewee | Position | Was obesity a priority when they first took office? 1.1We define the core purpose of a board as being to ensure the effective operation of an organisation. This involves leading, directing, and guiding the organisation to deliver its objectives. It also includes taking responsibility for the governance of the organisation, and the performance and development of the chief executive.
1.2To do this effectively, boards need to have a clear understanding of what they are trying to achieve, and how they will achieve it. They also need to be able to make decisions quickly and efficiently, and to ensure that those decisions are implemented.
1.3It is also important for boards to be able to monitor the performance of the organisation, and to ensure that it is meeting its objectives. This includes regular reviews of financial performance, operational performance, and the achievement of strategic goals.
1.4Boards also need to be able to identify and manage risks. This includes both financial and non-financial risks, and ensuring that appropriate controls are in place to mitigate those risks.
1.5Finally, boards need to be able to communicate effectively with stakeholders, including shareholders, employees, customers, and regulators. This involves being transparent about the organisation's performance, and ensuring that stakeholders are kept informed of important developments.
| Government | Interviewee | Position | 'Nanny state' accusations ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------## 1. Introduction to Digital Public Infrastructure
Digital Public Infrastructure (DPI) is a topic that has recently gained significant attention, particularly within the development community. DPI refers to foundational digital systems that facilitate the provision of essential public and private services. These systems often include digital identity, payments, and data exchange. The concept is based on the idea that certain digital capabilities should be available to everyone, much like physical infrastructure such as roads or electricity. DPI is increasingly seen as a critical component for achieving sustainable development goals, fostering economic growth, and enhancing social equity.
1.1 What is Digital Public Infrastructure?
DPI encompasses a set of interconnected digital systems and platforms that enable a society to function effectively in the digital age. Key components typically include:
- Digital Identity: Systems that allow individuals and entities to prove who they are digitally, such as Aadhaar in India.
- Digital Payments: Platforms that enable secure and efficient financial transactions, like the Unified Payments Interface (UPI) in India.
- Data Exchange Systems: Secure and standardized mechanisms for sharing data between different entities, often built on open standards.
These components are designed to be interoperable, allowing different applications and services to build upon them, creating a vibrant digital ecosystem.
1.2 The Growing Importance of DPI
The significance of DPI has surged due to several factors:
- Economic Growth: By reducing transaction costs and increasing access to markets, DPI can stimulate economic activity and foster innovation.
- Financial Inclusion: Digital payment systems can bring unbanked populations into the formal economy, providing access to essential financial services.
- Efficient Public Service Delivery: Governments can use DPI to deliver services more efficiently, transparently, and at lower cost.
- Resilience during Crises: During events like pandemics, robust DPI can enable rapid distribution of aid and information.
- Data-driven Governance: Secure data exchange mechanisms facilitate better policymaking and resource allocation.
The COVID-19 pandemic, in particular, highlighted the critical role that robust digital infrastructure plays in societal resilience and continuity. Countries with advanced DPI were better equipped to manage crisis responses, from vaccine distribution to social welfare payments.
1.3 Key Principles of DPI
Effective DPI is typically built upon several core principles to ensure its benefits are widespread and equitable:
- Open Standards and Protocols: Promoting interoperability and preventing vendor lock-in.
- Privacy by Design: Integrating privacy protections from the outset.
- Security: Ensuring robust cybersecurity measures to protect user data and system integrity.
- Inclusion and Accessibility: Designing systems that are usable by all, regardless of digital literacy, disability, or location.
- Governance: Establishing clear legal and regulatory frameworks for the development and operation of DPI.
- Portability: Allowing users to easily transfer their data and digital assets between different services.
These principles aim to create a trusted and sustainable digital environment that serves the public good.
1.4 Challenges in DPI Implementation
Despite the immense potential, implementing DPI comes with significant challenges:
- Funding and Sustainability: Securing adequate long-term funding for development and maintenance.
- Digital Divide: Ensuring equitable access and digital literacy across all segments of society.
- Governance and Regulation: Establishing appropriate regulatory frameworks to balance innovation, competition, and public interest.
- Cybersecurity Risks: Protecting against sophisticated cyber threats and data breaches.
- Data Privacy Concerns: Addressing public apprehension about data collection and usage by government or private entities.
- Interoperability: Ensuring seamless integration across diverse systems and platforms, especially across borders.
Overcoming these challenges requires a multi-stakeholder approach involving governments, civil society, the private sector, and international organizations. DPI's success hinges on addressing these issues comprehensively to build public trust and ensure widespread adoption.
