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The following interview reflects the fact that natural health care is replacing dependency upon the pharmaceutical ‘business with disease’ on a global level.

This initiative in Wales can become a role model for every community in America, Europe, Asia, Africa and anywhere else in the world.

Every person, anywhere in the world can immediately understand the benefits of this new approach to health care - and take action at the community level.

What are we waiting for?

"We put our nutrition strategy at the forefront of community development initiatives"

Welsh Assembly Health Minister Jane Hutt talks to the Dr Rath Health Foundation about the importance of nutrition for Wales

In February, the Welsh Assembly announced its cross-community health initiative ‘Food and Well Being – Reducing inequalities through a nutrition strategy for Wales’. Minister for Health and Social Services, Jane Hutt, spoke to us about the new policy.

Interview by Angela Meredith

Wales has chosen to adopt a preventative, nutrition-based strategy rather than just using pharmaceuticals to treat illness when it occurs. Is this primarily for economic rather than healthcare reasons?

JH: No, it’s basically because we have a strong commitment to improving health and well being in Wales, primarily through a long-term prevention agenda. But obviously it does have an impact on economic development, growth and prosperity in Wales because we have a legacy of ill health in Wales – and a legacy which was very starkly illustrated in the recent 2001 Census figures that were published a couple of weeks ago, which show that we have higher numbers of people with life-limiting illness of working age in Wales than in England, and quite stark inequalities within Wales itself.

We also have higher levels of people who say that in the last year they have experienced poor health as opposed to good health – which was a key Census question – so it does all link up with health, well being and the promotion of economic regeneration and prosperity. But ostensibly it’s a public health motivation that’s behind the nutrition strategy.

There is no mention in the Targets and Milestones section of the report ‘Food and Well Being’ whether the results of the strategy will be measured in financial terms. Assuming that Wales follows the advice of the strategy and improves its nutritional intake, will you be expecting to see any financial savings – in NHS prescribing budgets, for example?

JH: Well, we certainly haven’t set out to measure it in those terms – the nutrition strategy is going to be measured much more in terms of health outcomes, health gains indicators. Clearly, I suspect it will have an impact in terms of savings on the prescribing budget. But as I said, it’s not been a motivating factor in developing the nutrition strategy. Of course, we actually do have higher prescribing rates in Wales, compared to levels in England. We’ve set up separately a Medicines Strategy Group to look at those issues, but I think the nutrition strategy has been totally driven by our health and well being agenda.

Is that why it is taking priority over, for example, employment or education? You say in your forward to the report that health and well being are actually at the top of the Welsh Assembly Government’s agenda.

JH: Because one of the benefits of devolution is that we do all work together in a very joined up way, education, health and environment at ministerial and policy level are very joined up. For example, in the work that we’re doing in schools, the Education Minister and myself work very closely in the development of our network of healthy schools, the promotion of fruit tuck shops, the nutrition standards of school meals and the changes we would want to impact on the curriculum in bringing back cooking skills – and the use of schools as a focus in the community for regeneration.

We also have a regeneration strategy called Communities First, where we are investing a lot of money through local government in the most deprived wards and communities in Wales, and we would put our nutrition strategy at the forefront of community development initiatives that are being funded through our Communities First initiative. So the Welsh Assembly Government does try to act in a joined up way, but it is true to say that there is a recognition that we still have high levels of economic inactivity – we do have issues in relation to the impact that poor diet and nutrition would have on educational attainment, so it does all link up.

You mention in the report specific groups that you’ve targeted for improved nutrition, and we’ve spoken about schoolchildren in particular – you also mention that hospital patients will be targeted through improved catering, and also the elderly who have long-term illness. But one group not mentioned in the report are those already suffering from disease and illness. Do you think this group should have been included in the nutrition strategy?

