I welcome Mr. John Treacy and Mr. Paul McDermott and ask them to commence their presentation on the significant rise in adult and child obesity. I suggest the presentation last for approximately 15 minutes, after which we will have questions.
Adult and Child Obesity: Presentation.
Obesity has become a significant problem in Ireland and represents a major threat to the health of the nation. The Government responded to this looming crisis by establishing a national task force on obesity in 2004. I was invited to act as chairman and was pleased to accept the invitation because I recognised the importance of the group's work.
Ireland is one of the first EU countries to establish an obesity task force and produce a report with recommendations, following the 2002 Danish Presidency of the Union, which highlighted this issue. I thank the committee for inviting me to make this presentation and for allowing me describe the work of the task force. This is an important opportunity to further highlight this growing health issue.
The task force, with a membership including 20 high level experts representing all relevant sectors, reported in May 2005. I pay tribute to my colleagues on the task force and the secretariat who, individually and collectively, made an enormous contribution to the work of the group and the preparation of the final report.
The composition of the task force reflected its underlying philosophy. Public and private sector interests worked with experts on health, diet, nutrition, food safety and physical activity. It was of particular importance that representatives of the private sector were involved. Rapid progress in addressing obesity requires the co-operation and collaboration of the food and associated industries.
The Taoiseach launched the report. I acknowledge his personal commitment and support of the group's work. His presence helped generate significant public and media attention for the report and placed obesity high on the political and health agendas.
The report made 93 recommendations across six major headings. The recommendations make practical suggestions on how to halt the onset of obesity in individuals and communities. The number, variety and scale of the recommendations indicate the complexity of formulating an effective response to this crisis. They amount to a manifesto for changing social attitudes and behaviours, affecting Government, communities, families and individuals, in order that the problems associated with obesity can be successfully resolved.
The core function of the task force was to develop a strategy to halt the rise and reverse the trend of obesity. Its work included establishing the current rates and trends of obesity in Ireland. The report identified the major factors underlying the issue and established the future impact of an increasing problem on the health service and wider society.
The task force was expected to identify best practice for prevention, detection and treatment of obesity and to make recommendations on how to create the social and physical environment that would make it easier for children and adults to eat more healthily and be more active on a regular basis. The group worked within the existing national and EU health and health promotion strategies. It consulted widely, receiving more than 300 submissions from individuals, the public and private sectors and other groups and organisations. We gathered international evidence to assist in framing our thinking and to put the Irish experience into a global context. It became necessary to establish sub-committees to examine specific areas of concern. All of these elements were crucial in the framing of the final report.
I will highlight some facts from the report. The prevalence of overweight and obesity has increased with alarming speed over the past 20 years and continues to rise. The World Health Organisation has described obesity as a global epidemic. In Ireland, 39% of the adult population are overweight, while a further 18% are obese. Irish rates of obesity are growing at a rate of 1% per year.
Overweight and obesity constitute a public health issue because they are related to high blood pressure, type 2 diabetes, heart attack and cancers, including colon cancer. Obesity also involves major psychological problems. It is currently estimated that 2,000 premature deaths a year in Ireland can be attributed to obesity. The task force report estimates that as many as 300,000 children on the island of Ireland are overweight or obese. Childhood obesity has reached epidemic proportions in Europe. The task force report estimated that in economic terms, associated inpatient costs in Irish hospitals amounted to €30 million in 2003. Considering the 2,000 premature deaths, indirect costs to the economy are estimated at about €4 billion per year.
The two major determinants of body weight are diet and physical activity. A balance of food intake and physical activity is required to attain and maintain a healthy weight. The diet and eating habits of the Irish population have changed. The trend is towards energy-dense foods that are high in fats, sugar and starch, all of which promote weight gain. Simultaneously, social changes dictate that people take less physical activity in their daily lives. The trend is towards more sedentary lifestyles, with individuals needing to seek out physical activity rather than find it as part of their daily routines. The combination of these two negative trends has led to the increased prevalence of obesity and overweight in Ireland. Consequently, the recommendations of the task force are concerned with how to reverse negative trends regarding healthy eating and active living.
Given the adverse effects of obesity on individuals and communities, the rationale for government intervention is clear. The 2006 Estimates provided additional funding of €3 million for the implementation of the recommendations of the report. This is a significant development that should go some way to addressing the resource challenge facing the health sector in tackling obesity. There is a requirement to provide treatment for those people currently suffering from the ill effects of obesity and related problems. Treatment of this growing problem is a burden on the health services, as highlighted in various media reports.
