Joint Committee on Health debate -
Wednesday, 10 Jul 2024

I reiterate apologies have been received from Senator Hoey. Apologies have also been received from Deputy Cullinane, who has had to leave for a conference.

Minutes of the committee meetings of 2 July and 3 July 2024 have been circulated among members for their consideration. Are they agreed? Agreed.

The purpose of today's meeting is to consider the issue of childhood obesity with the Minister of State responsible for public health, well-being and the national drugs strategy, Deputy Colm Burke. This is his first appearance before the committee since his appointment. I welcome him and the officials from the Department of Health and the HSE. From Safefood, I welcome Dr. Gary A. Kearney, chief executive officer, Dr. Aileen McGloin, nutrition director, and Ms Joana Caldeira Fernandes da Silva, chief specialist in nutrition.

Witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity either by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in respect of an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction.

Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official either by name or in such a way as to make him or her identifiable. I remind members of the constitutional requirement that they must be physically present within the confines of the Leinster House complex in order to participate at public meetings. I will not permit a member to participate where they are not adhering to this constitutional requirement. Therefore, any member who attempts to participate from outside the precincts will be asked to leave the meeting. In this regard, I ask any member participating via Microsoft Teams to confirm, prior to making his or contribution to the meeting, they are on the grounds of the Leinster House campus.

To commence our consideration of the issue of childhood obesity, I invite the Minister of State to make his opening remarks.

I thank the Chair. I served a 13-year apprenticeship at this committee and am delighted to be back here as Minister of State.

The members will have heard from my predecessor, Deputy Naughton, in February on the commercial determinants of health. I very much welcome the opportunity to speak to members today about a related matter of great importance: childhood obesity. I am delighted that representatives of Safefood have also been invited to the committee meeting today. I had the opportunity to launch the Safefood public health campaign on addressing the food environment in June. I am joined today by my Department officials from the health and well-being programme, namely, Matthew Doyle, Catherine Curran and Colin O'Hehir. I am also joined by Dr. Orla Walsh, a consultant paediatrician with expertise in treating child and adolescent obesity in Children's Health Ireland's child and adolescent complex obesity service. Dr. Walsh chairs the obesity programme clinical advisory group for the HSE.

One in five of our primary school children is living with being overweight or with obesity. In socially deprived areas, it is one in every four children. These are the latest figures from the WHO Childhood Obesity Surveillance Initiative, COSI, a report on which I launched in June. It is reassuring that the majority of our primary school children aged between seven and 11 are of a normal weight and that the prevalence of childhood obesity in Ireland has remained static since the COSI project started in 2008. This is despite recent challenges to lifestyle and health behaviours brought on by the Covid-19 pandemic.

The increase in childhood obesity rates experienced by our closest neighbour, the UK, during the pandemic did not happen here in Ireland. Nonetheless, it is concerning that the data continues to show higher levels of overweight and obesity in areas of disadvantage. Living with overweight and obesity can have a significant impact on a child's welfare. Such children are at risk of poor physical health into adulthood. They can also experience weight stigma, social isolation, poor self-esteem and poor mental health.

The Department of Health, under the Healthy Ireland framework and through the obesity policy and action plan, OPAP, is overseeing many cross-sectoral initiatives that seek to improve health and well-being for all children. I will briefly outline just some of the work we are doing and what our priorities are for the future. A Healthy Weight for Ireland, the obesity policy and action plan for 2016 to 2025, was published under the Healthy Ireland framework to address both childhood and adult obesity. The OPAP includes a range of actions on health promotion and education, prevention of overweight and obesity, actions to manage and treat obesity within our health services and actions that relate to the wider obesogenic environment. While the Department of Health, together with the health services and organisations under its auspices, is responsible for delivering most of the OPAP actions, a number of other Departments work with us and have responsibility for driving particular actions. They include the Department of Agriculture, Food and the Marine, the Department of Children, Equality, Disability, Integration and Youth, the Department of Education and the Department of Social Protection.

Policy measures under the OPAP are broadly in line with the World Health Organization's policy recommendations to address obesity. Ireland introduced a sugar-sweetened drinks tax in 2018. We have almost finalised an evaluation of the tax. Preliminary indications show the policy objectives of the tax, namely, to reduce sugar consumption associated with sugar-sweetened drinks and drive product reformulation, are being met. The evaluation will be published in the near future.

We established the food reformulation task force in 2021. A partnership between Healthy Ireland and the Food Safety Authority of Ireland, its objective is to deliver the food reformulation roadmap out to 2025. The voluntary reformulation programme aims to reduce consumption of calories and sugar by 20% and consumption of saturated fat and salt by 10% in priority food categories.

Marketing of unhealthy food to children has increased significantly as they have embraced digital technologies. Safefood has some very concerning findings in this regard. Ireland participated in the EU's joint action project on addressing marketing to children, Best-ReMaP. The output from that work will provide national policy direction. The Department has been engaging with Coimisiún na Meán as it prepares to review the children's commercial communications code to include online media platforms. That is a significant issue in regard to children.

The promotion of physical activity is a key priority under Healthy Ireland. Increasing population levels of physical activity relies on engagement with a wide range of stakeholders. My Department co-leads cross-sectoral actions under our national physical activity plan. We also work closely with the Department of Education on the Active School Flag initiative, which seeks to get more schools more active, more often. It operates chiefly in primary school settings across the country. We are now expanding the programme into post-primary settings as we seek to build on the 2,100 schools that have participated since 2009.

The Department of Health provides support to the hot school meals programme, which is led by the Department of Social Protection. It aims to provide regular, nutritious food to children to support them in taking full advantage of the education provided to them. The nutrition standards for the hot school meals programme, published by the Department of Health, are designed to support food business organisations in creating suitable menu options to meet healthy eating guidelines for children in primary school.

The HSE, under the OPAP, provides many services to support children having the best start in life and to promote healthy eating and active living in the community. Research shows that maternal weight at conception and gestational weight gain play roles in health outcomes for pregnancy. Nutritional guidelines are covered during the booking visit and in the My Pregnancy book for mothers-to-be. As care is individualised, further supports are provided as needed.

The Government remains committed to improving breast-feeding rates and moving towards normalising breast-feeding in our society. The HSE is currently evaluating the implementation of its breast-feeding action plan. The Department will work with the HSE to develop a future breast-feeding strategy.

Funding of €1.3 million was allocated to the HSE in 2022 for the recruitment of 19 community food and nutrition officers as part of the Sláintecare healthy communities programme. The HSE oversees the healthy eating and active living programme, which includes a number of community-based initiatives, including the healthy food made easy programme. Healthy Ireland also funds the training programme for healthcare professionals run by the Royal College of Surgeons in Ireland on child and adolescent obesity.

The OPAP does not cover just health promotion and obesity prevention. It also commits to providing services for the management and treatment of obesity. Professor Donal O'Shea, a champion for addressing obesity, was appointed as the clinical lead for obesity in 2017. The HSE has developed a model of care for the management and treatment of obesity for both children and adults. Services for children are beginning to be put in place.

Looking ahead to future actions, we are developing the next version of the OPAP. It will be our roadmap for future efforts in addressing obesity, including childhood obesity. The plan will emphasise the need for a whole-of-government approach, recognising that the determinants of obesity are complex and interrelated. In addition to seeking to strengthen the supports available to children and parents within the health services, we will work with all relevant Departments and sectors of society to create the right environment within which our children can live healthy and active lives. By addressing the broader social and commercial determinants of health, we can create sustainable change and reduce the challenges faced by children living with overweight and obesity.

There is great value in educating children and parents on the importance of healthy eating and physical activity through the school curriculum, through community-based organisations, in mass media campaigns and in many other settings. However, research and practice show that such initiatives are not enough on their own. I very much welcome the focus of Safefood's new public health campaign. I hope it will ignite a discussion and raise awareness across Irish society about our children's food environment.

I am confident that as we develop the next OPAP to address obesity in Ireland, we will continue to introduce and strengthen measures that support an environment in which healthier food options are available, accessible and affordable. Together, we can create a healthier future for our children, ensuring they grow up with the opportunity to lead full, healthy and active lives. I thank members for their time. I look forward to answering their questions.

