British-Irish Parliamentary Assembly (Committee D) Report on Childhood Obesity: Statements

I welcome the Minister of State at the Department of Health, Deputy Catherine Byrne, to the House. We will discuss No. 5, statements on the British-Irish Parliamentary Assembly committee D report on childhood obesity, with the time to be allocated to group spokespersons not to exceed eight minutes and that to all other Senators not to exceed five minutes, and the Minister to be given not less than five minutes to reply to the debate.

I am grateful for the opportunity to talk to the Members of the House on the question of obesity, specifically child obesity. I understand that the interest in us discussing this important issue today was in part prompted by the publication last summer of the report on childhood obesity from the British-Irish Parliamentary Assembly, BIPA. This report, which my Department had input into, sets out some information around the causes and consequences of childhood obesity, as well as looking at the various approaches to tackling the issue with the BIPA jurisdictions.

The report acknowledges our new obesity policy and action plan entitled A Healthy Weight for Ireland, which was approved by the Government last year and launched by the Minister for Health in September 2016. Our obesity policy and the approach being taken to implement it under the broader Healthy Ireland agenda is in line with the key conclusions and recommendations of the BIPA's report.

I will update Senators on some key initiatives and progress under way in implementing the obesity policy, but first I will outline some important facts. A range of health studies and surveys show that overweight and obesity, in both children and adults, is now a serious public health concern in Ireland. The annual Healthy Ireland survey for 2017 shows that almost two thirds of adults are overweight or obese. In addition, 30% of young people aged between 15 and 24 are overweight or obese. Being a healthy weight is no longer the norm. When it comes to children the statistics are just as worrying as studies confirm that one in four children is now overweight or obese.

The childhood obesity surveillance initiative, COSI, is conducted by the national nutrition surveillance centre in UCD on behalf of my Department and the HSE. Its most recent report was published last year. It drew on data from more than 17,000 examinations of primary school children in Ireland between the years 2008 and 2015. Among the key trends to emerge is that the incidence of being overweight and obese in children in first class in Ireland, as for children aged eight years, appears to be stabilising. However, it is also evident that this stabilisation is not observed in children who attend DEIS schools. There is also a marked difference between girls and boys as more young girls tend to be overweight and obese. While any positive direction in the trends is welcome, there is certainly no room for complacency.

Overweight and obesity are not about one's shape or how one looks. There are very real clinical health issues. The consequences of child obesity are significant. Being overweight or obese carries with it an increased risk of several chronic diseases, including heart disease, type 2 diabetes and certain cancers. In addition to the physical health implications, there is often also a significant reduction in quality of life, a reduced opportunity to contribute to society and ability to reach potential, as well as mental health implications for some people.

For children, obesity carries a stigma and may be linked with bullying. We also cannot ignore the financial dimension to this challenge. According to safefood's recently published report, the lifetime costs of childhood overweight and obesity were estimated at €4.6 billion. This is the landscape of obesity that we must deal with and what our obesity policy seeks to address. We know that obesity is a complex problem with nutritional, activity related, psychological, biological and social determinants. Consequently, realistic solutions must be multifaceted and implemented as part of a suite of measures.

The policy acknowledges the importance of an integrated approach across Government to tackle the social determinants of health and well-being, in particular those that contribute to health inequalities in the population. No single sector or agency can solve this issue on its own. Individuals and families need to be supported to make informed choices in healthy eating and being physically active so that they can achieve and maintain a healthy weight. The obesity policy and action plan strives to empower individuals, families and communities to enhance their own skills to improve their health.

What we must never forget is that child obesity is largely preventable. Tackling the challenge requires a whole-of-government and a whole-of-society response. This is the approach taken with A Healthy Weight for Ireland, our obesity policy and action plan. The policy covers the period up to 2025 and aims to reverse obesity trends, prevent health complications and reduce the overall burden for individuals, families, the health system and the wider society and economy. The policy acknowledged that every sector of our society has a role in reducing the burden of obesity. It is guided by the Healthy Ireland principles to ensure it is life-course oriented with a focus on children and families and prevention-focused with an emphasis on targeting inequalities. The policy contains concrete indicators to measure the success of its implementation. It set a short-term target of 0.5% per annum for a sustained downward trend in levels of excess weight in children and a reduction in the gap in obesity levels between the highest and lowest socio-economic groups by 10%. The development of the obesity policy involved a consultation with children and young people which was facilitated by the citizen participation unit of the Department of Children and Youth Affairs and recruitment supported through the Irish Primary Principals' Network as well as Comhairle na nÓg. The report of this consultation, Healthy Lifestyles - Have Your Say, was launched with the obesity policy. The implementation of the policy commits to continuing to include the voices and contributions of children and young people.

Obesity is a complex problem with nutritional, activity-related, psychological, biological and social determinants. Consequently, any realistic solutions must be multifaceted and be implemented as part of a suite of measures. No single sector or agency is able to solve this issue on its own. Individuals and families need to be supported to make informed choices in healthy eating and being physically active so they can achieve and maintain a healthy weight. The obesity policy and action plan strives to empower individuals, families and communities to enhance their own skills to improve their health. The obesity policy prescribes Ten Steps Forward that would be taken to prevent overweight and obesity. Under each step, there are a number of actions, some of which have been identified for early implementation.