JH: Well, they are all part of the population, but the groups that we have perhaps prioritised – the elderly, ethnic minority groups, infants, children and young people, but also middle aged men and women of childbearing age – are additional priority groups. Obviously those with chronic ill health and long-term conditions will be a very important part of the population to be served by the nutrition strategy, and they will also be recognised, for example, through other national service frameworks [NSFs], such as the Diabetes NSF. With joined up government at local and national level, it does start having an impact across the board on those wider population groups.

You obviously support the fact that nutrition can be used as a means of preventing illness, but do you think the Welsh Assembly might consider extending its strategy to using nutrition in treating disease, given the weight of evidence that suggests nutritional intake can actually improve certain conditions?

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JH: I would hope so. I think the important thing is that we’ve taken the lead in Wales with this nutrition strategy – with the Food Standards Agency and the Welsh Assembly Government producing it – and now we’ve taken those first steps, I think it does open the door to a wider understanding of how nutrition could be a key factor in the treatment of conditions. For example, we’re now starting to pilot our Expert Patients Programme and looking at the long-term conditions, and how we can develop guidelines in terms of clinical pathways – and maybe we do need to make sure that the connections are being made with the nutrition strategy. It’s very early days for us, but of course there are endless possibilities once you have embraced the nutrition agenda.

You seem to be taking a separate route from the established policy of waiting until someone becomes ill, and then treating them with pharmaceuticals. Did you set up the strategy with the intention of creating a separate identity from established policy, which traditionally relies on pharmaceuticals rather than nutrition?

JH: I think if you spoke to many of our clinicians and health professionals in Wales – and probably many Assembly Members – they would be seeing this as much more a health-promoting agenda and an ill health-prevention agenda. But if we look at, for example, tackling coronary heart disease, because our national service framework is different from the English NSF in terms of the first standards of prevention, we are focusing very much on diet and nutrition in communities.

We have already had a community food initiative, which interestingly has been very popular not just with socially disadvantaged groups, but, for example, people with mental ill health. And we’ve also funded a health inequalities programme in which teams throughout Wales are developed – with funding directly though the Assembly – to work with people to prevent heart disease; and that can extend from physical exercise, as well as dietary nutrition programmes, with a dietician involved in all of these projects.

In Anglesey, for example, the whole of the island has signed up to an initiative called Calon Lân, which is Welsh for “healthy heart”. It is a bit like what has happened in Finland, in that it focuses the whole community on what they eat, how they eat and lifestyle – as an alternative to, for example, the use of statins in the treatment of coronary heart disease. We know that an alternative is exercise and healthy eating, and that you don’t necessarily need to reduce cholesterol levels through statins.

How important do you think it is that the policy should have a definite Welsh identity, rather just being a strategy that is part of a wider UK policy? Do you think it’s important that people in Wales feel it is specifically for the people of Wales and are more likely to trust it because of this?

JH: We are now in our fourth year of existence as a devolved government and we are developing some very distinctive strategies. We are doing this, for example, not only in our nutrition strategy but also in social policy. We have reintroduced free school milk for Key Stage 1 in schools. We hope we have the confidence of the Welsh people that we are moving in a different direction – but obviously many will subscribe to the conventions of traditional medicine and what patient expectations will be.

I’m afraid we have got a population where prescribing levels have been too high, so the nutrition strategy has got to change hearts and minds – it’s not itself going to be accepted.

For example, in all the links you can make between diabetes, heart disease and mental ill health, people are now starting to recognise some of the same solutions and answers that relate to lifestyle, diet, exercise and well being – which in the long-term would mean being far less dependent on pharmaceuticals and, indeed, on medical intervention. I think it’s beginning to click in communities that there is an alternative and that the Welsh Assembly Government is opening a few new doors.

So the aim is to initiate a sense of community responsibility or family responsibility for health?

JH: Yes. We like to use the words community health development.

And so who is ultimately responsible for children’s health – parents or the government?

JH: On a day-to-day basis, profoundly it’s the parents – but we have the responsibility through their parents and their communities to try and support the whole family. For example, because we have now have fruit tuck shops in our schools, there have been a couple of occasions when parents have complained that we’re replacing tuck shops, where there used to be crisps and chocolate and pop, with fruit and milk. But we’ve said that when they’re in school, that’s just what we’re going to offer. But it is a difficult balance.

