No problem. Good morning. I thank the committee for the invitation to address it about public health and the commercial determinants of health. I was here two weeks ago with the Minister, Deputy Donnelly, to discuss the Department of Health's 2024 Estimates process and I mentioned some of our key Healthy Ireland initiatives on that occasion. The committee indicated that it would like to hear more about obesity measures and those relating to the commercial determinants of health, so I have returned today to provide those updates.
Healthy Ireland supports a range of initiatives across Government Departments, agencies and civil society. The Healthy Ireland vision is for a healthy Ireland where everyone can enjoy physical and mental health and well-being to their full potential, where well-being is valued and supported at every level of society and is everyone's responsibility.
The Healthy Ireland Strategic Action Plan was published in May 2021 and sets out the priorities until the end of 2025. Among the policies contained in the plan include the national physical activity plan, the national sexual health strategy, the national mental health promotion plan and the national obesity policy action plan. Cross-sectoral collaboration is a core factor in the implementation of Healthy Ireland and is driven by the principle that good health and well-being benefit us all and are everyone’s responsibility.
This is recognised across Government. It is worth noting that the Departments of the Taoiseach and Public Expenditure, NDP Delivery and Reform are leading the Government well-being framework, to which we are contributing, and have introduced well-being, equality and green budgeting initiatives, all of which support national health and well-being.
Today’s discussion focuses on public health and the commercial determinants of health. Members will be familiar with World Health Organization guidance on commercial determinants of health, which defines these as “the private sector activities that affect people’s health, directly or indirectly, positively or negatively”. Commercial determinants can impact a wide range of risk factors - such as smoking, alcohol use, air quality, obesity and physical inactivity - and health outcomes, including non-communicable diseases, cancer, mental and physical health.
I would like to first highlight two particular examples from the World Health Organization list of risk factors, where successive governments have driven policy reform over many years. As members will all be aware, Ireland became the first country in the world to implement legislation creating smoke-free enclosed workplaces in 2004. The introduction of this measure was based on the clear and unequivocal evidence about the effects of smoking on both smokers and non-smokers alike. The Public Health (Tobacco Products and Nicotine Inhaling Products) Act 2023 continues to build on the progress made to reduce smoking rates. This important legislation prohibits the sale of tobacco products and nicotine inhaling products to those aged under 18. Legislation is also being developed to further regulate tobacco and nicotine inhaling products.
Data from our Healthy Ireland survey shows that tobacco use has reduced from 23% in 2015 to 18% in 2022 and 2023. By way of comparison, the smoking rate in the 1980s was estimated at about 35% which indicated that significant progress has been made.
We know that alcohol consumption is a major cause of disease, disability and death. In 2019, an estimated 4.8% of all deaths here and 5.2% of disability-adjusted life years were attributable to alcohol, according to Global Burden of Disease data. The Public Health (Alcohol) Act was enacted in 2018 with 28 of the 31 provisions now commenced. The Act seeks to address the high volumes and harmful patterns of consumption of alcohol prevalent in Ireland through a suite of measures, including minimum unit pricing, the regulation of advertising and sponsorship, the display of products in mixed retail outlets, and the regulation of the sale and supply of alcohol. In the past year, the Minister has signed into law the Public Health (Alcohol) (Labelling) Regulations 2023, provided for under section 12 of the Act and commenced the broadcast watershed provision of the Public Health (Alcohol) Act, which will come into effect in 2026 and 2025 respectively.
A Healthy Weight for Ireland, Ireland’s Obesity Policy and Action Plan, more commonly known as OPAP, was published in 2016 and runs to 2025. Why do we need an obesity policy and action plan? The figures speak for themselves. The WHO European Regional Obesity Report published in 2022, found that just under 59% of adults and 8% of children under the age of five in the World Health Organization European area were living with overweight and obesity. Ireland ranked 11th out of 51 countries, with obesity and overweight rates that were slightly above the European region average.
Over one quarter of adults live with obesity. This figure is based on international data from 2016. We know from more recent studies, such as our Healthy Ireland Survey 2022, that these rates remain reasonably stable, but worryingly high. Almost one in five primary-school children is living with overweight or obesity according to the WHO Childhood Obesity Surveillance Initiative, COSI, from 2020. This figure is concerning, particularly given the negative mental and physical impact that living with overweight and obesity can have on a child and the long-term negative health impacts if this persists into adulthood. The figures for prevalence of obesity and overweight among children had stabilised in the COSI fifth round data compared with the previous survey. Work on the COSI sixth round is being finalised and we expect the report to be published in the coming months.