I am pleased to report that we have already made progress in a few areas that are of particular interest with reference to child obesity. My Department has established an obesity policy implementation oversight group. The first meeting of this cross-sectoral group took place last October. The Minister for Finance announced in budget 2018 the introduction of a sugar tax on sugar-sweetened drinks. The policy objective of this levy is to reduce rates of obesity as well as rates of dental deterioration, particularly in young people. My Department has been engaging with the food industry, including food retailers, on a code of practice to reduce the marketing of products high in fat, sugar and salt with a particular aim to reduce consumption of such products by children and young people. This voluntary code of practice for non-broadcast media advertising and marketing of food and non-alcoholic beverages, including sponsorship and retail product placement, will be launched in the coming weeks. Last November, the Minister for Health and I launched a new child obesity campaign called START, which my Department has developed with Safefood and the HSE. New healthy eating guidelines and a revised food pyramid have been published and supporting resources are being developed and disseminated widely such as in September when we circulated them to all primary and post-primary schools. Work has now commenced on developing healthy eating guidelines for the one to five year old age group. New nutrition standards for schools with an initial focus on school meal programmes funded by the Department of Employment Affairs and Social Protection have also been developed. These nutrition standards were launched by the Ministers for Health, Education and Skills and Employment Affairs and Social Protection last September. The development and implementation of these standards meets commitments in the DEIS action plan as well as the obesity policy.

Other developments in the HSE through a new Healthy Eating, Active Living programme will support work in the education sector as well as with parents, families and communities in supporting a more co-ordinated approach to prevention and early intervention in child obesity. A new clinical lead for obesity, Professor Donal O'Shea, was appointed by the HSE in 2017. A children's communication code, which restricts broadcast advertising of high-fat, sugar and salt foods, is already being implemented and will be reviewed in 2018. There is another dimension to combatting obesity in the short to medium term.

The obesity policy acknowledged the key role of physical activity in the prevention of obesity while the broader benefits of a more active population are set out in the national physical activity plan. Being active is vital for healthy growth and development and has emotional, social and cognitive benefits for children and young people as well as benefits for their physical and mental health and well-being. The national physical activity plan is one of the key developments arising from Healthy Ireland and was approved by Government and launched in early 2016. The implementation of that plan is well under way in collaboration with the Department of Transport, Tourism and Sport and a range of other stakeholders, including the Department of Education and Skills.

The new Healthy Ireland fund launched by An Taoiseach and the Minister for Health last October will provide funding for a range of projects to support partnership working to implement key policies under the Healthy Ireland banner, including the obesity policy and the physical activity plan. In addition to these actions, what we do in our homes, schools and communities to help build healthy habits for all children and families is vital to childhood obesity prevention efforts. These healthy habits are critical in helping those children who are a healthy weight now stay a healthy weight and those who are overweight or obese achieve a healthier weight as they grow and develop. The key healthy habits are to reduce portion sizes, eat plenty of fruit and vegetables every day, manage treat foods - not every day, replace sugary drinks with water, make being active fun - everyday, reduce screen time and encourage more sleep.

Finally, just earlier this month along with An Taoiseach, we launched a major new Healthy Ireland 2018 campaign to communicate and engage with citizens. It focused on three key themes - healthy eating, physical activity and mental well-being. This campaign will support the cross-sectoral policy implementation work happening at both national and local level and will help and encourage people and families to make those positive changes and choices to improve their health. The campaign through a new online presence at www.gov.ie/healthyireland as well as social, digital and other media and a series of events throughout the year aims to provide information and connect people with resources and organisations across the country so everyone can get involved in the national effort to create a healthier Ireland.

I thank the departmental staff accompanying me today who have been very helpful since I have been given my brief. I apologise to Senators as I must leave the Chamber in a little while. The Minister of State, Deputy Jim Daly, will be coming in. My husband is seriously ill in hospital. I just wanted to acknowledge that so people do not think I am walking out before a number of questions are put.

I am very sorry to hear that the Minister of State's husband is unwell. Hopefully, he will be better soon. Senator Noone is the next speaker. Senator Wilson is deferring to Senator Noone.

If ever there was a sign of new politics, this is it.

Very chivalrous - if that is still allowed. Senator Noone still only has eight minutes though.

I need a little bit more.

She will have eight and a little bit.

I will take some of someone's time. I am sure everyone will not speak for eight minutes. Arguably, we should have more contributors. I welcome the Minister of State and am sorry to hear that Joe is unwell. Hopefully, he will make a speedy recovery. She should leave whenever she needs to. We can chat about this again in any case. I thank her for her speech. It highlights how much benefit to the country is provided by the notion of preventive health. There is nothing complex about the idea of preventive health. If there was more prevention and more preventive health, the fiscal space would be far bigger when it comes to the amount we spend on obesity and alcohol-related illnesses in the form of cancer, heart disease, etc.

I note the Minister of State said what the obesity policy is striving for and aims to achieve. It is a recent one and we need to keep an eye on it in terms of the way forward. The Minister of State said that no single sector or agency is able to solve this issue on its own. That is for sure. That is what we learned during our work on this report, which I will go into in more detail later.

