Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

According to the report Health in Ireland: Key Trends 2009, published on 1 December 2009 by the Department of Health and Children, "obesity in Ireland is now one of the major challenges which faces the health services into the future. In 2007, 59% of men and 41% of women self-reported as either being overweight or obese". This is a fairly stark statement and it needs to be taken very seriously but it requires qualification. Many people see being overweight or obese as a question of appearance and for some, it will always be no more than that. Some people may be marginally overweight and this may cause no health difficulties or unduly restrict them from living their lives to the full. However, for too many people — the number is increasing — obesity seriously impairs health and quality of life or threatens to do so in the future. Of particular concern is the rise in levels of obesity among young people and children. The position was well stated in the report of the Inquiry into Obesity conducted by the Committee for Health, Social Services and Public Safety in the Six County Assembly and published last October, with which the Minister of State may be familiar. In its introduction, that report states:

Obesity has been variously described to us as a 'well established epidemic', a 'tsunami', a 'crisis' and a 'population time bomb'. It is a problem that will have an enormous impact, not just on the health of the population, but something that threatens to engulf the entire health service and it will have a very serious impact on society and the economy. For many people obesity is seen primarily as a vanity or aesthetic issue. However, it has very serious and life-threatening health implications through a wide range of conditions, such as heart disease, type 2 diabetes, some forms of cancer, and high blood pressure. We were told that obesity could cause the present generation growing up to have a shorter life span than their parents.

All of this applies across the island of Ireland and is not unique to the six north-eastern counties of our country. We must take very careful note of the findings and recommendations of that report. Studies in the United States and elsewhere have shown a link between obesity and low income poverty. People on lower incomes in developed countries tend to have poorer diets in terms of quality, if not in quantity, with more junk food and less health-giving foods in their diets. Also, they have fewer opportunities for healthy leisure activities and fewer amenities to aid physical fitness. People on lower incomes are more likely to be smokers and to experience the adverse effects of abuse of alcohol and other drugs. Alcohol itself is a contributory factor to obesity.

Many respondents to the Assembly Inquiry into Obesity report from which I have cited highlighted the links between poverty and obesity. I refer to some examples. Action Cancer pointed to research which found that, "people on lower income have higher propensity for fast food diets and food with little nutritional value. Additionally, people with little disposable income are less motivated to engage in regular exercise due to the high costs associated with gyms or sports clubs". Dr. Colin Hamilton of the British Medical Association suggested that, "looking back 50 or 60 years, one discovers that obesity was not a working-class problem, but, rather, one of the middle and other classes — the people who had money to spend on food. Nowadays, the situation has totally reversed". John News of Sport Northern Ireland, agreed stating that, "the settings are important; not everyone wants to go to a council-owned leisure centre, but neither can everyone afford to go to a private health club or leisure centre. The health inequalities across Northern Ireland show a definite correlation between socio-economic status and participation in sport and physical activity".

The Public Health Alliance for the island of Ireland, with which we are all familiar, is an all-Ireland organisation which addresses health inequalities. It pointed to research undertaken in 2007 to examine the scope and extent of food poverty in the North of Ireland. That research concluded that, "there is strong evidence to indicate that people living in food poverty almost always have a diet which predisposes them to the risk of obesity". I refer to another example. Andrew Dougal, Northern Ireland Chest Heart and Stroke Association, has pointed out that success in preventing heart disease and stroke has been achieved in the higher socio-economic groups and while he agreed with the total-population approach he argued that, "there may be a need to focus on the more deprived groups in society to ensure that those people are empowered to change their lifestyles".

Andrea Marnoch, Food Standards Agency Northern Ireland, reported on the findings of the low income diet and nutrition survey, LIDNS, carried out between 2003 and 2005, and published in 2007. Its aim was to study material deprivation in the diets of what it called the bottom 15% of the population. It concluded that:

Compared with the general population, the low-income population was less likely to consume wholemeal bread and tended to consume more non-diet soft drinks, more processed meats, more whole milk and more table sugar. Consumption of fruit and vegetables fell well below the recommended level of five portions a day, and consumption of oily fish was very low.

