THURSDAY 16 MARCH 2000

PROFESSOR SIR JOHN KREBS and MR GEOFFREY PODGER

  20. Can I finally try and test out: are you disappointed or not or do you think the Board could have been enhanced if there had been a direct consumer representative, in addition to other Board members who may have a consumer background in one shape or form, rather than having two former local government officers?
  (Professor Sir John Krebs) With a Board of 12 people there are always going to be areas that are not covered or considered by some to be inadequately covered, but I am not disappointed. I reiterate that the Board were appointed on the basis of their individual qualities and I am delighted with the quality of the people that I will be working with.

  21. What do you think are the main concerns of consumers and how do you know?
  (Professor Sir John Krebs) There are numerous studies that have asked consumers what their concerns are. Of course they change with time. I looked at some recent work that had been done which showed that food poisoning, GM foods and BSE were the three top priorities and then cost of food came somewhat lower down. That varies with time. GM foods have become the predominant issue in many people's minds in the last couple of years. If you look back to 1996 to 1997, when the first GM products were in the supermarkets, GM tomato paste, it was not a consumer concern at all. We have both to look at the available evidence on what consumer concerns are, but also be aware that there are some fluctuations with time and we must look at the underpinning, longer term issues rather than purely bounce back and forth according to current fashions.

  22. Does that mean you believe that people are more concerned with food safety than they are with nutritional standards?
  (Professor Sir John Krebs) The survey work that I have seen has suggested that people are more concerned with food safety, BSE and GM foods than they are with nutrition, even though you could argue that in terms of health of the nation nutrition was far more important an issue.

  23. I was going to bring up this issue of nutrition and public health. A couple of years ago in evidence to the Agriculture Committee inquiry into food safety Professor James pointed out that globally 10 times more ill health is attributable to the inappropriate nutritional quality of diet than to infection, so although it may not be perceived by the consumer as a major concern in fact it is very important. I wonder what emphasis you place on this aspect of your work. Have you made an assessment of the current state of nutrition in the United Kingdom and how can you improve it?
  (Professor Sir John Krebs) Clearly our role in relation to a balanced diet and nutritional labelling and nutritional standards is very important, and I completely agree with you that if you look in terms of health impacts, deaths or illness related to nutritional consequences are far greater than those related to food poisoning. Our role is to provide information and to encourage the industry and those that work in Brussels in the European Union to adopt appropriate labelling standards so that information is clearly accessible to people. Our emphasis is really on informed choice rather than on direction. Going beyond that, I think we have a role not only in providing the wherewithal for people to make informed choices through labelling and through information promulgated through whatever means, maybe on the Internet, maybe through leaflets or whatever but also in offering an opinion to people, not telling people but offering an opinion to people about the nature of a balanced diet and what kind of food they might want to consume to make up a balanced diet. I repeat: it is not really our role to tell people what to do but simply to offer information and perhaps offer opinion to help people make informed choices.

  24. How will you co-ordinate that with the Department of Health, say, in a future Health Development Agency?
  (Professor Sir John Krebs) By working very closely with them. Perhaps I could ask Geoffrey Podger to comment on that.
  (Mr Podger) As Sir John says, it is even more important with the new arrangements that we do have close working relationships with the other departments, and we have already both formalised an agreement as to how we are going to co-operate but, more to the point, as individuals have got very close to each other in terms of determining how to take things forward. The one lesson we have learned from the past is that to fragment effort in this area across government is not to get the maximum benefit from the investment that can be made. We look forward to working very closely with the Health Department and also with the Department for Education and Employment across this whole field. If I can add to your earlier point, we will of course inherit from the Ministry of Agriculture the responsibility for running the national dietary surveys which are the major point of information as to dietary intake in this country and that is a very important responsibility which we shall be taking forward.

  25. I admire the fact that you are going to work closely with these partners, what structure do you have in place to do that? What does that mean? Does it mean that you are on the phone twice a day or do you have a structure of meetings?
  (Mr Podger) Your comment is fair. It is not sufficient I think just for everyone to know each other's name and go to the pub occasionally. What you actually need is to work together on initiatives and, as you may know, in the White Paper and subsequently, we have set out the division of responsibility. It is clear that any meaningful nutritional effort will both involve the Agency, because of its responsibility for general dietary advice, and the Department of Health who may have an interest in particular population groups, perhaps with people with particular illnesses who relate to this area of activity. We are quite clear that what it actually means is working together on a project basis.

  26. One of the interest groups is low income consumers. How will you get the message across to them?
  (Professor Sir John Krebs) That is a very interesting question. When I have looked at the literature that has been produced by government departments up to now I come back to the point I brought up earlier on. It is essentially aimed at the middle-class family. It is couched in those terms; it is that kind of document. I believe that one has to start thinking from the psychology of the receiver so you work backwards from who you are trying to get the message to, what their language is, what their frame of reference is, and where they read or interact with messages. It may be completely pointless producing leaflets for the groups you are referring to if they do not read leaflets or go to places where leaflets are distributed. We have got to be very creative about how we put our messages across. The principle is to start at the other end with the psychology of the receiver and the life of the receiver and construct the message on that basis.