I want to address a few points the Minister of State made. The guidelines are great and it is marvellous to have them, but how do we get the message in them across? How do we communicate it? How do we make sure that people are educated by osmosis? How do we ensure people who do not have the time to read this information on websites get it, regardless of that? Is there a role for teaching children in schools about food to ensure the message gets through to their parents indirectly if the parents do not necessarily have time to be dealing with this issue.

I note the Minister of State's comments about physical activity and I agree entirely with her on those. In terms of the national activity plan, it is vital we talk about the cross-departmental collaboration between the Department of Transport, Tourism and Sport and the Department and Education and Skills. In addition, the Minister of State outlined the seven basic and obvious healthy habits one needs to build to be healthy but sometimes in our busy lives in this busy world we forget how obvious they are. I thank the Minister of State for her ongoing work.

This report came about through a committee of the British-Irish Parliamentary Assembly. I suggested we examine the issue of obesity between the jurisdictions and the statistics on it, and prepare a useful report on a matter that I consider to be a major issue. Normally we would go to one another's jurisdiction, namely, to London, Belfast, Scotland and so on, to discuss such an issue, but I made the point that I thought that would be futile because we are all appalling on this front. We all have similar statistics. We went to the Netherlands and I will go into its statistics on this issue later. In terms of obesity, we rank among the worst in the world and we are on course to be the fattest country in the world by 2030, which is nothing to boast about. I have bored Members talking on this subject. I am looking at Senator Norris and I am sure he is sick listening to me talking about these statistics-----

No, I think the Senator is very good.

-----but this is such an important and, pardon my sad pun, such a massive issue.

It must be emphasised that childhood obesity has consequences not only for the physical health of the individual concerned but also for his or her emotional and psychological well-being, vitality and life. It is all well and good to say such a person is fat and should just eat well, but it is not that simple. I have lived this. It is not down to bad parenting. I have great parents. It is just not that simple. It is a complex issue. The Minister of State has said that.

I will not go into the statistics in detail because we all know it is problem but, basically, in Ireland 26.6% of boys under the age of 20 are overweight with 6.9% obese, and 25.6% of girls under the age of 20 are overweight with 7.2% obese. This is an epidemic. I have been talking about this issue since I first got elected and it is only recently that we are starting to make some sort of an impact on it. I get very frustrated at times. In light of these statistics, we looked at the issue in the Netherlands because it appears to have produced some results in reducing the prevalence of childhood obesity and its rates are low in any case. Some 18% of boys there are overweight with 4% being obese. Therefore, the Netherlands is performing very well on international standards on the issue of obesity.

The Minister of State has already spoken about policies, and they are very welcome. Any measures are welcome but anyone who says this issue comes down to parenting and that children just need to eat less is not educated on this issue. The Healthy Ireland strategy proposes a ten-point action plan, to which the Minister of State referred. That is all good and we are speaking in terms of aims, striving and that type of language but we need to get to a place where we are achieving results. I do not want to be negative because that is not what this is about.

Ireland has sought to place rigorous restrictions on advertising aimed at children. While the Broadcasting Authority of Ireland has a strict code which restricts the advertising of high fat and high sugar, we are very much subject to what the UK does because we watch UK television a good deal of the time. That is a major issue.

One cannot out-train a bad diet, therefore, physical activity will only keep one so healthy. That is evidenced by the number of MAMILs, middle-aged men in lycra, one sees on bikes at the weekend cycling their legs off and potentially wrecking their knees. Fair play to them and they are healthier but they are no thinner. If one is carrying fat around one's abdomen, it is a danger to one's health. Fat takes on its own hormonal system and it affects all of one's health. I have learned this through bitter experience. I am not talking about this like I am holier than thou or better than anyone. I have lived this and I was chronically obese as a child so I know what I am talking about on this issue. Therefore, physical activity will go only so far in addressing this issue.

With regard to the role of schools and education, many witnesses we met made reference to the key role schools must play in tackling childhood obesity, obviously, along with the children's parents. While schools have made many improvements in recent years, more can be done in this space. A number of possible measures for schools were discussed such as making health and well-being mandatory elements in school inspections and additional training for teachers in order that they know how to address physical and mental health issues such as complex ones like this.

Is the Acting Chairman indicating that I have one minute remaining?

Just to ensure the Senator knows.

It is okay. I will allow the Senator some of my time.

No fry zones have already been introduced in Wicklow. It is a nanny state type of measure. One wonders about the potential efficacy of it but a belt and braces approach is needed on this issue.

Nannies are wonderful.

I am apparently the queen nanny of Ireland.

The Senator has at least told us so.

Yes. I have the award to prove it.

I know. The Senator told us about it during the debate on the Public Health (Alcohol) Bill.

Statistics show, especially in America, that if a child's school is near a big outlet or a big chipper it has an impact in terms of this issue. Small chippers in Ireland target children with deals to get them to go to them with the small amount of money they have and spend it. Be it said that this is a nanny state approach or otherwise, a policy where, ideally, chippers are not located near schools is a good one and we are reasonable in our approach in that respect.

In terms of changing the narrative around childhood obesity, the committee was directed towards an academic study which suggested that parents are not very good at identifying when their own children are overweight. Our medics need to be a bit more mature in saying that one's child might have a problem and parents should not take that personally as some reflection on them; they should just try to deal with the issue.