Cross-governmental Challenges
| Government | Interviewee | Position | Cross-governmental challenges +
| Government | Interviewee | Position | Cross-governmental challenges +
| Government |
Interviewee |
Position |
Cross-governmental challenges |
| Jeremy Hunt |
Secretary of State for Health, 2012–2018 |
"The extent to which No 10 is on board matters." |
|
| Michael Gove |
Secretary of State for Education, 2010–2014 and for the Environment, Food & Rural Affairs, 2017–2019 |
"The biggest factor is the character of departments. So, the character of the Department of Health is manage the institutions of the NHS; the character of DEFRA [Department for the Environment, Food & Rural Affairs] is keep on the right side of the producer; the character of Department for Education is the most important thing is what happens in schools, then universities, then apprenticeships, then children's services, you know, children's risk of abuse, and let other things come afterwards; and the characteristic view of the Treasury is let business be business, and tax is there to raise money, not change behaviour.” |
|
| Conservative: 2015-2024 |
Matt Hancock |
Secretary of State for Health, 2018–2021 |
“If the Prime Minister isn't onside, if the Prime Minister isn't enthusiastic about the policy area, then one individual cabinet minister who's determined enough can kill it... It's [obesity and food-related ill health] a complicated policy area to get through where all the leaders aren't necessarily in one department, right? The health department doesn't control the rules for supermarkets and where they put their advertising.” |
| Sadiq Khan |
Mayor of London, Labour, 2016–present |
“As mentioned previously, beyond the duty to publish a strategy, the Mayor of London does not have any other statutory duties or responsibilities in this area. It also means that there is no funding or resource for this work at a pan-London level. This has been a barrier in terms of the action I have taken in this space. It is a barrier I've managed to overcome, because I have made it a political and policy priority in my budgets, but with further funding from central government, we could have gone much further. It could be a barrier for future action in this space at a pan-London level too, though.” |
|
Whether the UK Government's Obesity Approach Has Been Sufficient
| Government | Interviewee | Position | Whether the UK government's obesity approach has been sufficient |
| Coalition (Conservative –Liberal Democrat): 2010–2015 | Lord David Cameron | Prime Minister, 2010–2016 | “There is a lot more that government can and should do." |
| Sir Nick Clegg | Deputy Prime Minister, 2010–2015 | “Self-evidently not... it sounds as if things have gone backwards... The thing I have no answers to is just how do you create a culture shift? It cannot be that other countries which are poorer than us just have a completely different attitude... towards food. Everyone is entitled to good food, it doesn't matter whether you're rich or poor.” |
| George Osborne | Chancellor of the Exchequer, 2010–2016 | “I would do much more in this space.” |
| Lord Andrew Lansley | Secretary of State for Health, 2010–2105 | “No, no, no.” |
| Jeremy Hunt | Secretary of State for Health, 2012–2018 | “No... I wish in particular we had made more progress with kids' obesity where most people are less sensitive to the ‘nanny state' arguments.” |
| Jo Churchill | Public Health Minister, 2019–2021 | “I don't know many health secretaries there's been since then. A lot. They will have their sets of priorities and you need to have a collision of Number 10's priorities, Treasury's priorities, the department, an individual minister and just the stars aligning. And people have got to stick at it, and I think the thing is, as you move people, rotate them a lot, which happened a lot, these things are just going to keep going up and down and trying to get something through is hard.” |
| Jo Churchill | Public Health Minister, 2019–2021 | “I think the genie is out of the bottle is my worry... a combination of marketing, large organisations, lifestyle changes over 30 years has driven us to a point where we are not in a very good place as far as food goes, is all I would say. So therefore, my analysis would be that no, there hasn't.” |
| Conservative: 2015-2024 | Boris Johnson | Mayor of London, 2008–2016, and Prime Minister, 2019–2022 | "Well, obviously not, because the problem has increased." |
| Matt Hancock | Secretary of State for Health, 2018–2021 | “No,we obviously haven't made enough progress on this because the public's got less healthy over the last 30 years... I think there's more that can be done.” |
| Seema Kennedy | Minister of State for Public Health, 2019 | “I don't know many health secretaries there's been since then. A lot. They will have their sets of priorities and you need to have a collision of Number 10's priorities, Treasury's priorities, the department, an individual minister and just the stars aligning. And people have got to stick at it, and I think the thing is, as you move people, rotate them a lot, which happened a lot, these things are just going to keep going up and down and trying to get something through is hard.” |