Of great concern to the task force was the broader question of prevention. It was the strong view of the task force that due to the prevalence of obesity and its growing threat that a "population health" approach was required. This entails addressing all those factors which create an "obesogenic" environment. This includes creating conditions over time such that the population can choose to eat more healthily and adopt a healthy lifestyle incorporating physical activity. While that may be expressed relatively simply, it requires a complex series of responses. Providing the population with choices involves effecting social change, which underlines all the report recommendations, requiring multi-sectoral and multifaceted responses.
Several Departments and State agencies will have a role in addressing the issue. The Department of Health and Children will be a central player and must be assisted by several other agencies, including the Sports Council. Joined-up government is required, but we must acknowledge that the approach presents its own challenges. It is also clear that the private sector has a crucial role to play. Through its representation on the task force, it has acknowledged its responsibilities, and that is the first crucial step towards effective action.
The task force quoted estimates valuing food and beverage advertising in Ireland in 2003 at approximately €132 million, with an emphasis on foodstuffs high in the food pyramid — high in sugar, starch and fats — ultimately reflected in popularity with consumers. We must recognise that it is extremely difficult for health promotion campaigns to counteract the impact of annual advertising spending of that magnitude.
Of great concern here is the responsiveness of children to television advertising and their exposure to the advertising of unhealthy products. Watching a great deal of television appears to have a doubly negative effect or to be a double-edged sword, replacing physical activity and increasing the likelihood of consuming food that can lead to obesity. It is not surprising that research continues to show a strong suggestive link between high rates of television viewing and obesity in children. There is much that the food industry can do, most urgently making changes to the marketing and advertising of food products that contribute to weight gain, especially those aimed at children.
The primary concern of many is the growing problem of obesity among young children. With the principle of early intervention in mind, the education system also has a crucial role to play in that regard, notwithstanding the central responsibility of parents and families in ensuring a balanced and healthy lifestyle for family and children. All schools must be encouraged to promote healthy eating and active living with the support of the Department of Education and Science. It is recommended that children receive at least 60 minutes of physical activity a day. It is also strongly recommended that two hours of PE be provided each week by appropriately qualified staff in schools.
It has been found in other countries that the most effective health promotion is achieved through the health-proofing of policies across a range of bodies. Many of the report's recommendations can be implemented if all relevant agencies, public and private, give due regard to some of the guidelines in the report. We urge agencies to consult the report and keep its recommendations in mind when preparing service plans, marketing programmes and the implementation of services.
The Health Service Executive has an implementation plan, with its health promotion officers around the country taking a multidisciplinary approach to offering services that contribute to the resolution of obesity and related issues. I acknowledge the work being undertaken by health promotion officers in dealing with weight issues, especially in an environment of resource constraints and pressure on the health service as a whole. The wide variety of clinical, nutrition and physical activity programmes provided is responding to the needs of individuals suffering the adverse effects of obesity. It should also be noted that the Health Service Executive supports the health population philosophy, as recommended by the task force report.
The Irish Sports Council, as the statutory body for the development of sport in Ireland, is one of the agencies with a contributory role in addressing obesity. There is a link between physical activity and health. By increasing participation rates in physical activity in the population, sport can make its contribution to the battle against obesity.
Our research programme underpins our programmes and policies. In collaboration with the Economic and Social Research Institute, we have produced a series of reports giving a clear map of participation rates among adults and young people in Ireland. We have found that one in five adults in Ireland takes no physical exercise, and only two in five take enough exercise to meet the minimum standards of physical activity recommended by the World Health Organisation.
Second level schoolchildren access sport both in the formal school setting and through opportunities provided by volunteers in the community. Some 46% get four or more sessions of sport per week, while a further 26% get two to three sessions of sport per week from those two sources. However, among schoolchildren there are significant minorities who get little or no sport. Some 27% of second level students get one session or less per week of extracurricular or non-school sport. Among that group, there is also a substantially higher number of girls than boys, with 38% of girls missing out, compared with 17% of boys. The proportion with low levels of participation is also higher among older students.
It emerged from all the research that the role of the volunteer in providing opportunities in sport remains crucial, especially to young people. There is also a drop in participation as people move through the life cycle, a trend of particular concern to us. One major conclusion of our research was that, to make the maximum impact on public health, physical activity programmes should be targeted at the sedentary population. That has major implications for our work, as the community of sport consists of active or potentially active populations.
We have a range of participation programmes, run through the governing bodies of sport and sports partnerships, that target the population segments that will benefit most from intervention. The council has targeted programmes, including the Buntús programme to support the PE curriculum in primary schools, Sport for Young People in Disadvantaged Areas, Women in Sport and Sport for Older People. Those programmes have proven popular and effective.
The vision of the task force is expressed as follows: "An Irish society that enables people through health promotion, prevention and care to achieve and maintain healthy eating and active living throughout their lifespan." The establishment of the task force was in itself a major step forward. There can be no argument that it is firmly on the political and social agenda. That is the first step towards changing attitudes and, ultimately, behaviour.
