On Tesco’s Late Equaliser and the Value of Bite-Sized Chunks

I was delighted to hear from Tesco yesterday in response to my campaign to change the labelling of breakfast cereals in supermarkets. Three letters and a few tweets have finally borne fruit, and Tesco are following Sainsbury’s lead by removing the misleading signs from all their stores. If you have not been following my campaign against the concept of “Children’s Cereals” then you can follow the story in the blog here, here and here. I was even more pleased when I had cause to visit my local Sainsbury’s later that day to find that their signs have indeed disappeared as promised.

Cereals for all – Tesco are removing the sign denoting children’s cereals

It is comforting to know that I will now be able to venture into both stores without having my blood pressure challenged in the cereals section, but this is only a small part of a wider public debate on how we treat our children: If we believe that children will only eat food that is coated in sugar or high in saturated fat, then the chances are that they will grow up wanting to eat food that is coated in sugar or high in saturated fat. It is a debate that we must keep in the public domain, and a war that must be waged on many fronts.

It struck me that there is a parallel with many seemingly insurmountable health problems here, and that this has been a helpful lesson in the immense value of breaking down problems into bite-sized chunks. My overwhelming problem is the challenge society faces with the frightening increase in childhood obesity – surely it is impossible for me to impact this and it seems ridiculous to try. Even if I break it down to the role of the supermarkets and how food is marketed to children I am still defeated into a state of inactivity, believing I cannot succeed. Reduce it further to the issue of two small signs in the cereal aisle and I am starting to think about action – still not confident that I will succeed, but willing to give it a go. And it turns out that it was possible after all. I haven’t changed the world, my problem has not gone away, but I have changed something, and perhaps I can now change something else.

So too with health problems. Maybe I feel crushed by my failure to lose weight, cannot consider how to face the week without the comfort of a bottle of wine or am overwhelmed by anxiety every time I consider venturing from my home. The scale of my problem is so great that my spirit is broken from the start, and I tolerate the status quo for months, even years, because I cannot even imagine any other way. The way forward has to be to imagine a different future, look at the problem in a new light and find a bite-sized chunk that I know I can break off, where I have some confidence that in a small way I can succeed.

So with weight loss – to set the challenge of losing a certain amount of weight in a set time often sets us up to failure – but perhaps it is not so unrealistic to aim to make one small change: maybe the biscuit with your coffee becomes an apple, maybe three potatoes becomes two, or the lift is exchanged for the stairs. The lover of wine might not be able to contemplate cutting down to recommended limits just yet, but perhaps they can consider having one day a week that is alcohol free; and the person with anxiety may not be ready to book a holiday to Venice, but could they find a friend to help them and venture somewhere new just a little outside their comfort zone?

When we break things down it is vital that we are careful how we measure our success. If I were to measure my campaign against the level of childhood obesity in the UK I would clearly see no impact at all and might berate myself for trying. In the same way, if you challenge yourself to change a biscuit to an apple, assess your success on just that – have you kept your promise to yourself and are you eating fewer biscuits? It is unfair to measure your success only in terms of the bathroom scales – that will come in time, but we need minor victories along the way to win the war. Success is empowering, and we need to practise it if we are to overcome the more intransigent problems, both in our own health and in society.

Responsible drinkers or a responsible society?

Whatever you may think about the Government’s proposed 40p minimum price for a unit of alcohol, there are certainly questions to be asked. Most importantly, will it actually work? If it does ‘work’, what do we mean by that? Will it reduce consumption in those with an alcohol problem, or just in the rest of us who like to think we don’t? Will it get to the root of the issue of binge drinking? And, for some most importantly of all, is it fair?

Well, it probably will work, if by that we mean that overall consumption of alcohol will decrease. The evidence for most things is that if you increase the price of a commodity you decrease its consumption, whether it is cigarettes, petrol or chocolate bars, and the evidence is no different for alcohol. Will it make a difference to all heavy drinkers? Hardly – as the critics correctly argue, someone who is truly addicted to alcohol will not be put off by a price hike.  And what about the underlying cause of binge drinking? I can’t see it having much impact here either – there is something about the attitude to alcohol in the UK that is much more to do with culture than economics, and a rise in prices seems more of a sticking plaster solution than a curative operation.

There are questions, too, about the depth of the problem with heavy drinking in the UK. Is it as bad as the media, and possibly the Government, would have us believe? In fact, the evidence points to a sustained decline in the consumption of alcohol over the last 5 years, so there are reasons to doubt whether we need to do anything at all. Maybe it is just a cynical Coalition attempt to draw attention from the bad headlines associated with the Granny Tax hidden within the Budget, and the image of drunken louts laying claim to our city centres is just in the public imagination. This may well be true, but, like many doctors, I am in favour of minimum pricing because I come up against problem drinking far too often, and because it is young people who are not yet dependent on alcohol that worry me the most. This is where we need to look for a difference in consumption that might be achieved by getting rid of cheap alcohol.

While I find many of the arguments against the 40p minimum price to be powerful, even if they do not ultimately convince me, there is one argument that holds no sway with me at all. It is the complaint that the proposal would be unfair to moderate drinkers, and far from winning me over, it leaves me questioning the sort of society that we live in. This argument is usually stated by the supermarkets and suppliers, and I have not heard it directly from a moderate drinker themselves – but as a member of this large section of society I would like to say a loud NO to those who would like to make this argument on my behalf.

The first reason why I find myself getting agitated about this is that moderate drinkers are already paying for the problems caused by alcohol – through our taxes. The extra cost of Friday and Saturday night attendances at Accident and Emergency departments up and down the country, the extra police required to patrol our city centres at night to keep order, the financial strain of alcoholic liver disease, not to mention all the other health problems directly related to alcohol misuse – these might be more hidden costs than an extra few pence on a bottle of wine, but they are no less real. And these costs are bourne not only by moderate drinkers, but by light drinkers and teetotalers as well.

The second, more fundamental, objection I have to this complaint relates to the concept of society. If we are all content to live as self-centred individuals whose only way of judging a new policy statement is how it directly affects our own pocket, then we will have to expect to jump up and down shouting ‘not fair’ every time a new proposal even slightly dents our income. Is it not possible, however, that I might be quite content to pay a few pence extra at the checkouts if it means extra protection for the weak and vulnerable in our society? Of course it is, or why else would there be such an attachment to the NHS in the public consciousness – it is not just that we want to know that we will have health care free at the point of delivery should we fall ill ourselves, but also that we want to live in a society where no-one misses out on health care because of a lack of means. If (and it is an ‘if’, I grant you) minimum alcohol pricing will help to protect even some young people from going down a track of ever-increasing alcohol misuse, then I am willing to bet that the majority of moderate drinkers will be more than happy to pay a little more to live in that sort of society.

At the moment the only factors that influence the price of alcohol are the Government’s need for revenue in the form of duty and VAT, and the all-powerful force of the market. We have seen the market for what it is in terms of its ability to securely manage our financial systems – why should the health of our nation be so openly exposed to its amoral power as well?