We are delighted to have the opportunity to make a presentation to the committee today. The presentation has two parts. First, I will give a short introduction to Safefood. After that, an overview of Safefood's work on childhood obesity, nutrition and healthy eating will be delivered by our nutrition director, Dr. Aileen McGloin. Also present is Ms Joana Caldeira Fernandes da Silva, our chief specialist in nutrition.

Safefood was set up as the Food Safety Promotion Board in December 1999 as one of six implementation bodies established under the terms of the Good Friday Agreement. Safefood implements, on an all-island and cross-Border basis, policies agreed in the health and food safety sectoral meetings of the North-South Ministerial Council, the most recent of which was held in Armagh on 27 June. Departmental responsibility rests with the Department of Health in Belfast and the Department of Health in Dublin.

Our headquarters are in Cork and we have a suboffice in Dublin that houses our marketing and communications people. This leaves us with four directorates reporting to the chief executive. Our budget for 2024 is €7.9 million, which is roughly £6.8 million. Funding is provided by the Oireachtas and by the Northern Ireland Assembly. The Oireachtas provides 70% of the funding, with 30% coming from the Northern Ireland Assembly. Safefood does not have a direct involvement in public communications relating to food safety incidents and alerts as these responsibilities are assigned to the Food Safety Authority of Ireland in Ireland and the Food Standards Agency in Northern Ireland. We have a permanent staffing level of 30.

Safefood has no function in the regulatory aspects of food; that is left to the regulatory bodies in both jurisdictions. Instead, we have a broad promotional role. Our key function is to promote food safety as a responsibility shared by the entire food chain - everybody from primary producers to the public. The organisation is also charged with providing advice on nutrition. However, our promotion role goes beyond promoting just to the public and those who produce and sell food. We commission and fund research and also promote scientific co-operation and laboratory linkages. Our governing legislation provides that the chief executive shall carry out the functions of the body under the direction of the North-South Ministerial Council, and I am assisted in this duty by a 12-member advisory board and an advisory committee of 13 members. We operate under four directorates, two scientific directorates, one of which deals with food safety and the other with healthy eating and nutrition; marketing and communications because communications area key aspect of our role; and corporate operations which supports the operational structure of the organisation.

Safefood’s strategy links economic, social, and cultural factors that continue to change over time, influencing the public’s concerns and their perceptions of behaviour in regard to food. We monitor these concerns and utilises its resources to appropriately inform and, where necessary, reassure consumers so that they may continue to make positive healthy and safe food choices. We also use targeted consumer messages to further inform, support and motivate consumers to put food safety and healthy eating at the centre stage of their lifestyle choice. Our focus has evolved from individual food poisoning crises and pathogens to an emphasis on the four Cs of basic food hygiene, that is, cook, clean, chill and cross-contamination in our home kitchens; from limited individual nutrient information to an holistic approach to the obesity epidemic; from bench research to applied and behavioural research; from mass media campaigns to multicomponent integrated campaigns; and from print and traditional media to social media platforms.

We are aware of the wider public health context in which we operate and we work in partnership with Governments and professional partners across the island of Ireland to inform the public of positive lifestyle choices to improve their health, particularly nutritional advice and good food safety practice. In addition, Safefood has promoted food safety and hygiene along the food chain through the establishment of an all-island food safety network, the Knowledge Network, a collaborative arrangement that creates and augment linkages across the island between food safety professionals. Many of these professionals, not only North-South but also east-west, do not get the opportunity to meet and share the of issues that arise. Therefore, this network has been quite impactful and a great success over the years.

With regard to research, we have continued to undertake appropriate research and knowledge-gathering in order to address gaps in scientific knowledge related to our core areas of food safety, hygiene and healthy eating. This builds the evidence base that facilitates Safefood’s communications to consumers and food safety professionals across the food chain. Our aim is always to provide messages that are supported by science and that are clear, concise, authoritative, relevant and independent. Our information must be accessible, accurate, and supportive of public policy.

I will hand over to Dr. Aileen McGloin who shall provide an overview of Safefood’s work in childhood obesity and nutrition.

I thank the committee for the opportunity to discuss the pressing issue of childhood obesity. I will detail the work of the Safefood nutrition team, which focuses on two principal areas, the prevention of obesity, particularly childhood obesity, and food poverty. These two priorities are interconnected, of course, and are reflected in all our work, whether that is our campaigns, programmes or work in the community. Safefood also commissions and funds research aimed at understanding the social determinants of health. Our research also informs the development of policies to improve the health of the population on the island of Ireland. More than ever, we understand the link between childhood obesity and food related illness such as type 2 diabetes, heart disease and many cancers, as the Minister of State outlined.

Now is the time for all of us within government and public bodies to reflect. While much good work has been achieved, we are now at a critical point to develop and implement public health initiatives that will protect our children's health. Our citizens are supportive of these changes. Recent studies have highlighted substantial public support and readiness to tackle obesity. This would be through measures, including child-focused policies, information and awareness campaigns, subsidies for healthy foods and collaboration between the Government and the food industry.

Today, one in five primary schoolchildren is living with overweight or obesity, according to the most recent World Health Organization childhood obesity surveillance initiative. While that number has stabilised, the figure increases to one in four children in less affluent areas. Overweight and obesity has significant negative mental and physical impact on children. When it persists through childhood into adulthood, it increases the risk of significant, long-term health risks including type 2 diabetes, cardiovascular disease, many cancers, hypertension, depression and premature mortality. In the past few weeks, members might have seen Safefood’s latest campaign, around building a healthier food environment. This is our new five-year public health campaign and was recently launched by the Minister of State, Deputy Burke. This campaign was developed in partnership with Healthy Ireland, the HSE, the FSAI, and in Northern Ireland, the Department of Health, Public Health Agency and Food Standards Agency. With this campaign, we aim to raise awareness of the unhealthy food environment that we all live in, how this is harmful to our children’s health and why it needs to urgently change.

Over the past 30 years, public health campaigns aimed at preventing childhood obesity have primarily focused on encouraging individual behaviour changes, with interventions focused on ways to help parents improve their children’s food choices. While there have been some successes, such as reducing children’s sugar intake, the levels of overweight and obesity remain high, impacting the lives of children, teenagers and adults on the island. Over those same 30 years, our food environment has changed out of all proportion, especially for children. Scientific research in this area has also progressed and shows that it is unrealistic to expect our citizens to make healthier choices or buy healthier food when they live in an unhealthy food environment that promotes that at every turn. Our food environment includes the spaces where we make decisions about food and drink, and how these products are made available, accessible, affordable and desirable. Our food choices are significantly influenced by physical, economic, political, and sociocultural factors. To build a healthier society, we must therefore change the environment that shapes our food choices. For a child, their food environment includes the foods they see daily, such as those in shops, petrol stations and leisure centres, or on TV or smartphones. Research we conducted with Ipsos before the campaign highlighted that more than seven in ten adults said they had seen unhealthy food for sale in non-food locations like bookshops or hardware outlets. Children are bombarded with marketing messages for unhealthy foods. We know from Irish research that many preschool children recognise unhealthy food brands before they learn to read or write.

The food industry’s aggressive marketing strategies directly target children, increasing their demand for and consumption of unhealthy food. Children aged eight and younger are especially vulnerable to this type of marketing, especially when celebrities or cartoon characters are used to market foods high in fat, salt or sugar. Last year, eight of the top-ten selling food brands in Ireland were chocolate, confectionery, sugary drinks or energy drinks. The World Health Organization has identified food marketing as detrimental to our health. This is a key area we must tackle.

We know from the latest research on obesity prevention the importance of local approaches to addressing obesity. Since 2010, Safefood has been working closely with local communities through our community food initiatives programme. This helps support the development of skills and knowledge of food. Since its inception, more than 50,000 people have taken part in this programme. The main types of activities are developing food preparation and cooking skills with cooking courses, as well as developing practical life skills such as meal planning, budgeting, shopping, reducing food waste and food safety.

We also fund research to gather the latest data to inform future programmes and policies. Our previous research into the lifetime costs of childhood overweight and obesity revealed a total lifetime cost to the island’s economy of €7.2 billion, of which €4.6 billion was in Ireland.

Our research from 2022 looked at the factors which influence the food choices we make as families. Time, or more specifically, a lack of time, was identified as one factor impacting food choice, particularly for one-parent households. The availability of free school meals was seen as a helpful initiative, particularly to free up household budgets for those on low incomes. Supermarket chains were also identified as having an influence on food choices due to the availability of store offers, special deals and vouchers for buying food.