The United Kingdom and Ireland ranked ninth and 12th on the OECD index with respect to obesity while the Netherlands ranks 31st, just behind Japan, Slovakia and South Korea. Those in the Netherlands know what they are talking about and we learned a good deal in this report about what they are doing. They take an integrated and localised approach to this issue, therefore, they deal with it at council and departmental level. They find ways to make water cool for children and they are engraving bottles. Their thinking is very innovative. I do not have enough time to go into all they are doing.

I began by talking about preventive health. The key point we learned, and I believe Senator Wilson will agree with me on this, is that early intervention is key and also the value of prevention. The sooner we educate people - "educate people" sounds like such a patronising phrase - and ensure there is an awareness in the psyche of our population that health is wealth, that it brings vitality and that what one eats will make one more productive, physically mentally and in school, the better. It is very important.

We need strong political leadership and commitment at both national and local level, a co-ordinated whole-of-government approach covering health care, education, local government, transport, finance, the environment, sports provision, advertising and scientific research, and a national strategic strategy, which combines with a localised approach, a co-ordinated approach at local level in order to provide joined-up services and support for children and parents, with a particular focus on deprived communities. The Minister of State touched on that point, that DEIS schools are struggling more than others on this issue, and that is a major issue. People in more deprived areas - I do not like using that type of language - or less well-off people tend to eat less well and have higher levels of obesity. It is not that they can afford to be eating loads and they are fat, it is nothing of the sort.

There are many points that I could talk about and it is disappointing to have only a measly eight minutes to talk on this issue. I thank the Minister of State for her contribution. The very fact that she is here to replace the Minister, Deputy Katherine Zappone, shows how much of a cross-departmental issue this is. It is a priority issue. It needs to be at the forefront of the Government's policy making into the future.

The Senator had almost 11 minutes, so she was quite indulged. I do not set the Order of Business, I only implement it, and it was agreed this morning.

I often sit where the Acting Chairman is sitting, and I would not necessarily highlight by how much I let people run over. However, I thank the Acting Chairman.

Senator Noone is very passionate about the topic. She has spoken about it extremely well many times, so I was giving her time. However, I am trying to let everybody else in as well.

The Acting Chairman is also using some of their time, so I thank him very much.

That will be the vision for Ireland.

In defence of the Acting Chairman, it is very difficult for a forensic accountant to stay away from figures and statistics. We will forgive him for what he said.

I think there is a compliment in there somewhere, if I look at it hard enough.

I welcome the Minister of State at the Department of Health, Deputy Jim Daly, to the House. I thank his fellow Minister of State, Deputy Catherine Byrne, for her contribution, and wish her husband a speedy recovery. I would like to acknowledge the presence of a former colleague of the Members of this House, former Sinn Féin Senator Kathryn Reilly, who recently became Mrs. Damien Walsh. I want to wish her very well in the future. She is very welcome. Kathryn is now working with the Irish Heart Foundation and has been very helpful to those of all parties where heart health and heart health promotion are concerned. I wish her well in her new position.

I commend Senator Noone, who was single-handedly responsible for getting committee D of the British-Irish Parliamentary Assembly to compile this excellent report on obesity. I ask any Member of the House who has not had an opportunity to read the report and its recommendations to please do so.

I will be very brief because Senator Noone has outlined the content better than most could, and certainly better than I could. According to the World Health Organization, WHO, childhood obesity is one of the most serious public health challenges of the 21st century. Closer to home, according to A Healthy Weight for Ireland: Obesity Policy and Action Plan 2016–2025, one in four children is overweight or obese. Six out of ten adults are overweight or obese. Prevalence of overweight and obese children was higher in schools in disadvantaged areas. That is an important point to note.

In the most deprived areas, just over one in four people aged 15 and over is obese. That can be compared with a prevalence of fewer than one in six in less deprived areas. The direct and indirect cost of obesity in Ireland is estimated at more than €1.2 billion. Imagine what we could do with that money in the health sector. It is possible to save that cost if we follow an integrated approach, as Senator Noone has called for.

Childhood obesity has consequences not just for the physical health of individuals concerned but also for their emotional and psychological well-being and for the wider economy and society. The fact there is a problem that needs to be addressed is universally recognised among policymakers and health care professionals, yet practical and durable solutions to the problem have proven harder to identify. I think the fact that I, along with Senator Noone and Members of the Lower House, sat in the committee and listened to the contributions that were made before us over a ten-month period gives me some understanding of the seriousness of this problem.

As a committee we heard evidence from politicians from all parties and none, health care practitioners, academic and medical experts, campaigners and those working on the ground alongside children and parents to tackle this issue. We held meetings in London and Cardiff. We held a meeting in Amsterdam, and I want to compliment Senator Noone on proposing that visit. It was hugely beneficial, and the evidence that was heard there is mentioned in detail in the report. The approach there is integrated. It is a bottom-up approach which appears to be working and is definitely worth taking a look at in this country.

We received written material about the situation in Ireland, Northern Ireland and Scotland. I pay tribute to our committee secretariat under the chairmanship of Lord Dubs. They were absolutely outstanding and are the reason that this report was compiled in as short a period of time as ten months.

