Crumbs of comfort

September 19, 1997

Dozens of Britons have died in recent years from contaminated foods. Philip James was asked by Labour to set out how an independent agency might safeguard the standard of our food and restore public confidence. In the run-up to next month's white paper, and amid lobbying to narrow the agency's remit, he reveals the background to his proposals

The recent crisis over British beef and BSE or "mad cow" disease has sparked off much of the debate about how safe our food really is. In fact, however, criticism of food in Britain has been quietly rumbling for years.

There was the campaign in the 1970s against food additives and colourings, which led to a reappraisal of the need for luridly coloured foods and the remarkably different amounts of additives in similar products. By the early 1980s the British public knew that many of their epidemic diseases, such as heart disease and cancer, had a dietary contribution, if not cause. They also realised that industrial processing could profoundly change the nature of food by, for example, altering its fatty acid content. Manipulations in one direction could lead to improved health; in another to an early death. Food labelling became more complex. Then came the food irradiation debate, the incidence of food poisoning soared, Edwina Currie and the salmonella-in-eggs crisis, and concern mounted about the heavy metal poisoning of fish. More recently, there has been debate about probiotics, prebiotics, functional foods and genetically modified plants and animals. This long series of food scares has chipped away at consumer confidence in our food industry.

A perception appears to have developed that the British food chain is controlled by companies primarily concerned with profit, which, in conjunction with the Ministry of Agriculture, Fisheries and Food, and under the guise of deregulation, have short-circuited rigorous checks over the safety of food. People feel that the ministry's dual role in protecting public health on one hand and promoting the food and agriculture industries on the other has sometimes led to conflicts of interest. These conflicts have been handled within the ministry or in discussions with the Department of Health and, because of the secrecy of such decision-making, it is not clear how they have been resolved. But MAFF is accused of having jumped too many times to the defence of farmers or food manufacturers.

The BSE crisis and the inadequacy of some of the controls on animal feeds and slaughterhouse procedures, has made the public question the scientific competence and the priorities of the Ministry of Agriculture. We discovered that consumers feel they have been treated to inept and condescending publicity campaigns over many years that, in practice, misled rather than reassured them. They believe that the ministry has concentrated on promoting the interests of companies while paying only lip-service to consumer and public health issues.

I became involved in the debate in March, after an exchange between the then prime minister, John Major, and Tony Blair, leader of the opposition, over the alleged suppression of a report about MAFF's recently established meat hygiene service. One of the issues was that the report had not been sent to the committee investigating a fatal outbreak of food poisoning in Scotland. On the evening of the parliamentary exchange, shadow agriculture minister Gavin Strang rang me. He had just met with Tony Blair who wanted a clear definition of the Labour party's commitment to a food standards agency. Although many people accepted the principle of an agency, it meant different things to different people. What was the most appropriate structure for such an agency? What should its remit be? The Conservatives had plans to appoint a food safety council chaired by a food safety adviser to provide the public as well as MAFF with advice. Most of the UK public interest groups dismissed this proposal as inadequate since it continued the assumption that the public was either over anxious or ignorant about food.

Those eager to maintain the status quo argued that the growing epidemic of food poisoning was caused by public ignorance about good hygiene practices at home. They said there was no need for any change in the food supply system, and used the phrase "food choice" incessantly in a bid to convey the value to the consumer of the abundance stemming from an increasingly free market in food, unfettered by outdated regulation.

In March, however, Tony Blair and I agreed that protecting public health was paramount. I would prepare a proposal for an independent food standards agency and would deliver it to him should Labour win the election. We also agreed that I would publish the report and make it available to whoever was in government after May 1. The agency would need to be accountable to Parliament and report to ministers but it would be free of political and industrial pressures.

With less than seven weeks to go to the election, the task initially seemed impossible. Yet within a week we were able to organise our first think-tank involving key representatives of the food industry, farming, medical, public health, microbiology, toxicology, novel foods and consumer interests. At that meeting we concentrated on two issues - how radical a reform was required and how broad a remit a new agency should tackle.

An amazing consensus emerged about the nature and extent of consumer unease. Surveys by the industry, consumer organisations and academics confirmed a widespread crisis of confidence in the UK system for ensuring food safety. It was clear that, contrary to the views of many in the food industry, educating a discerning member of the public about the issues increased rather than allayed anxieties. To advocate education and reassurance was not the solution - fundamental structural changes in the management and monitoring of the food chain were needed.

On the question of how broad the agency's remit should be, there was agreement that there were four big issues: food's microbiology, its toxicology, the genetic manipulation of food and the nutrition of the nation. At that point there was little dissent over the range of issues to be handled - perhaps because those we consulted were the real experts in the complexity of the food issues involved.

Much later, however, we heard the view that really we should have dealt only with food safety, concentrating in particular on the microbiology of food. This view is, of course, legitimate. If you think of food poisoning as the key issue in terms of risk to public health, then an agency for food safety with a limited remit could have been created. Some scientists who do not routinely deal with food issues feel more comfortable with this. They argue that the problems of microbiological food safety are difficult enough to handle without extending an agency's task into other areas.

Some doctors also believe that all that is needed in terms of improving the health of the nation is to educate consumers to make appropriate food choices. This view is usually accompanied by a failure to recognise that nutritional issues underlie most of our major health problems. Yet advice, from the Department of Health, for instance, on which foods are healthy or unhealthy always affects some British food or farming interest - potentially boosting or cutting sales. For the past 15 years, the recognition of the nutritional basis for many health problems has resulted in changes to DoH policies. Goals for dietary change, however, have been limited in part by concern that some industrial sectors - the sugar, dairy, oils, meat or salt-related industries, for instance - will make life difficult for the Government.