In addition, we currently have research ongoing in the field focused on the digital marketing environment of unhealthy food for children. This project, led by Dr. Mimi Tatlow-Golden, uses a novel WHO methodology to monitor digital marketing and the researchers are also exploring a child-rights approach to the development of market-related regulations and policies.

To support all of this work, Safefood works to build capacity and promote collaboration and co-operation through our long-established all-island networks for obesity and food poverty. Over the past 15 years, we have been bringing together professionals with particular interest in these two areas for training, learning and networking opportunities.

At a policy level, we have worked on new guidelines with our colleagues in the Department for children aged one to four, which was published in 2020. We have helped to develop nutrition standards for funded school meals that have been in place since 2017. In 2020, we completed similar work for the hot school meals pilot programme which initially benefited 6,000 children and is now available to 250,000 children. This will progress into universal provision by 2030. We very much welcome that.

In the early learning services, we have also worked with the Departments of Health and Children, Equality, Disability, Integration and Youth to produce standards for the sector, which were published last year.

At Safefood, our goal is to continue to contribute to the prevention of food-related ill health. Healthy eating should be possible and accessible to for every child in every community in Ireland. By building a healthier food environment that is enabling, we can ensure healthy and sustainable food choices will be the norm, rather than the exception. This may require policy changes by our public representatives and the greater availability of healthier products and environments from both the industry and retailers. Our current food environment today is harmful to our health. We need to take collective action to create a healthier future for our children.

My colleagues and I are delighted to answer any questions or provide further detail on our work.

I welcome the Minister of State, Deputy Colm Burke, to his first outing before the committee on that side of the table. He spent many years on this side of the table. I wish the Minister of State and his Department well in the pursuit of this particular subject and others. Likewise, I welcome Safefood. This is a very important subject which has a huge impact on the quality of life of both our young and ageing population. It has a third factor, in that it extends North and South, which is hugely important as we proceed into the future and address the issues that can make a difference to our populations both North and South.

First, this requires education and a new programme of education to highlight the issues that are the most salient and most likely to have an early impact on obesity for children and for people, like me, who have to address these issues on an ongoing basis. It is also an opportunity to identify the issues that are most likely to have an effect on consumers - we call them all consumers - and identify how we are doing that and to what extent we can do it in the future. For example, do we have a red-flag system to deal with food manufacturers? I refer to a system that rates food as healthy, medium, or otherwise. How aggressive a campaign can we mount to address this?

In the context of the education system and schools, as well as homes, as has already been mentioned, there are challenges for less well-off families and their abilities to cope with the situation. There are two challenges in this regard. One challenge is to try to ensure that the younger generation growing up is appeased, while at the same time pushing them in the direction of healthy eating, healthy food and the healthy manufacturing of food.

A rating band would be hugely important. While a certain amount of that already exists, it is not graphic enough to be able to get the attention of everyone in the supermarket, in the small corner shop or wherever. For parents with children, the tendency is to try to appease the child at a crucial time at the till, especially if the child stamps a small foot on the ground and refuses the direction in which he or she is being encouraged. I witnessed this many times myself and I understand what it is like. The parent will find themselves in a tempting situation in which he or she must decide between peace or peace of mind for the future. These are my first questions on which I would like further response from all of the contributors, including the Minister of State.

In the context of the whole issue of education, we must also look at the available food items. One of the things we have really focused on is food reformulation, which is an extremely important aspect. We set up the food reformulation task force in 2021. Basically, it is about reducing sugar content by 20% and saturated fat and salt content by 10% within the industry. No matter how much education is done, if there are products available in the market which have a high sugar, saturated fat or salt content, there will still be a difficulty. Therefore, the food reformulation is very important. We have made a lot of progress in this regard.

It is actually interesting. The other issue relates to the tax on drinks. Due to the reformulation and the reduction in sugar content, we last year saw for the first time the amount of tax we are collecting reduced because manufacturers and producers have responded. A higher level of sugar content comes a higher level of tax.

They have now got the message, and as a result the level of sugar content is reduced and the level of tax we are collecting is reduced. The figure has dropped. We collected €32 million in 2022 and that reduced to €29.3 million in 2023. It goes to show that manufacturers have responded, and the sugar tax has made a difference. The other point is about reformulation. On education, we have worked on that but it goes to show that this approach about healthy living and healthy eating cuts across a range of Departments. We have the Department of Social Protection under Deputy Humphreys. The school meals programme has been successful, but there is also co-ordination about the contracts entered into. There are also guidelines with regard to what kinds of food must be supplied under the contracts. It is up to the schools to enter into the contracts, but the contracts have conditions on them too. That is important. On education we have a lot of work to do, but between all of the State agencies and Departments whether agriculture, Deputy Humphreys' Department, or the Department of Education, there is a lot of co-ordination and co-operation, and we are making progress. While the figure has remained static since 2012 on obesity and overweight, the target now is to reduce it further. It has not grown, but that is not acceptable. It is now about getting it down, and that is where we need to do more work. That is what the long-term plan will be.

Is there some kind of system to award special status to food manufacturing companies that are involved in doing the things the Minister of State wants them to do such as reducing salt, sugar, and so on? I do not see any necessity. Sugar is an acquired taste, as is salt of course. However, the more of it you get the more you want, and the body becomes used to it. I should not have to tell the witnesses this. They know this. The body absorbs what is not good for it and it manifests as various illnesses as the child goes through life. I speak as one who does not use salt or sugar and has not used them for 20 years. I notice the huge difference in foods that have a sweetener or a saline ingredient. There are areas for an incisive movement to bring to everybody's attention, so we can say this is not good for us and we should not indulge in it. It should even be said to the small child, and that is through education.

Young girls, in particular, find it difficult to deal with the situation in this area. We often find eating disorders and all that is associated with them, which does not help at all. However, it is a warning to everybody that this kind of thing can happen. If we do not deal with this situation the best, we can there are downsides. We need to emphasise the situation that it is just an acquired taste. The more the individual or child gets the more they want. It is like everything else.

The task force is doing a lot of work with industry, but industry is not out in public saying they have reduced sugar or salt levels. They are not talking about it out there, but they have worked closely with the task force. Some of them are good and are interested in taking on the work the task force is doing. I referred to how obesity and overweight are at a higher level in the lower socio-demographic areas. One problem there is a higher number of fast-food outlets per head of population in those areas than in any other area, and there is a huge reliance on fast-food outlets. If we go to a fast-food outlet, as we all do from time to time, the first thing we are asked is if we want salt and almost a half-pound of salt is dumped on whatever we are purchasing. It is one of the things we seem to have accepted. While we cannot say to people they cannot go to a fast-food outlet, we should maybe be doing more work with fast-food outlets to get the message across to them as well. We also need to look at the planning process. Do we allow too many fast-food outlets in certain areas, and do we need to put a cap on that kind of activity? It is one area where we have not made any real effort and is something we should now look at. There is a lot of work being done between the task force and manufacturing with regard to reducing the levels of salt, sugar and saturated fat. Their target is set, and it is about both. We have also identified the priority foods we need to focus on, and what the main foods are. Another area we need to focus on is the importance of eating fruit. While we have made a lot of progress, we need to further emphasise that whole area. Safefood might like to comment on that.

Deputy Durkan has raised an important issue. When we think about encouraging behaviour change, it is with regard to three different elements. The Deputy mentioned education. The three elements are capacity building, opportunity and motivation. We need to continue helping people to build their knowledge and skills in this area, like work on the community food initiatives that Dr. Kearney mentioned. It is also important to mention the work of Sláintecare healthy communities, the food community food and nutrition workers and all the work on the ground. We cannot continue to expect people, based on their knowledge and skills alone, to be able to withstand daily bombardment by unhealthy food in their environment. People will only have so much resilience or resistance in that kind of environment. We need to provide them with the opportunity to eat healthy. We need it to be much easier to eat healthily. The last part of that equation is motivation, which obviously changes from individual to individual. However, communicating the consequences of living with overweight and obesity, or the health benefits of not, or appealing to a certain identity like a protector of children are all different techniques we have used in the past. It is that kind of holistic approach to prevention of obesity we feel is really important.