| Jo Churchill | Public Health Minister, 2019–2021 | “I think the genie is out of the bottle is my worry... a combination of marketing, large organisations, lifestyle changes over 30 years has driven us to a point where we are not in a very good place as far as food goes, is all I would say. So therefore, my analysis would be that no, there hasn't." |
| S Matt Hancock | Secretary of State for Health, 2018–2021 | “No,we obviously haven't made enough progress on this because the public's got less healthy over the last 30 years... I think there's more that can be done.” |
| Seema Kennedy | Minister of State for Public Health, 2019 | “No way. Not at all.” |
| Sir Sajid Javid | Secretary of State for Health, 2021–2022 | “One of the reasons it's complex is because it does cross all these government departments. You need the buy in, you need other departments to do stuff. You can't do it on your own." |
| Jo Churchill | Public Health Minister, 2019–2021 | “I think the genie is out of the bottle is my worry... a combination of marketing, large organisations, lifestyle changes over 30 years has driven us to a point where we are not in a very good place as far as food goes, is all I would say. So therefore, my analysis would be that no, there hasn't.” |
| Sadiq Khan | Mayor of London, Labour, 2016–present | “I think successive governments have tried and made considerable inroads. Over the last 30 years, there have been many policy interventions in this area... I also think public- and private-sector companies need to follow me and restrict the advertising of unhealthy food and drink and support me in my work to create child-centred healthy urban environments.” |
Summary of Interviewees' Advice for the Next Government
| Government | Interviewee | Position | Summary of interviewees' advice for the next government |
| Conservative: 1990–1997 | Lord William Waldegrave | Secretary of State for Health, 1990–1992) | “We haven't succeeded, so [it] can't have been. There were very strong things going the other way, of course, deep societal things like the shift to fast-food and less home cooking and less, therefore, control over what you're eating, and huge industries surrounding those various burgeoning fast-food things.” |
| Sir Sajid Javid | Secretary of State for Health, 2021–2022 | “One of the reasons it's complex is because it does cross all these government departments. You need the buy in, you need other departments to do stuff. You can't do it on your own." |
References
- Dicken et al (2023) Who consumes ultra-processed food? A systematic review of sociodemographic determinants of ultra-processed food consumption from nationally representative samples. Nutrition Research Reviews: 37(2):416-456
- Global Burden of Disease Study 2021 (GBD 2021) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME, 2024. Available from https://vizhub.healthdata.org/gbd-results/
- Hoenink et al (2024) Changes in UK price disparities between healthy and less healthy foods over 10 years: An updated analysis with insights in the context of inflationary increases in the cost-of-living from 2021. Appetite, 197:0195-6663
- The Health Foundation (2024) REAL Centre Health inequalities in 2040: current and projected patterns of illness by deprivation in England, Insight report
- Office for Health Improvement & Disparities (2023) Official Statistics, National Dental Epidemiology Programme (NDEP) for England: oral health survey of 5 year old children 2022
- The Food Foundation (2024) A neglected generation: Reversing the decline in children's health in England, Election ‘24 Nourishing the Nation
- House of Lords (2024) Recipe for Health: a plan to fix our broken food system, Food, Diet and Obesity Committee, Report of Session 2024-25
- Jackson, T. (2024) The False Economy of Big Food - and the case for a new food economy. Food, Farming & Countryside Commission
- Theis and White (2021) Is Obesity Policy in England Fit for Purpose? Analysis of Government Strategies and Policies, 1992–2020. Milbank Quarterly,99(1):126-170
- https://media.nesta.org.uk/documents/Nourishing_Britain_-_Transcripts.pdf
- Dimbleby, H. and Lewis, J. (2023) Ravenous: How to get ourselves and our planet into shape, Profile
- Food, Farming & Countryside Commission (2024) “Healthy food is a luxury”: Public back greater government intervention to ensure everyone can eat healthy food. Accessed 2024: https://ffcc.co.uk/news-and-press/healthy-food-is-a-luxury
- Jeremy Hunt's X (formerly Twitter) account (posted 6 June 2023). Accessed 2024: https://x.com/Jeremy_Hunt/status/1666124304046600199
- PepsiCo UK news's X (formerly Twitter) account (posted 6 June 2023): Accessed 2024: https://x.com/pepsico_uk/status/1665986978427420672
- The Guardian (2023) UK food giant calls for higher fat, sugar and salt taxes. Accessed 2024: https://www.theguardian.com/food/2023/jun/11/uk-food-giant-calls-for-higher-fat-sugar-and-salt-taxes
- HM Revenue & Customs (2024) Official Statistics: Soft Drinks Industry Levy statistics commentary 2024. Gov.uk. Accessed 2024: https://www.gov.uk/government/statistics/soft-drinks-industry-levy-statistics/soft-drinks-industry-levy-statistics-commentary-2021
- Rogers, NT et al (2024) Estimated changes in free sugar consumption one year after the UK soft drinks industry levy came into force: controlled interrupted time series analysis of the National Diet and Nutrition Survey (2011–2019). J Epidemiol Community Health; 78:578-584.
