Sally Davies , chief medical officer for England, thinks society needs to wake up to problems with body weight, drinking and e-cigarettes
What is the biggest health challenge that we face in the UK?
It is the normalisation of unhealthy behaviours. We have normalised obesity, and over drinking, and we are normalising e-cigarettes. We have normalised not taking sufficient physical exercise and the expectation that when people go to their GPs, they will walk out with a prescription for antibiotics, even though antimicrobial resistance is a problem.
Why are you against increased use of e-cigarettes?
If they were properly regulated as a medicine and we knew what was in them and the dose of nicotine, then they might play a useful role in stopping smoking. But they aren't, so at the moment we don't know their safety or the dose they deliver. They are often aimed at children with their flavourings – not only menthol but cookies and cream and bubblegum. They are sold rather cheaply and many of them are made in China, so I worry about what is in them. We have even got a verb for e-cigarette use: to vape. I am worried about normalising once again the activity of smoking. This matters particularly with children and adolescents.
So you are worried this could be a rerun of socially acceptable smoking?
Yes. Have you seen the adverts for e-cigarettes? They make them look cool and chic. In the Metrocentre in Newcastle they have a vaping boutique, which looks like a perfume boutique.
Do you think the UK has a problem with body weight?
Two thirds of adults in this country are now overweight, and one third of children. We have evidence that people don't recognise that being overweight is unhealthy. They don't think about the consequences, the increased blood pressure and risk of stroke, diabetes, cardiovascular disease and cancer. There is a study showing that 77 per cent of parents with overweight children didn't recognise they were overweight. We have normalised being overweight and even obese.
How do you get people to stop denying weight problems?
We are measuring children in primary schools, though there is evidence that some very large children opt out. People increasingly get their height and weight checked when they go to see their GP. Middle-aged and elderly people get offered an NHS health check every five years. People can also check their own body mass index (BMI). They just have to put BMI into Google and they will find the NHS Choices site and they can calculate it. It will tell them whether they have a healthy BMI or not.
BMI is sometimes criticised as a poor guide to health. Is it reliable?
It is a very good start. There are exceptions – if you are a body builder with a lot of muscle then it might be different, but that is a small minority. It is a good start and people should not shirk it.
Clothes-shop mannequins have got bigger too. Does that need to change?
We need to make people aware that a healthy weight is not overweight and the mannequins in dress shops showing large sizes rather than a range of sizes can contribute to this.
Could bringing in a sugar tax help to curb obesity?
This is a last resort. I want people to take individual responsibility, I want families to take responsibility, communities and society – and that includes industry. So if we move to a sugar tax, it would be a last resort and we haven't started working on what a sugar tax could be. We know that the fat tax in Denmark failed, we know that the tax on sugary drinks in France has had no impact, so we would have to investigate very carefully what impact a sugar tax here could have. At the moment it isn't on the table.
In what circumstances would a sugar tax be an option?
We would need to build a public coalition for it, which there isn't at the moment. You would have to have a government that felt they had public support and believed in regulation. We now have a generation of children who, because of their obesity, lack of physical activity and other behavioural issues, may not live as long as their parents. Maybe that will shift society.
Profile
Sally Davies is the chief medical officer for England and is chief scientific advisor for the Department of Health. Her latest report on the state of public health has just been published.
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