To turn to the subject of reducing inequalities, how easy do you think it’s going to be to iron out inequalities without making certain groups that are targeted feel exposed or singled out? There’s always been a difficulty, for example, in the take up of free school meals. Many of your strategies extend right across the community.

JH: Well, I think the whole of Wales to a certain extent feels as though it has levels of deprivation which aren’t experienced elsewhere. Virtually the whole of the Valleys, West Wales and most of North Wales are in Objective 1 European Funding regimes because of the level of GDP [gross domestic product], so everyone in those communities knows we’ve got to invest to bring them up to the level of other UK regions.

And there’s also a fact that we’ve had very low expectations in our poorest communities, and that we can all move forward together. That’s why I mentioned the example of the initiative on Ynys Môn – Anglesey – where if the whole population is engaged in tackling and bringing down levels of heart disease, it doesn’t matter whether you’re rich or poor, the whole population’s involved in it.

You’ve got communities in the South Wales Valleys, like the Rhondda, where the whole community, anyway, sits within the definition of disadvantaged. There are very few pockets of wealth and prosperity, so in a sense everybody does feel very proud of their communities, but also that they deserve more resources.

You talk about working with food producers and retailers to give vulnerable groups access to certain foods. How will this be funded?

JH: We are developing food cooperatives – and there are some good examples now around Wales – but recently our Minister for Rural Affairs organised a conference of people involved in procurement in the public sector, sitting alongside food producers. With a conference like that, you’ve got people involved in procurement, who are concerned about costs as well as nutrition – and in fact costs have predominated – and you’ve got local producers who basically want to sell their food. Nutrition is a sideline. So what is key is getting nutrition to be a uniting force for procurement and producing food. In Powys, in mid Wales, we now have local farmers supplying local hospitals and schools because they have come to local arrangements, and the NHS trust has facilitated that – and that’s an area of wealth where this is easier to do because you have got local producers on the doorstep of local services.

So there are special financial deals being arranged for communities by food producers?

JH: I think what they’ve done is sought to make the procurement work for the local producers, and they’ve done it within the procurement field rather than saying that there are going to be special financial incentives. It’s very early days for us – there may be many other examples in the rest of the UK where they’ve got further down the road, but there is an aspiration to try and bring this together.

And do you think the cooperative approach is the best way of reducing social inequalities?

JH: Yes. The inequalities that exist in Wales are very deep and they need action on every front, but the Welsh Assembly Government has committed itself to putting more money into those communities with the poorest health, and targeting initiatives at the population that can cross social boundaries as well – and it does seem to have been pretty well accepted in Wales as the approach we are taking.

From 1 April, the communities with the poorest health are going to get the greatest uplift of NHS funding, and that’s been a definite decision that we have made. You can do that when you’ve got growth in a budget because basically it means that nobody loses out, and some gain more as you have growth coming into the system – some will gain year on year incrementally more.

From 1 April, we have new local health boards taking over from the health authorities, which are being abolished. The local health boards are like the primary care trusts, except that they are coterminous with the local authority, and they have elected members from the local authority sitting on the health boards alongside GPs and health professionals. They also have two people from the voluntary sector and an unpaid carer on every health board, and they have a duty to develop a health, social care and well being strategy. And one feature of that strategy is going to be nutrition, so they are going to have to bid their resources for commissioning health services. They will also have a duty to develop strategy which is about promoting health and well being.

The key issue for the nutrition strategy is how do we make sure that that money is targeted at the health, well being and health promotion agenda, so that’s where the nutrition strategy is going to be very important.

© Angela Meredith 2003

More information on the Welsh Assembly’s ‘Food and Well Being Strategy’:

Report – ‘Food and Well Being –
Reducing Inequalities through a nutrition strategy for Wales’

For natural health initiatives in other countries click here...

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