  27. Are you thinking of involving, say, the Department of Education in this?
  (Professor Sir John Krebs) Very much we would like to work with DoE.

  28. With respect, that sounds terribly weak and ineffective. I do hate to be controversial, but if you look at the figures, BSE has probably killed 30 or so people, e-coli may have killed 50 or 60 or so. We are talking about very tiny numbers here. And yet nutrition probably kills tens of thousands if not hundreds of thousands of people a year in this country alone. Worldwide I would not even begin to put numbers on it. Nutrition clearly has to be the most important public health matter in this country. Although I am not trying to undermine food safety, in numerical terms there are actually smaller numbers of people killed by dodgy food compared with the massive number that are damaged by poor nutrition. To simply say, "We will have middle-class leaflets and we will perhaps do a bit of education and we might even talk to the Department of Health", I do not think is even scratching the surface.
  (Professor Sir John Krebs) I think you were caricaturing my response in an unfair way. I said that we do have an important role in relation to nutrition and balanced diet. What I was emphasising was that there have been many initiatives in the past in this country and in other countries that have been ineffective. The facts that you refer to are not new. We all know about them. Therefore my point was that if we are going to have an impact we must not simply do more of the same. We have to think radically about it. There is a creative initiative for example at the University of North Wales on children eating fruit and vegetables at school—it is the work of Fergus Lowe—which has taken a very creative and different approach to it. I do not want to be specific because I do not yet have the answers for you. What I would say in general terms is that if we are to make a difference in this area we have to do things in a way that differs from the way that things have been done by departments in the past.

  29. That is my point. You are saying that it is radical. I am saying that it is exactly the same thing. I do not believe that this is as radical as it should be. I was hoping when the Food Standards Agency was set up that it really would be radical and take a totally new approach to the way we look at things and make some possibly bizarre suggestions but at least suggestions that would be worthy of intellectual rigour and discussion. Just saying, "Oh, we will have a few leaflets"—I do not believe we are being as radical as the opportunities might dictate.
  (Professor Sir John Krebs) Maybe I should come and consult with you and seek some radical suggestions. We have not yet, as I said right at the beginning, sat down as a board to discuss these issues. I am simply saying that we have to do it differently. The suggestions I was offering and saying were, rather than produce the standard government leaflet, let us work from the other end to see where the young kids in inner city sink estates are, what they do, what their lifestyle is and work from that end, work from their language back to the kind of message that we might be interested in conveying. In relation to what has been done in the past that is quite radical because it is turning the whole communication channel on its head so that it is not us handing information to you. It is, how do you think, where do you go, what is your frame of reference, and couching the messages in relation to that. It may not sound radical but it is actually quite a different way of thinking about communication of information.

  30. But it seems to me that unless we are prepared to tackle the main food producers and really sort out what it is they put on to the supermarket shelves, talking to kids in inner cities about what they eat in the burger bar down the road is not going to get us anywhere. We have to make some very bold moves towards looking hard at this. It is the same as when we are talking about the tobacco industry. We have to take these people on head on and do something very major. Otherwise we are not making any significant changes.
  (Professor Sir John Krebs) The psychologists that I have talked to about this, and I have consulted my colleagues in Oxford, social psychologists, emphasise that the important thing is not to see healthy eating as being a substitute for what you are doing now but as something in addition. It is about diversity in addition to as fun rather than "Eat your greens because they are damn good for you and stop eating those salty potato crisps". You have to look at it in a different way.

  31. That is exactly what I am saying. Until we ask why is it that the manufacturers are producing crisps with such high fat and salt contents, why is it that the food you buy in burger bars is nutritionally such rubbish, we will not get anywhere. That is the thing we need to tackle. People buy what is available on their inner city estates because that is the only option they have got. What we need to ensure is that what is available is decent food.
  (Professor Sir John Krebs) I quite agree that there is an access issue. That is something that is difficult for us to tackle directly because it is not within our remit to consider directly the access to food in inner city estates, to take that example. I quite agree with you: that is absolutely critical to any successful initiative.

  32. You and your colleagues were appointed by the Department of Health and are in a position where you are expected to advise ministers particularly in relation to the area that Eileen has raised of nutritional policy. What I am interested to explore with you is how you would resolve an area of conflict between your thoughts on nutritional policy and the specific policies of the National Health Service. Let me throw in an example that struck me very strongly when I first came in here nearly 13 years ago. There was a great debate going on about the issue of the introduction of cook/chill catering within the NHS. Nutritional standards and the nutritional content of that food were not perhaps what one might have expected them to be and particularly where it was being provided to people in long-stay institutions on the NHS. The Health Service had a vested interest in diminishing the cost of food provision in such circumstances. I do not want to get into a debate about the merits of cook/chill, but if you had a concern about a particular policy being adopted on food in similar circumstances by the NHS how would you resolve those difficulties with the National Health Service, with the Department of Health, bearing in mind that you are effectively a product of the same department?
  (Professor Sir John Krebs) I will give a preliminary answer and then ask Geoffrey Podger to follow up. The overriding principle which is laid down in our foundation is that we can publish our advice openly without having to seek permission from ministers. My philosophy and my approach to that would be a relationship of no surprises between myself and health ministers or other ministers but a relationship which makes it clear that the Agency has a view and the Agency wishes to publish that view and even if it is uncomfortable for ministers we would go ahead with publishing it.