While the rates of obesity have increased most among adults and children from poorer backgrounds, research has also found that the widening of obesity inequalities is more evident among women than men. The Fit Futures report in the North stated: "Higher rates of obesity have been found in adults, especially women, with mild to moderate learning disabilities that live in the community than in the general population". The Royal College of Psychiatrists reported that "people with mental illness and those with learning disabilities are more likely than the general population to be obese". It would useful to put on record a summary of the recommendations of that useful Assembly report, especially those that can be applied to this jurisdiction, most of which can. It recognises that obesity is the most serious and most challenging public health issue that we face at this time and it is also one of the most complex. There is, therefore, an urgent need to develop and implement a comprehensive and robust strategy to address the issue.

Growing levels of obesity will continue to generate enormous costs to society, particularly the health and social care sector in the years ahead. Given this and the potential for significant cost benefits, it is imperative that substantial and sustained resources are provided to implement a life course strategy, in other words, a strategy that addresses people's lives and health in the round to address obesity.

A joined-up approach is required across all Departments, public sector agencies, including local authorities, the private sector and the voluntary and community sectors to tackle obesity. There needs to be an audit of existing obesity-related initiatives so that the need for evaluation or further research can be identified and examples of good practice can be rolled out more widely.

There needs to be a range of evidence-based referral options for use by primary care practitioners. The Minister should undertake a comprehensive review of weight management services at all levels for adults and children. The review must address, for example, the need for dedicated obesity clinics. The review should also consider the merits of adopting examples of good practice from elsewhere, such as the Counterweight programme in Scotland and the Carnegie Weight Management programme in England. There is much that we can learn from international best practice. The problem is not unique to us; it is global, certainly in the developed Western society as we know it, and we can learn from the approaches employed in other jurisdictions.

The HSE and the Department of Health and Children should exert pressure at a national and European level to introduce regulatory controls on the levels of salt and saturated fat in manufactured foods. The Assembly report urged a single, consistent food labelling scheme and urged a system that could be made mandatory on all food retail products. It called for more action to enforce a similar, clear and simple nutrition labelling system at non-retail outlets such as restaurants, hotel and other catering establishments. Sinn Féin urges an all-Ireland approach to this aspect of food labelling and, indeed, to all food labelling.

While recognising the difficulty in regulating food portion sizes in catering and similar settings, we urge the Department to examine how issues such as food promotion and pricing impact on portion sizes, and how they might be influenced.

Significantly, the report recognised that there is confusion over what exactly constitutes five portions of fruit and vegetables daily, and particularly around the size and content of a portion. The Department and-or the HSE should examine how greater clarity and understanding about this health message can be achieved and how it might impact on levels of obesity.

Publicly provided sports and leisure facilities are vital in tackling obesity and overall health and fitness needs of the population. In some ways, the North is more advanced than this jurisdiction in that regard and much work needs to be done in the State in that area over the years ahead. Every Department should recognise that it has a crucial role to play in responding to the obesity epidemic, either through direct action or through policies and practices that impact on the factors that contribute to obesity.

We need to explore the feasibility of banning the advertising of food and drink products that are high in fat, salt or sugar before the 9 p.m. watershed. New and emerging media should also be used to engage with young people because they tend more to these new means of contact communication. Such media should be explored and opportunities identified in order to address more young people on the issues of health, fitness and obesity. Crucially, health inequalities must be recognised, and particularly the need to address the higher levels of obesity in areas of social deprivation.

It needs to be noted by so many across society that there are real benefits for both employers and employees in promoting healthy lifestyles in the workplace, and that employers have a role to play. They should consider initiatives, within or in association with the workplace, that promote healthy eating and greater levels of exercise.

The answers to all of the problems presented by obesity are at the end of the day relatively simple. The difficulty is getting everyone on board and signed on for the overall project of address of this major challenge that we face today and, ultimately, encouraging enough within society to recognise the importance of that address.

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