It was very evident was that the links between our consumer markets mean that a consistent approach needs to be taken, particularly between Northern Ireland and the Republic of Ireland. During the debate on the Public Health (Alcohol) Bill 2015, I advocated for an all-Ireland 32 county approach to tackling the problem of alcohol. Introducing tariffs on sweets or sugary products in the Republic without the same law applying to the Six Counties will have no effect in the Border region. I would like to see a 32 county approach to this. I do not know what difficulty Brexit will bring, but it is something upon which we should work with the Northern Ireland Assembly.

The way to tackle this is through education and an integrated approach by the various Departments and from the bottom up. When I was going to school in the 1980s, there was a huge emphasis on education around tobacco and the difficulties it caused for people's health. Huge resources were put into it. After a very short period of time, only two out of a class of 35 continued to smoke. If we start with educational material that can be understood by young people, I think it will work. Physical education and food are very important. As a Youthreach co-ordinator, I implemented a programme in Cavan Youthreach offering practical cookery classes not only for the young students, but for their parents. The classes included advice on how to save money by shopping, and how to avoid buying takeaways or jars of sauce by preparing ingredients at home. This knowledge was beneficial to the economy and health of the household and to the general health of the communities the classes were drawn from.

Once again, I thank the Ministers of State at the Department of Health for appearing before the House. I also thank Senator Noone for her commitment to this particular issue and urge her to keep it up.

I will be brief. First, I welcome the Minister of State and I acknowledge the work that my colleague, Senator Noone, has done in this area. She has been very active in the British-Irish Parliamentary Assembly, BIPA. Senator Wilson is a member of BIPA too. What is really important about BIPA is that it drills down to very local issues. It is not all about highfalutin politics. It is about our experiences in life and our shared common approach and understanding of particular issues. It was very helpful, particularly the sessions in London where we met people at the coalface of health services, education and dealing with young people. Obesity is a problem, right across the world, let alone Europe.

To continue with what Senator Wilson was saying, a multifaceted approach is needed. The approach must be across all Departments. We know that our current Taoiseach is very much into sport, health and fitness. He is very much at the forefront of all of those activities. It is very much something that he likes doing, and he has given a public face to everything that goes with health and sport. That goes for a lot of other people in the Houses. This is about implementing the policy, working with our partners in youth affairs and children's affairs. It will involve working with education, encouraging people and participating. It is about exercise. It is about the synergy with local authorities. Most local authorities are now rolling out community gyms and community health fora.

RTE is playing a significant role in talking about the body, and the effects of obesity on our physical and mental health and well-being. It is a really good story and many people are on track and talking about it. I think we should encourage people to keep talking about it. I thank Senator Noone for her role in driving this issue and bringing this policy to public attention. It is about food, exercise and positive physical and mental health. I wish all involved well. Let us keep the issue on the radar.

I acknowledge the importance of bringing reports of sub-committees or other bodies that are tied into the Oireachtas to public attention. It is a good day when we do not allow such reports sit and gather dust but bring them to the Seanad, discuss them and follow up on them. It would be no harm to return to this report next year and see what progress we have made.

Senator Máire Devine has eight minutes.

I welcome the Minister of State at the Department of Health, Deputy Jim Daly, and thank Senator Noone for driving this issue. I hope we can use this time to get detailed feedback on the progress of a Healthy Weight for Ireland plan and other initiatives that aim to tackle the issues raised in the report.

I commend the work of the committee on this report and I agree with very many of the key recommendations and findings. This report provides more evidence that childhood obesity is island wide. Somewhere between 25% and 28% of children on the entire island of Ireland are overweight or obese. It is a serious issue both North and South. It seems that a common policy, sharing of expertise and resources makes sense in tackling this issue across the island. That perspective is applicable to all health issues. I ask the Minister of State to consider how we can do more North-South collaboration on this issue. After all co-operation seems to be the theme of the committee of the British-Irish Parliamentary Assembly.

There are other considerations in childhood obesity. It is hard being an overweight child. The health risks are obvious, and include diabetes, cardiac issues in later life and impairment of respiratory, renal and other functions. All organs are affected by the extra burden of carrying an increased body mass index. It leads to a shorter lifespan.

It is chilling to think that statistics from the United States and a few other countries show that this generation may be the first generation to have a shorter lifespan than their parents. I think that is amazing. As well as the impact on physical health, the psychological consequences cannot be over estimated. Obesity affects self esteem, mood swings, depression and suicidal thoughts. Children who are overweight often play in isolation, which encourages further psychological consequences of being overweight, the humiliation in the playground sends them back to being by themselves, the indignity of being called names would have a significant impact on a child and how vulnerable they would become.

In the course of the report the committee recommends involving and consulting children and young people as part of any approach to reduce childhood obesity. I welcome this consultation with them. If we want to influence the behaviours of young children, adults or teenagers we must get them on-side. We cannot forget the invaluable input they will contribute by their insight into their real-life experience. They need to be included in the decision making that affects them and that is vital.

The advertising of unhealthy food is targeted at children. This is a key finding of the report. I would like to know what plans the Government has to help tackle this. We all felt the iron fist of the powerful industry lobby during the debate on the Public Health (Alcohol) Bill 2015. If this report's recommendations are to be implemented in full, then the Minister and the Government must be resilient to the vested interests of industry.