  33. If the minister did not respond and you had a very serious concern would you do that?
  (Professor Sir John Krebs) I think it would be up to the public and maybe people like yourselves to become involved at that moment. If people looked at the argument and say, "Well, the FSA has produced a perfectly structured and argued case which is watertight and bombproof for this particular position and ministers have chosen to ignore it", then I guess people would take the debate forward.

  34. What you are saying is that despite the fact that you are effectively a baby of the department you would not feel inhibited in crossing the department on issues of serious concern of this kind?
  (Professor Sir John Krebs) I would not feel inhibited about publishing our advice even if the advice were not advice that ministers felt necessarily that they wanted to see published. I do also reiterate that I want to operate in a culture of no surprises.

  35. Can we turn to the issue of risk? Clearly with limited resources you cannot tackle every single issue in food policy that you might wish to tackle. You also have to work out how to apportion the task of managing this between yourselves as a government agency and various food companies in the food chain itself and indeed the consumer. How do you tackle the task of defining the risk analysis that is required to do that job?
  (Professor Sir John Krebs) The risk analysis, the risk assessment, the risk communication, risk management, is a very complex area as I am sure you are aware. I believe that consumers are good at making risk/benefit calculations. Perhaps in the past people's capacity to assess risk has been underestimated and therefore government spokespeople have been driven into positions of saying, "X is absolutely safe." We can all think of examples without reiterating specific stories where government spokespeople have said that. I believe that we should move away from that kind of culture where we are saying, "This particular foodstuff is absolutely safe" because nothing is actually risk-free. People accept it. Even after the link between BSE and variant CJD was identified, even straight after Stephen Dorrell had made the announcement, people were still buying beef, and when Sainsburys cut the price of beef they had sold out within 24 hours. People do make risk/benefit calculations. I think it is a matter of giving people information about risk and allowing them to make their own decisions.

  36. Yes, but there must be a methodology by which you approach that task. You are really relying rather on an anecdotal process, certainly in the example we are all very familiar with, but there must be a process of identifying how to focus the need, for example, to ban something as against the need to inform people that there is a risk in consumers eating it and certainly my Committee has gone through the process of looking at a variety of cases in which those choices have had to be made. How do you make that judgment?
  (Professor Sir John Krebs) There is a formal risk assessment procedure which would involve our expert committees advising us. The relationship between the risk assessment, the risk communication and the risk management is something that has to be treated on a case by case basis. I do not think one can write a general set of rules. I think I would have to say that it depends on the particular instance what we would do in relation to a particular risk area.

  37. To give you a bit of help in this, drinking large amounts of alcohol obviously carries a significant risk. Probably consuming large amounts of salt carries a significant risk. Smoking cigarettes carries a very significant risk. To use a political example which fortunately we are past, eating beef on the bone probably carries a very small risk. How does one weigh the policy approach in dealing with these issues of risk for the consumer?
  (Mr Podger) Perhaps I could come in, having had experience in the practicalities of this field. One has to say that there is not an absolute framework which produces an answer to any given level of risk. I think that is quite proper given that people's feeling and social climate about issues play a quite proper part in choosing how to deal with a particular risk. The view we would take, as Sir John has said, is that what we need is the best scientific risk assessment we can get that we make public. What the Agency will then seek to do is to identify the various options on the way forward. For example, one tends to think that always it is a matter of regulatory authorities trying to ban things, but to quote the example of salt which you have quoted and which Dr Stoate quoted earlier, we currently have under way an initiative with the food industry, both the processors and the retailers, which is aimed in partnership with them at reducing the amount of salt in food in such a way that it does not reduce its palatability. That seems to me an excellent example of addressing a risk through voluntary initiative and industry co-operation. It is clear, and it is certainly very clear to me on the basis of my experience, that there are some foods which carry a risk which people nevertheless feel particularly attached to consuming for wider reasons. In that area it is particularly important to do consultations before reaching a view as to what should be done in managing that risk so you have a clear understanding of where these sensitivities lie and what the options are. Overall my own view is that what we have to do first is identify the risks. We have then to produce options which are suited not merely to the quantification of that risk but to the nature of it, how people perceive it, and we have to consult extensively on those sensitive issues where people feel yes, there is a risk but nevertheless we like to run it, but where there may be other vulnerable groups who would be at risk if one had that policy without some kind of warning label or whatever.

  38. So we could be reasonably confident that you would not repeat the Vitamin B6 exercise that we went through about 18 months, two years ago?
  (Mr Podger) What I would be inclined to say is that that kind of issue perhaps shows rather clearly that the model whereby you publish a risk assessment so that people can comment critically if they want to on it, but then also canvass the various options before you take a decision as to what you want to do, has benefits.

  39. So we have learned from that experience perhaps?
  (Mr Podger) I am bound to say, having been in this area for three and a half years, I have learned a great deal.