I am glad the Deputy mentioned eating disorders because I wanted to take the opportunity to mention that a lot of people are afraid to talk about being overweight and obesity with their child and adolescent for fear of starting an eating disorder or causing harm. Research shows that when we do it correctly, speak in appropriate language and talk openly with our young people and adolescents, and when we are treating young people with obesity and are trained to do so properly, then there is no risk of causing an eating disorder in these young people. The COSI study has shown that overweight and obesity is more likely in girls, as are eating disorders, and we need to improve our education and support of female adolescents to improve their health. Obesity in adolescents is an epidemic now, and we need to take this opportunity to treat it and not be afraid of doing that for fear of causing an eating disorder. There are both important topics facing the health of our adolescents at the moment, and if we are to invest in anything, we should invest in the health of our adolescents. If we have healthy adolescents, we will have healthier old people and a healthier next generation.

I apologise for being late. I was speaking in the Chamber. I would like to particularly welcome the Minister of State back to this room in a different capacity. I wish him very well in his new role. I would like to start with the commitments in the programme for Government in respect of the epidemic, as it is described, of obesity. The first commitment was to work with stakeholders to introduce a public health obesity Act including examining restrictions on promotion and advertising aimed at children. Where are we now in the dying days of this Government in respect of that commitment?

We have been working on the whole area of advertising of unhealthy foods. For instance, there is a children's commercial communications code. This is a statutory broadcasting code issued by the Broadcasting Authority of Ireland pursuant to section 42 of the Broadcasting Act. The establishment of Coimisiún na Meán under the online safety and media regulations provides for the creation of codes and rules which may prohibit or restrict the inclusion of programmes for commercial communications. We have done work on this area. There is ongoing consultation between the Department of Health and Coimisiún na Meán about introducing further codes in this area.

The issue in relation to legislation is ongoing. The Department is still working with the various interest groups. There has been progress made in relation to reducing those elements in food. I gave the information already about how the amount of tax coming in has come down because we have achieved some goals.

I think the experience with alcohol has shown that working with the industry only holds you back. The industry has a different priority. The priority of industry is to maximise profits, not to deal with health matters. Experience tells us that the industry should not be involved when it comes to public health considerations.

In fairness, progress has been made in a whole range of areas in relation to dealing with this challenge. For instance, the Department of Social Protection school meals programme did not need legislation. Likewise, the contracts entered into between the schools and the suppliers do not require legislation.

The Department's understanding is that codes in relation to high-sugar, salt and fat foods will be addressed in a separate consultation in the context of the review of the children's commercial code. The Department and the national intersectional working group will continue to engage with the commission on this issue.

That is not saying anything, really. That is talking about continuing consultation with the industry. Who will be regulating food in terms of levels of salt, sugar and fat, and in terms of the advertising of junk food to children? Who will have responsibility for regulating that? Will it be Coimisiún na Meán or will it continue to be the Advertising Standards Authority?

In fairness, now, the legislation has been put in place in relation to reducing saturated fat, sugar and salt. The legislation has been put in place in relation to the sugar item on that. That tax is now completed and we have provided the tax figures already. It was €32 million in 2022 and is now down to €29 million because the industry has responded appropriately.

Those figures are available. In relation to the evaluation of the response, there is a review under way and the evaluation of that will be available within the next few weeks. The legislation was put in place in 2018. The full evaluation as regards the work and the progress of the implementation of reducing the sugar levels is happening. The team asked to do that evaluation are to report within the next few weeks.

We know from the data the Minister of State referred to that children living in areas of deprivation, as defined by the Pobal data, have higher rates of being overweight and obesity. We know that in those areas people tend to be more at risk of food-related diseases like heart disease, cancer, type two diabetes and so on. That has been ongoing since 2008, so we have good, longitudinal tracking data of that.

Some of the pieces I have mentioned are the work in communities, such as the Sláintecare healthy communities and the 19 areas of deprivation, which is really important there. From Safefood's perspective, we have been working at community level by developing a number of community food initiatives which we have been doing-----

This is a very interesting subject matter. In terms of ultra-processed foods, there has been much commentary in relation to processed foods that are high in salt, saturates and so forth. There is commentary that these foods should be labelled. I know that in some countries in South America they are labelled with distinctive labels in terms of these ultra-processed foods. Would the witnesses consider that some of these foods that are ultra-processed and not particularly good for your health should be labelled in whatever form in Ireland? It is a general question to anybody.

There has been a huge amount of media attention on ultra-processed foods and, to be fair, we have been probably talking about people eating healthier foods that are minimally processed for the last 30 years. The amount of research is growing but at the moment, most of those studies are still at an observational level. When they try to interrogate the reasons for the relationship between ultra-processed foods and ill health, which there are, they find that the key mechanisms are the amount of sugar, fat and salt in the food. Ultra-processed foods are also high in sugar, fat and salt. It is very difficult to distinguish between the nutritional quality of the food and the fact that it has been processed.

At the moment, it is premature to base a labelling strategy on the processing level until we have some more research, which is of course evolving. However, it does go back to Deputy Durkan's point earlier on that the front of pack labelling, enabling people to easily identify what is healthy and what is unhealthy, could be a very important part of our strategy to create a healthier environment for people where it is easier to make healthier choices.

There has been commentary in terms of ultra-processed foods that these are such a present danger, it is akin to what tobacco did to adults 50 to 60 years ago. Obviously, children are consuming these products because the marketing behind these products is absolutely insidious. There is a war going on and we are losing this war. The people winning that war are the marketeers and profiteers of these huge companies that are basically drug dealers. They put out this food and try to sell it as much as possible to get people hooked. Does Dr. McGloin see any sort of parallel between what has happened to the tobacco industry and the ultra-processed food industry?

I absolutely see parallels between the tobacco industry and the industry that produces foods that are high in sugar, fat and salt. We can learn a lot from the journey of tobacco over the last 40 to 50 years, although I hope it will not take us as long. The ban on advertising of tobacco is really important, which came in many years ago. When we banned smoking in pubs and restaurants, that was with the protection of the worker at the centre of the policy. Now we want the protection of children at the centre of our policy and I think banning unhealthy food from areas where children gather could be a really important part of our policy.

The last piece is the removal of tobacco products from being visible within a retail setting. At the moment, if you go into a supermarket, you are 16 times more likely to see an unhealthy food at the end of an aisle or at a till than a healthy food. What you should have to do when you go into a supermarket is to have to seek out unhealthy food, which have a place in our diet on occasions and so on, but they should be hidden in the same way tobacco is hidden. Drawing that parallel is exactly right in terms of how we respond as well as the journey.

Obviously, there is a responsibility on these huge companies in terms of marketing and how they sell these products but it seems to be the wild west in terms of how this food is actually marketed. If you go into a supermarket, it is like they play mind games with you, especially children when they go into this space. We obviously have to go in because it is a necessary evil. However, if you look around, it is absolute madness what is going on in terms of how food is placed and marketed towards young children.

We totally agree and that is the essence of the campaign we are running at the moment. I do not know if Deputy Kenny was here at the beginning when we mentioned that as part of our formative research, 72% of parents had seen offers of unhealthy food in non-food locations such as DIY stores and leisure centres. Even if you try to the right thing with your child, you go into the leisure centre and you are faced with the vending machine at the door so the child of course makes a beeline for the sweets. Of course, the child would do that, we are all human. These are the kinds of protections we would love to see in places where children gather, specifically. We think that could be a very important part of how we move forward.

On the front of pack labelling, it is being considered in the context of the European Commission's proposal. The Commission has to review the Food Information to Consumers Regulation under both the farm to fork strategy and Europe's beating cancer plan. Unfortunately, that has been deferred by the Directorate-General for Health and Food Safety, SANTE, and there has been no revised date provided to progress the draft proposals but it is something that would obviously be extremely beneficial. Ireland welcomes the proposal to review the Food Information to Consumers Regulation and we would be in favour of front of pack labelling that was included in the European Commission's proposal.

There is a proposal at European level and that is something we need to work on and try to get through.

I thank the Minister of State. I refer to the issue around social determinants, which I believe is an enormous issue in working class areas where people are finding it difficult to put food on the table. People might do it but at a lower quality. That is feeding into childhood obesity, and so forth. That will have a trigger effect on a child when they are growing up because they will have access to poor and ultra-processed foods. Again, that is a socioeconomic factor as to what we can consume. How one addresses that is by people having better incomes and their food is better rather than the ultra-processed foods.

