Friday, 11 March 2016

Tackling obesity - big fish and small fry

It is in the spirit of the age to believe that any fact, no matter how suspect, is superior to any imaginative exercise, no matter how true.
Gore Vidal



The McKinsey Global Institute produced a terrific report in November 2014 called “How the world could better fight obesity”.

The report sets out the scale of the obesity crisis, and its costs.  Obesity is up there with smoking and war as a global killer.  It costs billions and billions, both directly and indirectly.

The McKinsey report identifies 74 interventions to tackle obesity that have been discussed or piloted somewhere in the world; and presents analysis for 44 of these where there is “sufficient evidence to estimate what might be the potential costs and impact”.

The report’s first and headline conclusion is that:

“Based on existing evidence, any single intervention is likely to have only a small overall impact on its own. A systemic, sustained portfolio of initiatives, delivered at scale, is needed to address the health burden.”

I think the key phrase here is “based on existing evidence”.  It is supposed to make us think that the conclusions drawn are credible and correct.  Who, after all, can refute the ‘evidence’?

The problem, however, is that all the evidence comes from inside a system-wide failure.  Each individual intervention may, as the report points out, be ‘cost effective for society’, but there is no reason to suppose that adding up a small hill of beans will make anything other than a hill of beans.  Their conclusion misunderstands the nature of complex systems. 

Sometimes, as I once heard Michael Grade put it, you have to slap them in the face with a fish.

Bad Habits, Hard Choices proposes negative VAT on healthy foods and high VAT on unhealthy foods.  There is no ‘pilot’ for this; and McKinsey are not in a position to assess the ‘evidence’.  But it is a system-level intervention, designed in light of what we know about how real people behave in the real world, requiring only the courage to pick the thing up by the tail and swing it hard.

If it fails – we’ll have wasted a few million pounds, maybe a few tens of millions of pounds, on a deliberative exercise and some administration.  Given the scale of the current crisis, this may be no more than a couple of weeks’ worth of current annual health spending on obesity.


If it works – we might just jolt the whole system onto a new trajectory, one in which virtuous cycles of health replace the vicious cycles of obesity in which we have become trapped.