- Rogers, NT et al (2023) Associations between trajectories of obesity prevalence in English primary school children and the UK soft drinks industry levy: An interrupted time series analysis of surveillance data. Plos Medicine:10.1
- Rogers, NT et al (2023) Estimated impact of the UK soft drinks industry levy on childhood hospital admissions for carious tooth extractions: interrupted time series analysis. BMJ Nutrition, Prevention & Health; 6.
- Rogers, NT et al (2024) The UK Soft Drinks Industry Levy and childhood hospital admissions for asthma in England. Nature Communications:15, 4934.
- Cabinet Office (2022) Guide to Making Legislation
- The Food Foundation (2017) UK's Restrictions on Junk Food Advertising to Children, International Learning Series/3
- House of Lords (2020) Hungry for change: fixing the failures in food. Select Committee on Food, Poverty, Health and the Environment, Report of Session 2019-20
- Nesta (2024) Nesta's blueprint for halving obesity. Accessed 2024: https://www.nesta.org.uk/feature/nestas-blueprint-for-halving-obesity/
- Recipe for Change (2024) Experts urge Government to build healthier food industry as polling shows public distrust in companies. Accessed 2024: https://www.recipeforchange.org.uk/news-and-blogs/nov24-polling-letter-to-chancellor-health-secretary/
- Guy's and St Thomas' NHS Foundation Trust (2022) Overview: Diabetes medicines: GLP-1 agonists. Accessed 2024: https://www.guysandstthomas.nhs.uk/health-information/diabetes-medicines-glp-1-agonists
- KFF (2024) KFF Health Tracking Poll May 2024: The Public's Use and Views of GLP-1 Drugs. Accessed 2024: https://www.kff.org/health-costs/poll-finding/kff-health-tracking-poll-may-2024-the-publics-use-and-views-of-glp-1-drugs/
- J.P.Morgan (2023) The increase in appetite for obesity drugs. Accessed 2024: [https://www.jpmorgan.com/insights/global-research/current-events/obesity-drugs#:
:text=J.P.%20Morgan%20Research%20forecasts%20that,such%20as%20food%20and%20beverage.](https://www.jpmorgan.com/insights/global-research/current-events/obesity-drugs#::text=J.P.%20Morgan%20Research%20forecasts%20that,such%20as%20food%20and%20beverage.)
- Dimbleby, H (2021) National Food Strategy: Independent Review The Plan
- Food, Farming & Countryside Commission (2024) New poll unearths food crisis in Britain: Food is not working for everyday people. Accessed 2024: https://ffcc.co.uk/publications/new-poll-unearths-food-crisis-in-britain
- Obesity Health Alliance (2023) Voters Feel Let Down by Lack of Action on Childhood Obesity. Accessed 2024: https://obesityhealthalliance.org.uk/2023/05/23/manifesto-pr/
- Sustain (2023) Public wants more action to curb junk food industry. Accessed 2024: https://www.sustainweb.org/news/may23-public-wants-action-health/
- https://www.nesta.org.uk/
- https://urbanhealth.org.uk/
- Braun and Clarke (2022) Thematic Analysis: A Practical Guide. SAGE
- Cullerton et al (2016): Playing the policy game: a review of the barriers to and enablers of nutrition policy change. Public Health Nutrition:19(14):2643-53.
- Baker et al (2018): What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations Decade of Action on Nutrition. BMJ Global Health: 3.
- Pereira et al (2023): Barriers and Facilitators Related to the Adoption of Policies to Reduce Ultra-Processed Foods Consumption: A Scoping Review. Int. J. Environ. Res. Public Health:20:4729.
- Institute for Government (2023): Tackling obesity: improving policy making on food and health
- Ng et al (2022): Identifying barriers and facilitators in the development and implementation of government-led food environment policies: a systematic review. Nutrition Reviews:80;8:1896-1918