With regard to all of the marketing, which goes with these processed foods, the amount of money which goes into the marketing of these type of foods is pretty staggering. The people who are behind this are quite smart, if not too smart, because they want to make a person consume certain products not just in small quantities but for the person to eat as much as they want. That is the biggest factor of all. These foods become addictive, particularly for small children. Once a person consumes so much of these products, they will then have health difficulties not only in the present time but also in the future time by way of diabetes and obesity.

We are all losing the war on marketing. The people who are winning this war are the marketeers of these huge companies which are immensely profitable. How can we address that, and challenge it through legislation, in regard to the marketing of what they are trying to sell? Again, this is a general question.

It generated €32 million in 2022 and went from €16.3 million initially in 2018 up to €32 million in 2022. It is now coming back down because when it was introduced, the entire issue was about the VAT code. The tax was imposed with a different rate, depending on the sugar content in the drinks, so with the higher sugar content, the more tax was paid. The whole idea is to reduce down the sugar content.

This is not to do with a salt tax but it is specifically to do with sugar. Remember, the entire matter concerns the health issues which can arise if people consume excessive amounts of products which have excessive amounts of sugar. The whole idea is to try to reduce that not only by campaigns advising people that they need to eat more healthily but also ensuring the foods which are available have reduced sugar content in them. That is what the whole idea of the tax is. An evaluation is currently being done on the progress that is being made on that. That report should be out in the next five to six weeks as to the success of this or whether more things need to be done in order to improve it further.

I thank the Deputy very much for his questions. I work for the Minister of State in the Department on the obesity policy, the action plan and its implementation. Speaking specifically to the evaluation which is being carried out on the sugar-sweetened drinks tax, we have a draft of the report already. It has not yet been released but hopefully it will be released in the next coming weeks. I can give the Deputy preliminary indications of what the findings are. The tax was introduced in 2018 with two policy objectives which were to reduce the consumption of sugar in carbonated drinks and to encourage reformulation of products. What we have seen, and what the figures are showing us, is that we have tax take figures and figures from Euromonitor International on the volumes of sugar being consumed but also on the levels of sugar compared to volumes being consumed.

We can see that there has been radical reformulation of the products of sugar-sweetened drinks over the past number of years. It was already beginning to happen and this is what industry argued with us, which is that it was already happening and in place from about 2008 to 2009 when we were already seeing reformulation of sugar-sweetened drinks. It has, however, accelerated since the introduction of the tax.

We can also see that four out of the five top brands do not pay the tax as they fall below the tax threshold. These are their normal and full sugar products as such. It is not their diet or zero-sugar product. They fall below 5 g per 100 mg tax threshold. That is encouraging to see.

The consumption of sugar has gone down and already we see, as the Minister of State said, that the tax take is reducing because the level of consumption of sugar is falling as more products fall out of the tax bracket or move from the higher tax bracket into the 5 g to 8 g of sugar per 100 mg threshold, which is the lower tax bracket. Above 8 g is the higher tax bracket. It is very encouraging to see this and we hope to have these results published in the coming weeks. We can circulate them and we will ensure the committee gets copies of the report when it is published.

The World Health Organization policy recommendations are what we are trying to follow through on now. That is a reason we have taken some action following on from the World Health Organization's recommendations. A tax on unhealthy foods is one of the things we are talking about. We are also looking at marketing restrictions, subsidies for fruit and vegetables and mandatory front of packet nutrition labelling. There are two of those. A tax on unhealthy foods is one we have already worked on where I talked about the sugar tax. The mandatory front of packet nutrition labelling is the second, which is being worked on. There is a proposal from the European Commission on that which is ongoing. It is something that we need to try to work on now both in Ireland and at a European level.

The other approach then is about media campaigns and getting correct information out there. It is also about working with the different Government Departments, say, agriculture and education and within the whole schools meals programme. It is about ensuring that it is not just good enough to provide the school meals programme but that it must also be nutritional.

We must ensure that people have access to healthy food that can help children and families and that is what we are doing at the moment. It is not just one Department but requires the involvement of quite a lot of Departments.

I will give examples form other countries around Europe. My colleague, Dr. McGloin, mentioned the all-systems approach and all the work that has been done in Amsterdam in areas of high deprivation where there is systems thinking. Many organisations are building capacity and utilising the structures in their local areas to work together to align different programmes that will improve the availability of healthier foods and education and will bring all the systems together. London, for example, successfully progressed the restriction of the marketing of unhealthy foods on public transport. Everyone can think about coming down the escalators to catch a tube train. We used to be surrounded by advertisements for unhealthy food there but that is now gone from public transport in London.

In Portugal, there are strict restrictions on the marketing, including digital marketing, of unhealthy foods to children. New legislation relating to supermarkets was introduced in England. In respect of product placement, unhealthy foods cannot be placed in certain locations. There are also restrictions on price promotions. Two-for-the-price-of-three deals are restricted. I mean three-for-the-price-of-two. Perhaps there should be two-for-the-price-of-three deals for unhealthy foods. The three-for-the-price-of-two deals are no longer possible for certain types of food.

Those are good examples. I would also like to make reference to the good work we have done in Ireland recently. We are an example of the provision of meals to children in DEIS schools and that programme is going to be expanded. The Department of children recently published standards that will regulate provision in the early learning and care settings, and the community work has been growing. That aligns with the Sláintecare health communities. We made reference earlier to the food and nutrition workers but there is more work ongoing. There is social prescribing, the healthy food made easy campaign and smoking cessation and mental health campaigns. It is about taking an holistic approach to health. That is touching on healthy behaviours that relate to food and will reduce our rates of childhood obesity.

Okay. The school meals programme is obviously an important initiative for basic nutrition and offers a saving for parents if there are children who are going without. What is the prevalence of uptake? I hear that some schools have said they do not need the hot school meals programme. I am concerned that the focus is not on ensuring that every child who needs a hot school meal is receiving one. Perhaps hot meals are required throughout the day. Has Safefood considered a review of the scheme and its operation?

I would have to get in touch with my colleagues in the Department of Social Protection, which manages the scheme, to give that detail. Our role was to support the Departments in the development of the nutrition standards for that setting. As an all-island organisation, we had some lessons from the provision of school meals in Northern Ireland. That scheme had been running since 2008 and standards were in place since that year.

On the uptake, I can tell the Senator that since September 2023, the scheme has been available to all DEIS schools. In April 2024, it was announced that the scheme was going to be expanded to potentially include another 150,000 children. However, I would have to go back to the Department of Social Protection to get the figures for the Senator. I am happy to do that and could submit those figures to the committee after the meeting. The scheme has been evaluated. The hot school meals pilot was evaluated in 2021 and there is a published report for which I am also happy to send the Senator a link.

Ireland now has a model of care for the prevention and treatment of childhood obesity that is absolutely in line with international best practice. It has been chosen by WHO Europe to be a demonstrator site for other countries. In January 2025, the WHO and other countries are going to come to see how we are delivering treatment for obesity to children and adolescents so we can collaborate with other countries. We have that model of care and are getting it up and running. When it is fully funded, operational and in place, we will be leading prevention and treatment of obesity in children in Ireland.

It is important to be clear about whether we are talking about the prevention or treatment of obesity. For the prevention of obesity, my colleagues in Safefood are looking at the food environment and diet is a huge contributor. Products that are sold as food but have a very low nutritional value and a very high calorie value are constantly being marketed to our children. For the treatment of obesity, we need a different approach. We have children and adolescents who are living with obesity. They are living with stigma and the shame related to it every day. They have physical health consequences as a result. In my clinic every week, I see 13-year-olds with hypertension, obstructive sleep apnea and pre-diabetes. These children and adolescents need treatment now for this complex disease. Internationally, there is access to weight loss medications and surgeries. We in Ireland need to up our game so we can offer those treatments to children.

I thank the witnesses for their engagement with the committee. I welcome the Minister of State, whom we were glad to see back in the Chamber.