Despite making only modest proposals on dietary change, the publication of the last DoH report on heart disease led to press stories of ministers being called back from holiday by the prime minister to be berated in private by the chairmen of the affected industries. There were also reports of civil servants being asked to leave the room while the issues were discussed. The Scottish Diet Action report - started by Ian Lang and with Lord James Douglas Hamilton continuing in the chair - was also systematically opposed by DoH and MAFF ministers because it was too radical.

Nutrition is a major political and industrial punch-ball. It is little wonder therefore that consumers and other public interest groups insist it be part of the remit of an independent food standards agency. These intense industrial pressures relate to multi-billion dollar markets. Furthermore, the economic impact of nutrition on health is more important than all the other food safety costs put together - including the BSE and E. coli O157 crises. A Danish study concluded that the economic costs of inappropriate nutrition was three to four times that of all other food safety hazards.

An interesting aspect of our inquiries was that many organisations still regard "consumers" as troublesome busybodies. Consumer organisations in Britain are, however, often very sophisticated. They are adamant that the agency should be for food standards and not food safety; taking in a range of issues including food labelling, chemical contaminants, additives and questions of genetic modification. Public interest groups have also highlighted their concern about the way Department of Health policies are influenced by industrial concerns and MAFF interference. In fact, despite MAFF's introduction of consumer panels and its appointment of consumer representatives to some of its expert advisory committees, we found that nearly all the public interest groups consulted wanted to transfer the agriculture ministry's powers over health or consumer protection to the new agency. Whatever the truth of these allegations most respondents warned that the agency was doomed if public health did not dominate.

With such sensitive subjects as food and health how were we to devise an appropriate system? Should the agency be completely independent of government, subject to no democratic control? This did not sit comfortably with an agency handling delicate issues of considerable economic and political impact. But if the agency were to be managed by ministers, it could remain subject to political dogma and be driven by a need to protect political figures. As a compromise we turned to a successful governmental model: the Health and Safety Commission/Executive set up at a time of great concern about risky industrial procedures such as mining, North Sea oil and nuclear safety. Attractive features included the relationship between local authority and central enforcement and the combination of policy-making, monitoring and tough intervention based on legislation to stop malpractice. Politically, the split between a policy-based commission supervising an executive agency was also a clever device to maintain political interactions while still protecting the executive from political interference.

We devised a modified scheme including the best elements of the HSE but emphasising a new approach to the public. The Food Standards Agency should be governed by a "commission" of ten members, with consumer and public interest nominees in the majority. The commission would advise ministers and the chairman would be the body's "public face". There would be enough support staff to ensure all commissioners got the support needed to participate fully in discussions, a feature that has been missing from the Health and Safety Commission. Like the HSC, the commission would be supported by an operational arm - the executive.

It is difficult to restore confidence in a system where decisions are made behind closed doors. We knew that the ideal way through the interrelationships between government, Parliament, industrial concerns and the public would be to have a completely transparent system that allowed debate to be in the public domain. Yet, there can be opposition to such openness in the British establishment: it is a curious, cultural feature that seems to stem from the pre-war system of central decision-making by the educated elite. Nonetheless, a Freedom of Information Act was promised by Labour before the election and we believed we should be radical. We therefore proposed that most meetings of the commission and the advisory committees be held in public.

If this happens when the new agency is set up it should transform debates. The licensing work of the Pesticides Safety Directorate and the Veterinary Medicines Directorate, for instance, is funded by companies' application fees. These assessment processes are accused of developing their own culture, removed from the everyday concerns of society. Since our report was published, recommendations have been made for the inclusion of both directorates within the new agency and for opening their discussions to a wider public. The culture of decision-making needs to change.

A host of other developments has emerged since the debate began. The fragmentation of public and private components in the monitoring of food could be overcome if coherent regional structures were developed. There are also opportunities for public analysts to adopt a higher profile. Some have been sidelined by local authorities. Similarly, there are opportunities for change for the veterinary profession. The public health component of veterinary medicine is being redeveloped. A new emphasis in research could now also be developed - many DoH expert committees are frustrated by the paucity of data on which to make their toxicological, nutritional or other recommendations. The agency could also be used to transform interactions between the NHS, the veterinary world and local authorities.

Our proposals were produced under unusual circumstances with the help of many experts who could not all be named. The Government is preparing a white paper to take our suggestions forward. But given the proposals' incursion into territory defended by different professionals, industry and government over many decades, the challenge for ministers now will be how to maintain a course that not only addresses people's concerns, but also puts into place effective mechanisms to ensure a substantial improvement in public health.

Philip James is director of the Rowett Research Institute, Aberdeen, and author of the report Food Standards Agency: An interim proposal.

WHAT IS WRONG WITH THE SYSTEM?

* The dual role of the Ministry of Agriculture, Fisheries and Food in both protecting public health and promoting the food and agriculture industries can lead to conflicts of interest. A Food Standards Agency would separate the role of protecting public health from that ofpromoting business.

* There are gaps and overlaps between thevarious bodies involved in food policy andmonitoring and enforcing food safety. Conflicts have occurred between MAFF, the Department of Health and territorial departments such as the Scottish Office. There are also communication problems between different professional groups - the links between veterinarians and those involved in monitoring human healthand food safety are poor.

* Enforcement of food law is uneven. Itcompetes for funding with other local authority responsibilities.

THE TIMETABLE FOR CHANGE

* May 1997: publication of Philip James's report, A Food Standards Agency: An interim proposal

* June 20: deadline for responses to the report.

* October/November: white paper outlining the remit and structure of a food standards agency

* Early 1998: Draft bill

* Autumn 1998: passage of the leg- islation. Commis- sion to be estab- lished after the bill has had its second reading to take for ward the setting-up of the new agency.

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