This article is part of our special report Cardiovascular health in the UK.
If the UK is a leader among European countries in statin treatment and cardiac rehabilitation, it lags behind in addressing the behavioural causes of cardiovascular diseases (CVD), such as child obesity.
Public health and prevention are the Cinderellas of healthcare. Only 3% of total EU healthcare spending is currently allocated to prevention and public health programmes, and in some countries, the rate is as low as 1%.
The latest figures from the NHS’s national child measurement programme show that one in five children in England is obese in their last year of primary school (ages 10 and 11), while one in three is either overweight or obese. Childhood obesity is not, however, a uniquely British problem.
“More than 60% of children who are overweight before puberty will be overweight in early adulthood, and an estimated 25% of school-aged children in Europe are already overweight or obese. This predicts a grim future, as we know that overweight and obesity are key contributing factors to cardiovascular disease, cancer and diabetes,” says Dr Gauden Galea, Director of the Division of Non-communicable Diseases at the World Health Organisation (WHO) Europe.
A WHO report on junk-food marketing in Europe published last month, meanwhile, described current laws protecting children as “markedly insufficient”.
Alongside promoting greater physical exercise, health policy professionals have consistently lobbied governments to impose tobacco restrictions, obesity strategy, sugar tax, food reformulation and labelling. They have begun to gain traction on the latter.
Taxing junk food, soft drinks
While tax policy remains exclusively in the hands of EU governments, there has been something of a coordinated move towards levies on sugar across a number of European countries.
Earlier this month, Theresa May’s government pressed ahead with draft legislation for a tax on sugar-sweetened drinks, set to begin in April 2018.
The tax, which had been the brainchild of former Chancellor of the Exchequer George Osborne, will be in two bands: one for soft drinks with more than 5g of sugar per 100ml and a higher one for drinks with more than 8g per 100ml.
While the May government’s persistence with the planned tax came as a surprise rebuff to the food industry lobby, with Gavin Partington, of the British Soft Drinks Association, insisting that “there is no evidence worldwide that taxes of this sort reduce obesity”, it is part of a wider trend.
Spain and Portugal also announced plans for a two-tier sugar tax in December, while Ireland and Estonia will put in place levies between 2017 and 2018.
France was the first EU country to impose taxes on drinks with added sugar and with artificial sweeteners in January 2012. The tax raises around €400m (£344m) a year. Soft drink sales dropped by 3.3% in 2012 and 3.4% in 2013. The French treasury is now considering whether to introduce a tax on fatty foods.
Finland, Hungary and Denmark have also imposed levies on soft drinks and fatty foods, although Denmark repealed its two domestic laws on sugary and fatty foods in 2013 and 2014 respectively.
In October, the World Health Organisation (WHO) urged all countries to impose sugar taxes, arguing that a 20% increase in the retail price of sugary drinks would result in “proportional reductions in consumption”.
Critics such as Christopher Snowden of the right-wing Institute for Economic Affairs think tank, say that the levies are a cynical way for governments to raise revenue and a part of “a campaign to demonise sugar”.
If politicians think that sugar taxes are an easy sell to voters, they won’t be a silver bullet in the battle against obesity.
Sweden has acted on school meals, with legislation in 2011 requiring them to be nutritious and free. The nutritional quality of the meals, calorie content and portion sizes are laid down for each age group. Water and milk are the only permitted drinks. For its part, the Scottish government, for which healthcare is part of its devolved powers, is planning to introduce a Good Food Nation bill, with a consultation in 2017.
For the moment, sugar is a soft target. But lawmakers in the UK and the rest of Europe will need to be more ambitious to tackle the root causes of CVD.
To reduce the number of deaths from heart disease, EU member states have agreed to tackle the underlying health determinants behind cardiovascular health in its 2014-2020 health programme.
A key element in fighting cardiovascular disease is to address the underlying health determinants, including bad cholesterol, tobacco use, obesity, diet, physical activity and high blood pressure.
Several European countries have introduced taxes on certain foods and drinks justifying them on both health and economic grounds.
Taxes have been championed by some as an instrument to tackle rising obesity and as an attractive way to increase government revenue at a time of economic hardship.
Others argue that they are ineffective, drive down consumer demand and reduce companies' competitiveness.
Approximately four million people in Europe, and 1.5 million people in the EU, die of cardiovascular disease each year, according to the European Heart Network (EHN) and the European Society for Cardiology (ESC). The main forms of heart disease are coronary heart disease and stroke.
At EU level, the European Commission responded in 2007 by adopting a strategy on nutrition, overweight and obesity-related health issues, which included initiatives such as strengthening food labelling rules and regulating health and nutrition claims made on food products.
It also adopted a proposal to strengthen the declining consumption of fruit and milk among young people.
Sanofi have provided the funding for this report. Sanofi have had no editorial input or involvement in the content of this report.