I was interested in the earlier discussion on the hot school meals scheme. Prior to my election in 2020, I was a primary school teacher. My school successfully participated in the Food Dudes programme, which was reward-based. Children were encouraged to try different vegetables they had not previously eaten. Some were reluctant to do so. We received a few notes from parents about the scheme. When children were asked to bring in cherry tomatoes, they sometimes arrived with whole tomatoes. That presented a choking hazard for young children. Whether we are talking about hard carrot sticks or little broccoli florets, guidance should be given on the preparation of food to ensure that when it arrives in the school, it is safe to hand out to children for independent eating. Will the witnesses comment on that?

What level of oversight does Safefood have of the menu options available under the hot school meals scheme? Some food providers are on a direct contract with the Department of Social Protection. I assume Safefood has some oversight of the scheme. It comes directly under the Minister, Deputy Humphreys, but the Departments of Health and Education are also involved. What oversight is there of menus? In some cases, the food is prepared and provided by local operators. Is there consistency in the standard of food provided? Is there a risk that we could end up in a scenario in which children are having two dinners a day, which is not an intended consequence of the scheme? When I was in college, I often skipped lectures in the afternoon to have dinner and a few pints with friends before going home for a second dinner. Mom always puts the dinner on the table. If that is the case for a lot of youngsters, there is a risk of children eating a second large dinner at home in the evening. That has the unintended consequence of loading up those children with carbohydrates and calories.

The hot school meals programme was introduced by the Minister, Deputy Humphreys, in 2019. The contract for delivery of the scheme is between the school and its supplier. The Department of Social Protection has implemented an inspection programme of organisations participating in the scheme.

Under the existing audit process, some 400 schools are inspected annually by the Department and the Department also carries out ad hoc desk assessments and follows up on any issues that may be raised. There is also a review going on.

In relation to the contract, all schools that wish to avail of the funding are responsible for choosing their supplier on the open market in a fair and transparent manner in accordance with public procurement rules and the primary relationship is between the school and the supplier. To secure funding, a school must first agree to apply the standards set out by signing a service level agreement, which clearly sets out the school's responsibilities and obligations in terms of nutritional standards for school meals. Schools have that responsibility but then there is an overall inspection process within the Department as well. There is then the issue regarding the nutritional content guidelines. The nutritional standards for hot school meals were developed by a working group led by the health and well-being programme in my own Department in consultation with Safefood and the healthy eating and active living programme in the Health Service Executive.

This involves the Departments of Social Protection, Health and Education. There is co-ordination between them all but the important thing is that school inspections are being done and monitored all of the time.

I am happy to answer this. In relation to the development of the standards, the process is that our colleagues at the Food Safety Authority of Ireland develop scientific recommendations for the development of guidelines. The standards then reflect those guidelines. I will use the standards for early learning and care settings as an example. We ask that the grapes and the cherry tomatoes are served halved or quartered. The FSAI does not give any indication for children over five in relation to cherry tomatoes being a choking hazard, for example. That guidance is not there for the standards for funded school meals in primary schools.

As for the two dinners, the problem is not a hot meal twice a day, the problem is the portion. The standards follow the recommendations from the healthy eating guidelines that follow the recommendations from our colleagues in the scientific committee at the FSAI. If we ensure the child gets the correct portion of potatoes and salmon for lunch and pasta in the evening, there is no problem at all for a child to receive two hot meals. I believe my colleague Dr. Walsh would agree with that.

As the Minister of State said, there are overlapping Departments here but I think there should also be some concerns about the length of the school lunch break. Small break is typically ten minutes in the morning and big break is half an hour in the afternoon. In that half an hour, it is typically ten minutes in the classroom to eat and 20 minutes to play in the playground. Part of eating is what you are eating, the quality, the calorie content and the nutritional balance of it but the other point is how much are you eating and how quickly are you eating. You will often see children wolfing down food because the game of soccer, catch, bulldog or whatever they are going to play in the yard matters more to them. They may not fully be hungry as well as that time of the day. They are having a hot meal at ten past 12, which is debatable if that is the right time of the day to be loading up on your nutrition. It is wolfed down, they run out and they are back in again. It is one thing to have a sandwich, a bottle of water and an apple in ten minutes and go but it may not be the best way to try to eat that hot meal that comes out quite hot, in fact, from the school's heating chamber. The length of lunch breaks is not conducive to having these hot meals and the children are wolfing them down, quite literally, quickly to get out to the yard.

That is something that the healthy eating group, which is managed by the Department of Health, can definitely highlight. We have colleagues from the Department of Education who sit alongside us and we can highlight those concerns in terms of the length of the break that allows a child to eat a hot meal. There is huge value in providing hot school meals in schools in areas of high deprivation. Safefood did some research in the form of a report that we published a year and a half ago called Exploring the world of food and it removes pressure from the household from both a time perspective and a budget perspective. It frees up a bit of budget for those families that already live within a very tight budget. It is very important that we acknowledge those.

I want to ask the Minister of State about how, three years ago across the water, Marcus Rashford, who is known to most of us as a famous footballer, led a very impressive campaign that was in fact misunderstood by the British Government at the time. He was seeking that during the off-school period, there would also be meals provided to children. The idea was superb but I would say as a teacher who taught children for 16 years, it would need to be targeted at the most disadvantaged areas. We have statistics on that through Pobal and the DEIS categorisation for schools but that campaign was very much misunderstood. The primary school year is 183 days. Three additional days are discretionary closures. For 180 days, less than half the year, children are in school and they are at home for the other half. As things can slide off the scale very quickly, would the Minister of State give any consideration, in conjunction with his colleague, the Minister, Deputy Humphreys, to extending that?

As I have skin in the game in this regard, I must disclose that I farm organically at home but at present,15% of Irish farming is organic including beef, milk production, honey, grains and the whole lot. When I made the switch two years ago to organic beef farming, I made an alarming discovery. You rear an animal through best practice, you do not inject, you do not spray your land with fertiliser or pesticides and it is a really high quality, healthy animal that is produced before it is finished, slaughtered and prepared for the meat industry. The reality is, however, there is no end market in Ireland for most of those animals. They end up being sold conventionally through the mart system. I could debate this all day but to cut to the chase, but the IFA has made submissions to the Department that for State contracts for school meals, hospital meals and the Prison Service, the State should be trying to, where possible, insist that the contracts include organic food such as grains, vegetables, meat, etc.,and fish, although not all fish is organic. They certainly should be trying to do that so we are at least, as a State, leading out with best example. Most State vehicles are now transitioning to electric vehicles and surely, as a State, we could say there is good reason here to have State food contracts that are based around the organic industry. It ensures that the organic portion of the market, which is 15%, becomes a closed circle. At present, the cattle that I will sell in October have been reared for two years as organic animals. They will be sold conventionally in the mart in October and they will exit that food chain for which they have been set up.

First, on the hot school meals, it is provided during the school term. I know that the Minister, Deputy Humphreys, has indicated that her Department remains committed to working with colleagues to support children and families as much as possible as part of the wider cross-Government response, including through the Cabinet subcommittee on child poverty and the food poverty working group. We are on that group, so this issue about providing meals during the school holiday period is being looked at. The biggest problem is about its implementation. You can deliver on the hot school meals programme during school term and school days but how do you co-ordinate it when children are not in school? That is something the Department is looking at as I understand it but while we have not received a detailed response as to whether it can be progressed at an early stage, it is certainly one of the considerations. Obviously, it would be a welcome development if we could implement it but it is the co-ordination of delivery that would be the challenge.

As for the other issue the Deputy raised, it obviously is something that should be looked at. It probably would come in under the Department of agriculture's remit rather than under our Department's remit.

It would also come in under the various Departments, for example, the Department of Justice in relation to prisons and the Department of Education in relation to schools. It is again a case of all Government Departments working on that issue. I will certainly take it up with other Departments, especially the Department of agriculture to see what its proposal is and how we can better deal with the sale of animals that are reared in the way the Deputy talked about, that they just fall into the normal food chain. There is no designated route for them once they leave the farm. That needs be looked at but it would have to come in under the Department of agriculture. I will certainly take it up with the Department and see what can be done on that. As I understand it, there are people purchasing animals that are reared in that way directly, advertising that it is the way the animal has been reared and selling the end product that way. There are some private companies doing that, as I understand it. However, it is not generally done. There is a process already but I am not sure if it available in the Deputy’s area.

I thank the witnesses for coming and I wish the Minister of State well in his new role.