The participation of the private sector in the task force was very welcome. It acknowledges that it has an important role and responsibility in that regard and will be proactive in addressing obesity. The public sector, the private sector and the community and voluntary sectors should work in partnership to promote healthy eating and active living. Their collaboration will lead to individuals being empowered to tackle obesity. Interventions should be designed to support individuals in making the choices that will lead to a healthier life.
The task force produced a report that has set out a realistic and achievable strategy for tackling this growing health problem.
Some members have indicated that they have questions. Similar to procedure at the last session, we will bank three questions, first taking Deputy McManus, then Senator Browne and Deputy Connolly.
I thank Mr. Treacy for his presence. I apologise for having to leave to attend to something important presently, but perhaps I might first comment on what he has said.
It is a shocking phenomenon and can only be described as a betrayal of children that obesity is now taking hold to such an extent. The concern is that the life expectancy of children now growing up may well be less than that of their parents, something that would be unprecedented. I underline the point regarding joined-up government. We can all think of a mother feeding her child inappropriate food, but the Government can do a great deal if there is an interdepartmental approach. For example, I can cite from my town the example of a second level girls' school with no sports hall. Surely we must press to ensure every school has appropriate sports facilities. Every town over a certain population should have a swimming pool and a running track. Cycle lanes should work rather than being a danger to life and limb, and planning should ensure people walk more than they drive. It is crucial to have an environment that encourages good practice, rather than concentrating on what goes into people's mouths. I support Mr. Treacy on this issue as it is important. I apologise for having to leave so soon.
I welcome the delegates to the committee. I get annoyed when I see the State working against the citizen. Deputy McManus referred to the case of a school gym. I attended a meeting with the Department of Education and Science about a school in Carlow which needed two extra classrooms. The obvious solution was to build them or at least provide a prefab. However, the genius from the Department told the school representatives that they should split their gym into two rooms. Mr. Treacy referred to the need for two hours of physical education per week, but many schools do not even have a gym and those that do are being told by the Department to divide them up as a short-term solution to the accommodation crisis in some schools. Such a policy should not be allowed. The need for gyms for children is recognised throughout the world.
Where will teachers get the time to provide for two hours' PE? I am bemused by the fact that the solution to every ill in society seems to lie in the school. I am conscious that there are a set number of hours in a school day and a set number of school days in a year. I am aware that teachers cannot do any more unless the proposal is to reduce hours in another subject area, such as religion. I would be careful of recommending two hours of PE per week without thinking through the consequences of that. Schools are very hard-pressed for facilities and time.
I was contacted by three GAA clubs in Carlow that have installed floodlighting for their pitches and are being levied a standing charge of around €10,000 per annum by the ESB, irrespective of how much lighting they use. The clubs involved have no difficulty paying for the installation of the lighting or for the lighting used. However, it is nauseating for a voluntary club with limited finances to fork out a huge standing charge to the ESB. They are being treated as commercial customers for using floodlights. Local clubs put in the time and effort to encourage maximum use of their facilities, yet they are being clobbered by these charges.
I called the Department of Communications, Marine and Natural Resources but I did not even get a call back, even though I was promised one. I called the Department of Arts, Sport and Tourism and was told it was a problem for the Department of Communications, Marine and Natural Resources. There seems to be a lack of joined-up thinking between the Departments. We should be doing our best to encourage the development of sports facilities and to support clubs. I appreciate that these clubs received a grant from the Department of Arts, Sport and Tourism for the installation of the floodlights, but the recurring annual charge is crazy. The Departments should use their influence to have those charges waived so that participation in sport can be maximised. There should be no State deterrent to people participating in sport.
I thank Mr. Treacy for his presentation and welcome the fact that a task force has been set up. We are at least trying to address the problem to some degree. The fact that this is a Europe-wide problem shows that lifestyle changes have contributed greatly to this problem. The facts show that 39% of people are overweight and 18% are obese, which means that 57% of the population have a problem with weight. The task force report has 92 recommendations, but we should never shy away from the simple message that people have a responsibility regarding obesity. In some instances, obesity is in the genes, but if one is eating too much food, eating it at the wrong time or not taking enough exercise, then one should take responsibility for the consequences. Parents have a responsibility to ensure the right food is put on the plate at home. Parents often take the easy option and give children money for the chipper. Children will always go for the tastiest option and this contributes to the obesity problem.
How will food companies react to the recommendations of the task force? My experience has been that they will only put food on the shelf that sells, not what is good for the consumer. Food producers put preservatives into food that is only noticeable in the small print. Will these companies meet their responsibilities?
The education bodies also have a responsibility in this area. The habits acquired at school will be the habits of a lifetime. Do we have any way of examining the food served in school canteens? From what I have been told, much of it is just convenience food. It is not necessarily good food and the emphasis is not on health.