In the final debate before the summer recess on childhood obesity, Deputy Marcella Corcoran Kennedy, on behalf of the Government, stated the Department is working with the Broadcasting Authority of Ireland on a new code to restrict the marketing of food and drink to children. The children's code is being revised and we have made submissions in that regard. Perhaps we could get some detailed update on the work since then.

The report also recommends a strong focus on schools. What has been done to date to provide schools and communities with the resources they need to implement the policy? It is unfair to lump more and more responsibility on the schools without equipping them. In their role teachers must be counsellors and provide guidance and now it is expected that they be health experts also.

I want to focus on what Senator Noone said about early intervention, on nutrition and looking at early nutritional experiences. It is proven that breast-fed babies are protected against childhood obesity, but the breast-feeding rates in Ireland and perhaps across Europe are very low. In spite of the HSE, public health nurses and midwives trying to promote it, the rates are extremely low. Breastfeeding is not just a nutritional experience for an infant but the mother is much more aware of nutritional value. Babies that are formula fed are heavier than babies that are breast-fed. Breast-fed babies get the right amount at the right time and in the right calorie laden milk that the mother produces. That might be something that we really need to push on the health side in all our maternity hospitals-----

-----and prenatal and postnatal care. Perhaps that will be part of further discussions down the line on sexual and reproductive health for women and girls in this country.

I request that young mothers and young people continue to be involved. Young people need to be given a prominent role in the consultation and decisions that have yet to be made to become healthier, stronger and happier.

Before I call Senator Alice-Mary Higgins to speak, may I welcome a number of visitors from Chicago who are guests of Senator Billy Lawless and are in the Gallery. I welcome Mr. Tom Allison, Mr. Terry Patton and Mr. Jim Zaring to the Chamber and I hope they enjoy their day in Leinster House.

It is always a pleasure to meet associates of Senator Lawless.

The discussion on the report on childhood obesity is welcome. I congratulate Senator Noone for raising this issue consistently and all of the members of the British-Irish Parliamentary Assembly who in bringing their perspectives have contributed to the development of the report.

Many of the health impacts of obesity have already been covered and discussed at length so I will pick out three or four areas from the report that I believe can provide practical solutions, such as the collective learning, the very strong recommendation and how we might look at tackling them in Ireland.

An issue that has been touched on by others is the question of health equality and the fact that DEIS schools have a higher rate of childhood obesity. In producing solutions to deal with childhood obesity, we need to recognise issues around health inequality. A really positive initiative that was in place before it was terminated three or four years ago was Healthy Food for All. This initiative was sponsored by the then Department of Social Protection, working with the Department of Education and Skills. It produced a number of very strong and useful reports, looking specifically not only at the issue of obesity but of nutrition and equality around food and health. They produced a Good Practice Guide for School Food in 2009, the Good Practice Guide for Community Food Initiatives in 2011 and a Good Practice Guide for Breakfast Clubs in 2012.

When I worked with another organisation I had the chance to meet frequently with Healthy Food For All and witnessed how effective it was in tackling the underlying issues of equality and bringing them to the fore.

It brought issues to the table which Departments and others could then act on. I know that we now have a nutrition guide and a set of nutrition standards in respect of schools but something like Healthy Food for All was a way of tagging issues early on. An issue, for example, which is not widespread in Ireland but which is becoming more evident here and which is huge in the United States is that of food deserts. These are areas where it is increasingly hard for people to readily access good, nutritional food. In Ireland, now that we are moving towards a position where supermarkets to which one has to drive are the main source of food, with fewer local shops, we are beginning to see nascent food deserts here. Healthy Food for All was a very positive initiative which should be looked at again in this new frame, and reconsidered in the context of costing very little but producing very strong outcomes.

The Vincentian Partnership for Social Justice has produced excellent research on the minimum essential standards of living in which it has costed, item by item, the things that people in different households and different family structures buy week after week, as part of its annual pre-budget submission. There might be really interesting learning there in terms of the decisions that people are making and sometimes have to make around their daily and weekly household food and nutrition.

I also wish to refer to the issue of planning in the context of our schools. It is very important that we have local planning laws that take into consideration issues like the location of fast food outlets, advertising billboards and so on. There are differences of opinion, vis-à-vis the alcohol Bill, on the importance or effect of advertising near schools but we know that advertising has an impact. All of the research shows that it creates a climate and a desire, about which I have concerns. As legislators we have a mix of tools available to us but we need to be willing to use all of them. A sugar tax is a very positive step. The Government's proposal is very clear and fair and it is great to see that moving forward in Ireland because it is needed. There will be pressure around it, as international experience has shown, but we need to be very strong in terms of implementing the tax. The current idea with regard to communications is to have a code of practice but if that code does not deliver results we must be ready to follow up with harder measures, clear directives and legislation. Codes of practice are all very well but they must have a limited period of testing before we move to something firmer. That message must come across clearly. We need to create a counter incentive to the bottom line.

Breastfeeding was just mentioned and that is an area where, on a practical level, we need to provide more support. It is not enough to just promote breastfeeding. We also need to provide real supports for women by way of lactation consultants and others who can make the choice to breastfeed easier. Many women have difficulties with breastfeeding and we need to put practical supports in place.