This is kind of a follow-up to what Deputy Gino Kenny spoke about. In his opening statement, the Minister of State mentioned that childhood obesity is more prevalent in areas of disadvantage. I hear what he is saying. He placed great emphasis on the educational aspect of that, which is an important factor. However, in many instances, poor diet is not really caused by lack of education but, rather, by poverty. The Minister of State mentioned that he worked with several Departments to address this issue, in particular the Department of Social Protection. While the recruitment of community food and nutrition officers is very welcome, I am conscious of the cost associated with healthy foods, which can be very high. What have the two Departments achieved regarding lower income families? Have any measures been taken to address the financial aspect of healthy eating? We all know when we go into the supermarkets that everything in the healthy corner costs almost double the price. It is difficult for low-income families to be able to eat healthy food. What has been done? Have any measures been taken to address this?

On healthy eating, one issue that could apply in areas of lower socioeconomic areas is a lack of access to food outlets. People may not necessarily have the choice. For instance, I have come across shops in particular areas that will not sell fruit. The reason, they say, is that there is not a market for it. That is one of the problems that can exist as well.

As a result, if people living in the immediate area do not normally travel outside the area to shop, they are immediately denied access to something very important – fresh fruit. Can we introduce legislation insisting that outlets having a certain product for sale? That would be very difficult.

The Senator spoke about co-ordination between social welfare and the Department of Health.

My apologies. I referred to “social welfare” a few times this morning when it should be “social protection”. That is one of the reasons the Department of Social Protection rolled out the hot school meals programme. Remember, when we started that programme, we initially focused on DEIS schools in particular. There has been that co-ordination from the health point of view but also from the point of view of the Department of Social Protection. The whole idea is that it is not just about rolling out meals; it is also about making sure there is nutrition and the meals are of benefit to the students. An important issue was raised about what happens outside the school year; that needs to be looked at. How can we help families in those areas during the holiday period? We need to look at that. How can we work together in the Departments of Health and Social Protection, as well as other Departments, on delivering in the period when schools are off? This shows that the programme to date is working. It is being reviewed on an ongoing basis as regards the schools being visited and the product provided.

The Minister of State talked about the provision of food, particularly school meals. I will mention our food basket research, which we carry out every two years. That shows, as the Senator rightly said, that families on low income can spend up to 32% of their income every week trying to achieve a healthy food basket. This is a real challenge for people on a tight budget.

Another issue I will point out is that the areas of deprivation the Senator referred to also have a much poorer food environment. There have been a couple of pieces of research from Dublin in the past two years. One is from UCD and the Food Safety Authority of Ireland, which showed there is not a single market in the most deprived areas of Dublin. There is something around the mapping and planning piece that we have to fix. The other piece is that Dublin City Council has done some comparisons of areas of high income versus areas of low income. Taking one example, that of Cherry Orchard and Ballsbridge, in Cherry Orchard, there are 53 takeaways and in Ballsbridge there are 16. These are areas of similar population size. In Ballsbridge, there are 139 restaurants and there are 63 in Cherry Orchard. Those are an indicator of availability of healthy food. Looking at supermarkets, there is not a difference in the number of supermarkets. However, in Ballsbridge, people can walk to the supermarket whereas in Cherry Orchard, they either have to get public transport or drive. Those are the kinds of differences between areas of low income and high income that we need to try to change through planning.

Ms Caldeira Fernandes da Silva and the Minister of State mentioned the capping of the number of takeaways in a certain area of deprivation. That was done in Newcastle in the UK in the past month. The Senator may have seen in the news that new takeaways are being banned close to schools where it is known there are high levels of overweight and obesity. This is not new. It is being done elsewhere and it could be replicated here.

We have to try. In fact, I do not think we have to try but, rather, we have to change. Dr. McGloin just gave us an important piece of information.

I wish to come back to the Minister of State on-----

I would like to come in on that point. Between 1990 and 2008, the levels of overweight and obesity in Irish children doubled across all age groups. They actually doubled in that period. The one good thing that has happened since 2008 is that the level has been at least static, although we have not made progress in reducing it. It is important that all the work the various Departments have done has contributed to that. The next question is how we can now bring down overweight and obesity. That is the big challenge we have in the next OPAP programme. How can we reduce the numbers of overweight and obesity?

As regards the stigma, low self-esteem and social isolation attached to childhood obesity, who provides mental health support for these children? It is vital that children get supports, particularly around mental health. Does that require a certain specialty?

It is important that it is not just a general support but is specifically geared towards childhood obesity. I would imagine this has a huge impact on families too. Are similar supports available for families also? Mental health is key in all of this. It is one area I would be very concerned about and especially when we consider bullying and the likes that goes on. It must be very difficult for children.

Senator Black is absolutely 100% correct. Children living with obesity and being overweight are stigmatised and they have much higher rates of mental illness and ill health, as do their families, on a daily basis. I have the pleasure of working with a multidisciplinary team and we have an interest in and training for caring for these children, adolescents and their families. The problem is that we only see the tip of the iceberg. The criteria to come into our service is that the person is in the significantly higher percentile for BMI and already has two health comorbidities as a result. It is the children who do not meet our criteria who are at a loss for services at the moment. We do have a model of care that outlines how these children can be provided for at the different levels. We need commitment to get that model funded and operationalised for all children living with obesity. The service is only currently in Dublin. We have children travelling from Letterkenny and from Cork, for example, to access this service so we need to make it available to all children and adolescents throughout Ireland and at every population level.

We also need to work on pathways of services working with our colleagues in child and adolescent mental health services, CAMHS, because people need to be able to access obesity care wherever they are. The other important role is in working with our colleagues in the community disability network teams, CDNTs, to work with CAMHS to educate and upskill the staff that are there to have pathways between our service and their service for these children.

It needs to be worked on especially where people are having to travel to Dublin for care. Obviously it is something to look at. We also need to make sure that we have the expertise available to provide the level of care that people require and make sure it is managed in a proper manner. That is one of things we need to do in each of the health areas, that is, to have that special expertise in each of the areas rather than being focused totally in Dublin. We need to work on this and it needs to be given priority. It is a challenge for anyone who is overweight. It is a really difficult area for them to work through. For them to be able to work through it they need the maximum level of support across a whole range of services. It is important that we have the expertise available to them.

It is something the Department will have to look at in that regard but also working within the HSE because it is the HSE that will be providing the healthcare. It is also cutting across other Departments as well, for example, education and social protection. It is not just health that is involved here. It would have to be a joint approach by a number of different Departments and also by the HSE.

I congratulate the Minister of State on his appointment. He is a diligent and very thoughtful contributor here in the health committee. I have no doubt he will bring the same commitment to his new and very important role.

The Minister of State mentioned that some of the smaller shops in Cork do not stock fruit while there are bars of chocolate and ice cream and all that type of thing. The problem small shops have is that fruit goes off very quickly and there would be a significant amount of waste. Maybe something could be done through the Department to create an incentive for retailers to have fruit more prominently displayed.

I am concerned about the difficulties and challenges people and communities face in establishing farmers' markets. We all know that the vast majority of products that are sold in farmers' markets are healthy such as fruits, vegetables, gardening products and that type of thing. With the various by-laws and councils around the country some are very good, some are very supportive but others are very poor and work against the establishment of farmers' markets that would sell all the types of organic product that others here have spoken about. Perhaps there might be some advisory role the Department could adopt in encouraging the healthy Ireland sections of the local authorities to actually become more engaged with the planners and the people who set up by-laws, in order to encourage farmers' markets. This certainly leads to people purchasing more healthy products.

Free school meals is a great initiative. I have heard the calls from NGOs looking for free school meals to be provided during the summer period. Does the Department of Health take an active interest in the free school meals initiative? Does it have an advisory role with the Department of Education? Is there a role the Department of Health could play that would be more hands-on? Clearly the Minister of State's Department has a very specific brief. The Department of Social Protection has the brief of providing school meals but how do we stand over the quality from a healthy Ireland and healthy eating perspective of the whole free school meals concept, which is quite good? The Department of Health should have more of a role in advising schools on whole area of free school meals. Perhaps the Minister of State will address those points.