All recent literature setting out policy options stress the need for a multi-sectoral approach, given the many factors, including commercial determinants, that contribute to overweight and obesity. These include genetic predisposition, unhealthy diet from an early age, level of education and low physical activity levels, and ubiquitous access to low-cost, high-fat, sugar and salty processed foods which are marketed across all platforms, targeting children in particular.
It is worth noting that the WHO has stated that obesity is complex, with multifaceted determinants and health consequences, which means that no single intervention can halt the rise of this growing epidemic. The health consequences of living with obesity include increased risk of cardiovascular diseases, cancer, diabetes and reduced mobility to name but a few.
What are we doing about addressing obesity and overweight here in Ireland? The obesity policy and action plan is a ten-step programme to address obesity. It includes actions on health promotion, education and prevention of overweight and obesity, and actions to manage and treat obesity within our health services. It also involves close collaboration with a number of Departments. State agencies, all-island bodies and external stakeholders are key to driving this agenda. The Department is supported by a significant body of work managed through the healthy eating active living programme and the national clinical programme for obesity in the HSE, and also by Safefood and the Food Safety Authority of Ireland.
Ireland has made progress under the obesity plan, with highlights including the development of resources, communications campaigns and programmes to address health promotion, healthy eating and obesity prevention. Clinical guidelines for the management of obesity, a model of care for the treatment of obesity in the health services are additional key elements in treating this disease. A critical element of prevention, reduction and supporting those living with obesity in Ireland is, as I mentioned earlier, addressing the environment around us and not just targeting individual behavioural change.
I would like to briefly reference three areas under our plan that address the commercial determinants of health. Changing the food environment is recognised as a key policy action for helping prevent overweight and obesity. We published a “Roadmap for Food Product Reformulation in Ireland” in 2021. Food reformulation means improving the nutritional content of commonly consumed processed foods and drinks, reducing calorie content and targeting nutrients such as saturated fat, sugar and salt, to ensure a healthier food supply. The roadmap sets targets for the reduction of calories and sugar by 20% and salt and saturated fat by 10% between 2015 and 2025, across a range of food products.
The food reformulation task force is a strategic partnership between Healthy Ireland and the Food Safety Authority of Ireland. It was established to implement the roadmap and to work with industry to both drive and monitor progress. In an ideal world, consumers would like to eat more healthily, while continuing to enjoy their favourite foods. Food reformulation has the potential to make this a real possibility. Food reformulation is currently a voluntary initiative. Needless to say, if targets remain unmet by 2025, we will need to consider further options, including mandatory food reformulation.
Under the obesity plan, a commitment was given to develop proposals for a levy on sugar-sweetened drinks. In 2018, the Department of Finance introduced the sugar-sweetened drinks tax. This tax has been in operation for more than five years. Initial indications show positive impacts, particularly in terms of encouraging drinks producers to reduce sugar content to fall below key tax thresholds, essentially driving wider product reformulation. The Department has commissioned an evaluation of the tax, which is ongoing. We expect it to be complete in April 2024 and we hope to publish shortly thereafter.
The World Health Organization identifies restrictions on the marketing of food and drink considered unhealthy or harmful to children as a key policy tool in addressing the obesity epidemic. Work at EU level through the joint action Best-ReMaP, to which Ireland contributed, has resulted in a range of published resources on restricting marketing of unhealthy foods to children and adolescents.
This will help to inform policy development at national level. The establishment of Coimisiún na Meán represents a significant opportunity to drive the obesity policy. The standards and practices that can be addressed through regulatory codes and rules developed by Coimisiún na Meán include the advertisement of certain foods and beverages to children, as well as follow-on formula. Officials in my Department have commenced engagement with an coimisiún on this matter. An coimisiún is currently developing the first online safety code to address particularly harmful content, such as risk to life content, on digital platforms targeting children. The Department of Health made a submission to the consultation on this online safety code and we understand the coimisiún will be undertaking a review of a number of codes, including the children's commercial communications code, starting later this year. We will work with an coimisiún and other stakeholders to contribute to this review.
The obesity policy and action plan comes to a close at the end of 2025 and we are already turning our thoughts to the development of a successor policy. As part of the mid-term review of the plan, we asked the World Health Organization to identify a suite of policy options on nutrition for Ireland. Many of the options are already under way. A number of options, including some related to commercial determinants of health, are being examined and are likely to be a key feature in the next plan. Significant work on building an evidence base is under way in the WHO. Our officials participate in a number of its networks, including on salt and calorie reduction and marketing unhealthy foods to children, as well as a network of focal points for nutrition and obesity. Sharing experience, best practice and international expertise and emphasising the importance of concerted action is very welcome. I am happy to take any questions members may have.