The next issue, about which I am very passionate, is cycling. I would have to slightly disagree with Senator Noone on this. I believe that cycling is good for one and does make a difference.

Of course it does.

Reference was made to middle-aged men in lycra-----

I do not disagree. I know that Senator Noone-----

I do not have any lycra, for the record.

Regardless of whether one opts for lycra, I know that Senator Noone did not-----

What I was trying to say was that one cannot out-train a bad diet.

Yes, it is hard to out-train a bad diet. Nonetheless, cycling is key and influential. That is something that came across very strongly in our visit to Amsterdam. The Netherlands has a very good record in terms of cycling facilities and is the comparator in this report. In the Netherlands, two thirds of children cycle or walk to school. In Ireland, the rates are far lower with one exception, which is Westport, where 70% of children are cycling or walking to school. They are doing so because the infrastructure is in place. There is safe infrastructure there, with a cycle way linking in with the greenway which makes a huge difference.

There is a potentially significant overlap here in the context of the green schools initiative. The green schools programme includes sustainable transport officers who have been working with children, highlighting issues and making a big difference. I was speaking recently to Róisín Ní Ghairbhith, one such sustainable transport officer who told me that 500 children cycled through the streets of Ennis as part of a bike week. The green schools initiative includes some very practical ideas including lower speed limits around schools, ride and stride or ride and scoot programmes and so forth.

The Senator is way over time now.

Cycling is key. We really need to re-evaluate formal physical education, PE, so that we are not simply focusing on competitive sports. I am one of the many people who sat out PE classes because I was not on a team in a competitive sport. Acrobatics, dance, cycling and so on are physical activities that allow children to celebrate physical movement and it is important to provide a diversity of options.

My final point is that sugary drinks are a huge problem, even in the Netherlands, where sponsorship is allowed in schools. The provision of water fountains is one of the strongest recommendations in this report. There is a brilliant young group in Galway whose project is called Got The Bottle. They are urging children to bring reusable drinking bottles to school. They are also asking the Department of Education and Skills to provide drinking fountains in all schools. London is stepping up to the plate in that regard in providing usable public water fountains. This is an example of people taking personal responsibility and that responsibility being matched by the State.

There are lots of practical ideas. I apologise for going over time.

I will be brief because a lot of the issues that I wanted to deal with have been referred to already. I welcome the Minister of State, Deputy Jim Daly, to the House. I thank the Minister of State, Deputy Catherine Byrne, for being here earlier and I also thank my party colleague, Senator Catherine Noone, the other members of the committee and the those who are involved in the British-Irish Parliamentary Assembly for their work on this matter. This report was not produced overnight. There was quite a bit of work done on it.

Senator Higgins made reference to competitive sport. This is an issue that we must address because we are making every aspect of sport extremely competitive now and as a result, a lot of people who would benefit from sport are dropping out. We must focus on this. Every sporting organisation seems to be focused on competition and on winning. While that is important, we also need to remember that it is not just about winning. It is also about participation and that needs to be emphasised more.

One of the areas that I represented when I was on Cork City Council and where I still do some work is Knocknaheeny. The income levels of some of the people residing there would be quite low. It also has a number of problems with regard to education and health. One of the projects undertaken in recent years is called Young Knocknaheeny, which is modelled on the Young Ballymun project in Dublin. It is about involving parents in the whole education process. Part of the programme deals with healthy living. I remember listening to one mother who had three children. The older two very much relied on soft drinks and Tayto crisps. However, her third child was going through the Young Knocknaheeny programme and the mother herself learned a huge amount by participating in it.

Her third child is focused on healthy eating, including vegetables and fruit. It simply goes to show that we can have all the education we like in schools but the major influencers are the parents. We should remember that children are only in school initially for three or four hours per day and then five hours when they get older. It is about working with parents.

This is also relevant for the issue of drinking and the need to work with parents at an early stage. It is interesting to look at the Dutch model. In the first four years of life, health service providers or advisers visit the family 19 times. Clearly, monitoring is undertaken. It is not about the nanny state; it is about giving advice and assistance. I would like to know the Irish comparison in this area. It is important to look at that as well. It is important that help and assistance is given to people with young families at the early stages. I do not believe we are doing enough in that area. While the project I referenced in Knocknaheeny has worked successfully, it is important that we continue with similar work in areas of low income.

My final comment relates to targets. Other speakers have referred to how in Ireland 26.6% of boys under 20 years of age are overweight. The figure in the Netherlands is 18.3%. Surely we should set targets to reduce these figures in the coming five years. That is something we should aim at.

I thank everyone who worked on this question. I thank the Minister of State for coming to the House.

Thank you, Senator Burke. You had only five minutes but I knew you were going to be brief, so I did not correct you on it. You only used four and a half minutes. Senator Norris, you have five minutes as well. Go ahead.

I welcome the Minister of State, Deputy Jim Daly, to the House. I salute Senator Catherine Noone who has been campaigning on this issue for a long time. She is always interested in what is such an important subject.

