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Friday 17 October 2014

Tesco should not be responsible for tackling the UK’s diabetes crisis

There must be more to public health policy than supermarket vouchers for free diabetes tests

Tesco’s Clubcard is heralded as retail’s most successful deployment of big data. If supermarkets collect data on their customers’ every purchase, they can ruthlessly mine it to push them to spend that extra 50p.
Every month or so, Tesco sends me vouchers. Alcohol is profitable, it implies, so we’d like to see you buy more of that this quarter – 150 extra points should do it; 45p off potatoes; exactly 2.272 litres of milk for free; 65 extra points for coffee; 25p off bread. We have calculated precisely what it will take to make you come back. We have intelligence on your cheese intake and we intend to exploit it.
The other week was different. Along with the bonus booze points, my envelope of “11 coupons chosen just for you” contained a voucher for a diabetes check. What does Tesco know that I don’t?
Taking the risk of developing diabetes seriously makes sense. More than 3 million people in the UK have a diabetes diagnosis, including Sir David Nicholson, the former head of NHS England, which spends roughly a tenth of its money on treating the condition. A further 850,000 have the disease but don’t know it yet. And 11.5 million are at high risk.
Some of those numbers I learned from my diabetes check voucher. On the back, the reference for its 11.5 million figure is a BMJ paper, whichconfirms a rapid rise in our national diabetes risk. In eight years, prediabetes prevalence more than trebled in England, a phenomenon apparently unexplained by demographic shifts or measurement artefacts. In this respect, people’s diets and health are getting worse, fast.
The authors are gloomy about the chances of preventing risk from translating into disease. “A coordinated response” is required to achieve the “possible, although difficult” task of reversing the trend. But “prospects look poor”. What exactly that coordinated response would look like is left to the reader’s imagination, but the paper my Clubcard voucher recommended I read reckons today’s public health policy fixation on health checks and voluntary action by the food industry is unlikely to be the answer. With obesity and chronic disease becoming the new normal, the state of public health policy is parlous when it comes to food and the people who sell it to us.
The widely criticised Responsibility Deal (to which Tesco was an early signatory) puts the food industry, rather than regulators, in the driving seat. In its review of the literature on voluntary agreements between governments and business, the London School of Hygiene and Tropical Medicine found that while such relationships with industry can be effective, “there is little evidence on whether they are more effective than compulsory approaches”. In the meantime, the Responsibility Deal has been designed in such a way that makes it difficult to evaluate, while experts describe the pledges made so far as “a drop in the ocean”.
The health MOT, another policy pillar delivered by your local hypermarket, doesn’t stand up to much scrutiny either. The Cochrane Centre, which produces mythbusting evidence summaries on everything from whether fans work in heatwaves to the value of spending £424m on Tamiflu , concludes that health MOTs are a waste of time. Not that you’d know it if you’ve seen the now ubiquitous, scaremongering adverts for private health screening companies, which warn readers that “preventative screenings are not available on the NHS”. One wonders whether this marketing pressure is what is driving the NHS to introduce its own version of the health MOT in the face of advice from the Royal College of GPs.
That’s not to say targeted tests for the early warning signs of certain diseases among at-risk groups are a bad thing. But with a crisis on the horizon, how many of the 11.5 million understand their own diets well enough to even consider they might be at risk? Are they likely to get to grips with the situation quickly enough in an environment that puts the onus on individual responsibility? And are we really leaving it up to the very people who profit from our ill health to run public information campaigns?
We should all play more of a role in managing our own health. The trouble is, there just might not be time to learn about what’s really in our food and book our own tests before the NHS has to shoulder the burden of millions more people with avoidable chronic disease. We need there to be more to public health policy than voluntary agreements with industry, private healthcare marketing campaigns, and diabetes tests with your doughnut vouchers.

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