I will attempt to address all the issues raised. Deputy McManus raised an important point on joined-up government. Within the task force it was made clear that no agency or Department could address this issue on its own. As the 93 recommendations cut across 11 Departments, we need joined-up thinking if we are to address the issue. The Department of Health and Children and the Health Service Executive, HSE, have roles to play, as do the Departments of Arts, Sport and Tourism, Education and Science, Enterprise, Trade and Employment, and Transport. They all have specific roles in addressing the various issues. The Department of Transport has a role in providing cycle and walking paths, while local authorities must ensure green spaces are available for children to play on and for people to take walks.
We live in a sedentary society where everything we do lends itself to such a lifestyle. Therefore, we need to ensure it is convenient for people to get involved in physical activity. We need to ensure they have a choice in order that they can participate in physical activity and eat healthy food. A joined-up approach by the Government is needed to tackle the obesogenic environment we have created in Ireland in the past 20 years.
To clarify matters with regard to schoolchildren, 39% of the population is overweight or obese and 18% obese. It is a cumulative number.
As we heard from the Diabetes Federation of Ireland, children who are overweight or obese at an early stage will have lower life expectancy and experience prolonged health issues. Therefore, we need to ensure children are active and eat healthily. The report noted the obvious responsibilities borne by parents in terms of providing best examples to children. If parents are active, involved in physical activity and eating healthily, their children will probably do likewise.
The school setting is also of particular importance, although I disagree with Senator Browne on the issue of PE because I consider two hours to be the minimum length of time per school week. I have regularly pointed out to parents that while reading, writing and mathematics are vital, children's health and well-being are equally important, both in terms of school years and in later life. Two hours of physical activity in schools each week represents a good investment of time in the health of maturing children.
An issue was raised about school facilities. Our research has revealed much participation by children in sports and physical activities, particularly in primary schools. While the PE side was seen as weak, mainly because issues arose with regard to sports halls, there is a great deal of co-operation at community level in terms of facilities shared between schools and clubs and that trend is to be welcomed. I always ask what can rather than what cannot be done. Even if a sports hall is lacking, children can still go out to play or partake in physical activities because it does not rain all the time. The Government is investing approximately €60 million per year in community facilities and much has been done, especially in the past seven years, to address that issue.
With regard to the question on Europe, this is a global epidemic. It is estimated that 50% of the population of the United States will be obese by 2025. I already spoke on the health issues experienced by people who suffer from obesity and which place a huge burden on health services. Rather than following the example of the United States, Ireland and the rest of Europe needs to halt and reverse the rise in obesity levels. At present, Ireland is probably in the middle of the European table of obesity levels. Greece, Germany and England lead the way while Italy and France are at the bottom of the table. We need to be proactive in addressing the problems in Ireland. Joined-up government is the way to tackle this issue, with all State sector agencies working together to ensure obesity does not become a burden with which the health service cannot cope. The number one health strategy in place in the United States is to increase levels of physical activity. That tells its own story.
I do not disagree with the idea of two hours of PE per week. I speak as a teacher who used to give up my break to supervise leagues and who took part in after-school activities. However, I am conscious that only a certain amount can be packed into a day and that a new curriculum has been introduced to primary schools which includes subjects such as science and SPHE. The solution suggested for every matter, whether road fatalities or drug problems, is to pack it into the school curriculum. In my view, schools will be soon unable to cope.
A secondary school in Carlow has no gym facilities, although it will soon receive them. Students currently must spend 40 minutes walking to and from town for PE. They are losing this time, never mind the risks associated with their journey. It causes difficulties in terms of teachers' plans, while wet weather makes it almost impossible to practice PE. Major investments need to be made in PE halls.
Is the task force still in existence?
No.
We spoke about joined-up government but, being realistic, this is a multifaceted problem. Does Mr. Treacy see any role for the task force in acting as a monitoring body in the future in order that its recommendations will be implemented?
The task force was given the job of compiling this report and, as it completed its work in May 2005, its life is over. The report calls for the establishment of an implementation group that will ensure joined-up government in implementing recommendations but the responsibility for this lies with the Department of Health and Children.
That is what I meant. The next step which has not yet commenced involves establishment of the implementation group.
It is my understanding that, while the Department is examining that issue, efforts on it have not yet commenced.
Perhaps we might consider writing to the Department to recommend the establishment of the implementation body.
I thank the two representatives for their comprehensive and informative presentations and apologise again for the earlier delays. I remind members that the select committee will meet at 9.30 a.m. on Thursday, 26 January to discuss the Irish Medicines Board Bill.
The joint committee adjourned at noon until 9.30 a.m. on Thursday, 2 February 2006.