I was astonished to see that there has been a tenfold increase in the number of fat children in the country since 1975. That is horrifying, but we can see the evidence of it on the streets. We see grotesquely large children. I have to say that I blame the parents. There is real parental responsibility to ensure proper diet for children. They need to stop stuffing them with chips and hamburgers and so on all the time.

There is also an element of a class situation. We find that in DEIS programme schools the situation is far worse than in more middle-class environments. We have to be aware of the fact that there is a class element.

We need strong political leadership from the political classes, including the Seanad, the Dáil and Ministers. We have a good policy, A Healthy Weight for Ireland - Obesity Policy and Action Plan 2016-2025, but we have to implement it. There is no point in having a plan and simply leaving it there and not implementing it. There are quite a few positive elements in the plan. There are guidelines for planners about no-fry zones. That is an excellent idea. There is a national nutrition policy. There is reference to the appointment of a clinical lead for obesity and a special focus on disadvantaged areas.

However, there are areas where there has been little progress. One example is the question of the introduction of mandatory calorie postings on menus. I was the leader of a group from the Oireachtas on "Operation Transformation". I disciplined them. I made sure they ate salad in the restaurant. I caught one poor Fianna Fáil fellow stuffing into beef and potatoes and said, "What do you call that?" He said he was hungry. I told him he was about to get thin. I told the people to take it away and get him a salad. They got him a salad. We won - the political group won.

It was brilliant.

It was terrific. It was great fun.

I certainly need to, because I am F-A-T, fat and I have diabetes as well. It is partly from the transplant operation I had but also partly from the fact that I am overweight. I am fat, but I hope to improve in this area.

When "Operation Transformation" was finished I suggested that we keep together as a group but include other parliamentary colleagues and have a group to advise on this issue. This was some years ago now. One of the first recommendations we made was the introduction of mandatory calorie postings on menus. However, nothing has happened. We need implementation.

There is a link between marketing and the abuse of junk food by children. There is a relationship between that abuse and childhood obesity. We need to develop a whole-school approach to tackle obesity, especially the proliferation of unhealthy food on school premises. This is mad. In educational institutions people get unhealthy food and there are machines dispensing crisps, chocolate bars and calorie-rich foods.

They are in children's hospitals too.

It is absolutely insane. We need real consistency. My briefing note refers to tackling the obesogenic environment. I know what obesogenic is, but many people do not. I know what it is because I did Latin. We need to use simple language to get at people.

Here is a real weakness: there is no dedicated funding to tackle obesity, but there should be. Suggestions were made to the effect that money from the sugar tax should be ring-fenced. The Department of Finance, once again, stymied that. We should stand up to the Department of Finance in these areas.

The World Health Organization says there is complete, unequivocal evidence that childhood obesity is influenced by marketing, so we need to tackle marketing. Then, there is the question of access to water. Some 40% of schools do not have access to water. I find that astonishing. There should be water fountains in all schools. The stocking and sale of unhealthy products in school vending machines is pretty obvious. We need to pull the plug on vending machines. We need a national standard for the provision of school food. Financial support should be provided, where necessary, to help schools implement this policy. Drinking water should be freely available. Children should be protected from unhealthy food and beverage marketing within schools.

We should develop at a national level guidance for all local authorities on the introduction of no-fry zones. We should use a portion of the sugar-sweetened drinks levy revenue to establish a children's future health fund. That is a fine aim but we have to attack the Department of Finance and stop those involved from frustrating the wish of the Oireachtas to use this money. It is so obvious.

I made the same point when Tony Gregory and I were campaigning to introduce the Criminal Assets Bureau. I put down amendments to legislation to the effect that the money bled out of the veins of the unfortunate people in the north inner city of Dublin should be recirculated for drugs programmes in those areas. The Department of Finance sat on it and would not allow it. Those involved have to be challenged politically.

We need to develop family food initiatives to support children and families experiencing food poverty. This is another aspect of our situation. In 2018 we still have food poverty in this country. We need to address that.

Thank you very much, Senator Norris. I thank all Members for their comprehensive statements. It is an important issue that we are all battling with, some of us to a greater extent than others. A starting point is childhood obesity. We could debate all afternoon about obesity generally. Much of it statistics-----

Senator Butler had diabetes and lost seven stone.

That was amazing. Will the Minister of State conclude the debate?

I apologise to the Minister of State. I have a meeting with people from RTÉ. I do not mean to be rude.

I presume it is not about "Operation Transformation".

I thank all Senators sincerely for their contributions. It is always a pleasure to be in the Seanad and to listen to them. I thank my officials, who have been studiously taking on board all the contributions. They have been duly noted, including the comments on the role of education, the code of practice and the oversight implementation group, which does exist. The group is looking at the built environment and breastfeeding.

I assure Senators that the importance of many of these issues is noted and they will be taken back to the Minister of State with responsibility for this area, Deputy Catherine Byrne. The psychological impact is relevant as well, and that comes under my area of mental health. I thank Senators.

We did not have a chance to welcome the Minister, Deputy Daly, because he came in mid-debate. I thank him for his contribution. I congratulate the Acting Leader on her debate this afternoon. When is it proposed to sit again?

Next Tuesday at 2.30 p.m.

The Seanad adjourned at 3.10 p.m. until 2.30 p.m. on Tuesday, 30 January 2018.