The nutritional standards for the hot school meals programme were developed by a working group led by the health and well-being programme in my Department in consultation with Safefood and the healthy eating and active living programme in the Health Service Executive. We have all been involved with the nutrition content. The hot school meals programme is funded by the Department of Social Protection, the schools are involved and the Department of Education is involved, so it cuts across a number of different groups. We are involved in the nutrition standards and the Department of Social Protection does the inspections. As I said earlier, more than 400 schools are inspected annually by the Department. There is very much a hands-on approach by the Department and there is ongoing consultation between the different Departments in making sure that we continue to have a very high standard in what is made available to children while also making sure there is nutritional value in it.

On the farmers' markets issue we have no difficulty engaging with local authorities on this. It would come under local authorities. There is a process that local authorities would have to go through in making the space available. In fairness, many local authorities have come on board with that and where such markets have opened they are doing very well. It gives people the opportunity to purchase food so they know where it comes from and that it is not processed.

The Department should become a nuisance to the local authorities. It should push them to such a degree they become afraid of it and act. Sometimes when it comes to this type of thing, the planners tend to dictate a little bit too much. The stick needs to be used at times. I have been dealing with a situation in Clare where the local authority does not want the farmers' market. It would prefer to see cars parked in the space and potentially get revenue. The farmers' market should be front and centre because it creates an environment.

From his involvement with local authorities, Senator Conway may very well find there is resistance from ratepayers in some local authority areas to these markets being opened up. This is something that local authorities have to deal with. We have no difficulty in engaging with local authorities and encouraging them to do more work in this area. The response we are likely to get from local authorities is that unless they get a request for facilities to be made available, they are unlikely to do anything. The request would have to come in from them first-----

It would be interesting to make a freedom of information request to see how many requests were made and how many were granted.

To be quite honest about it, I have a concern about the quality of food in direct provision centres and accommodation housing Ukrainians. Some of the food is quite good and of a good standard, where the owners of the facilities are committed and care about the people staying with them. I also have seen situations where chicken and chips have been provided, with nuggets and chips for adults. I consider this wholly unacceptable. Does the Department have any role with either IPAS or the Department of integration? I do not know what role it might have in terms of inspections. It is probably does not have such a role but perhaps it should. If a health inspector or environmental inspector went out to these places they would deem them perfectly fine as they meet the HACCP standards. If chicken and chips or sausages and chips are cooked we cannot argue about it once they are cooked properly. My point is that they are not good for people. They are not good for their health. We have 70,000 or 80,000 people in hotel accommodation and direct provision centres. They are being thrown all sorts of trash, to be honest about it, and I am very concerned.

We could engage with the Department on this. I will have look at it to see whether we would correspond with the Department to see what are the guidelines it has issued to the contractors that provide the accommodation with regard to the food being provided. I am disappointed to hear this is occurring. Now that it has been raised, I will certainly engage with the Department involved in providing contracts. There must be a condition in the contract about the type of food being provided whereby it is of adequate standard. Now that Senator Conway has raised it I will engage with the Department.

I accept the Minister of State's bona fides on this because it is obviously something that has not been raised previously. The first exercise should be to get a copy of the contract template given to these facilities, with regard to IPAS and the contract for accommodating people from Ukraine, and see what the wording is with regard to the standard of food. This should be the first exercise and any information I have on the ground that would be useful I will pass on. It is a bigger issue that probably needs some engagement from the Department with regard to setting standards. The Department of integration is only interested in housing people and feeding them. They are not concerned about the quality of the food. They are dealing with an emergency situation, and I get this, but, as the Taoiseach has said, this has to move from an emergency to a more medium to long-term management. A critical part of this is the quality of the food that people are being fed. I thank the Minister of State and I wish him the very best of luck. I know he will do a very good job.

I have number of questions. Recently the committee travelled to the North and met some people in Ulster University who spoke about North-South co-operation on the area of obesity. The clinician who came to the meeting spoke about the things that trigger obesity. It is not just food. Why is one person hungry after a meal while another is not? They are looking at trying to identify the gene. A lot of research is being done. This is where co-operation is happening. There is very positive work on this. It is about what we eat, and we are what we eat, but there are other multiple factors. As part of the debate we need to look at this. In many cases people blame the child or blame the mother but there can be other reasons a child puts on weight and why one child can eat anything and not put on weight while another child puts on weight. We need to look at it through this prism.

There are all sorts of things we could talk about today regarding people not being able to cook so they are reliant on pizza and fast foods. People spoke about various offers available. I believe the action plan will be renewed shortly. Has the old action plan yielded tangible results? I will give an example. In 2018 the HSE reported to the committee on children similar obesity statistics to what we have today. Has the old action plan yielded the tangible results the Minister of State spoke about in this regard?

The Minister of State said the sugar tax is six years old. I remember raising the issue of a sugar tax when I first got elected in the early 2000s. I spoke about trying to get a ban on advertising sugary foods and various issues with regard to cartoons. I remember people looking at me as if I were mad at that time. This was in the early 2000s and it took us until 2018 to bring about the sugar tax. The sugar tax is only on fizzy drinks. Why is it not other products?

Have the representatives thought of that? Chocolate, which is a favourite of many of us, was mentioned. There is one well-known chocolate product and there used to be a difference between the product made in Britain and that made in Ireland. However, people are now saying that there is no difference and there is almost the same sugar content in them both. People’s tastebuds are being affected by this when they are younger. If a child starts off on particularly sugary foods, it is hard to get them off them. I do not know if anyone has tried to go off all sugar, but you go through withdrawals, you get headaches, etc. It therefore has a huge impact.

What initiatives are being proposed beyond the actual advertising campaign? The representatives said that the sugar tax made a difference, but could they outline to us in what way? Food education was touched on by many of our members here today. It is all very well and good to point to childhood obesity in disadvantaged areas, because that is where people eat less healthy food, which is more accessible, more affordable and it is often cheaper. That is the big challenge we are facing in society if it is cheaper. How do you say to a family in the middle of a cost-of-living crisis that they are buying the wrong food, particularly if that is all they can afford? As legislators, we can make foods cheaper and we can make the more harmful foods dearer.

That is why I came back to the issue of the sugar tax. All those years ago, people were very reluctant to do this. They said they would let the manufacturers change it and the industry change it, but we are still waiting for this. It has been nearly 20 years because we were talking about this in the early 2000s and it is now 2024. The changes are not happening, and we can see this every day. If we walk down the street and go into a school, we can see that children are getting bigger and bigger. The challenge for us, as legislators, is to do things differently. We were speaking about fast foods and where we can buy them. I suggest a simple step to the Minister of State and Safefood, although Safefood probably cannot comment on legislation, that we should not have sweets at a checkout. Parents would be ecstatic about that, because they have to run a gauntlet with a child screaming in their arms who is saying, “I want this, I want this”. It is the last chance to catch it. There is also the issue of the two-for-one deals on sweets, biscuits, etc., before you actually get to the till. I am outlining what is happening in my local shops, and I presume it is the same in the representatives' local shops. There is a greater responsibility on us, as legislators, to do things differently. Aside from the advertisement campaign, what does the Minister of State and his Department propose to do differently?

There is a huge genetic component to the disease of obesity. Obesity is a complex, chronic health condition. That needs to be noted. We are speaking a lot about prevention, but we are not speaking about the treatment for it. Genetic factors play a huge role in it. We understand the hormone levels in our body more and more now, and there are now better treatments available for obesity. There is a greater understanding of that. We are now living in an environment that is completely obesogenic, everywhere we go. I hate taking my four-year-old shopping because it causes a huge amount of stress. I am saying that, and I am in a privileged position. The children and families who are attending our clinics are coming from completely socially deprived areas. Every day is a struggle, it is hard for them to get to the clinic, it might take them multiple buses and they have to take time off work. We need to be thinking about all of these things, when we are trying to improve both the prevention and treatment of obesity.

I am in the CHO 7 area where there is no dietitian, and that is important. If your child is obese, where do you go? You will try to get a dietitian. I made the point about a parent whose child had food disorders, so they had to go and get a skin prick for the child and they then got to the consultant. They cannot go directly to the consultant because the normal pathway is through a dietitian. These are the challenges and they are saying that they are to do with the moratorium in the HSE and the job freezes. That is why there is no dietitian in CHO 7. I am also interested in the one clinic we do have in CHI at Temple Street if the witnesses have time to address it, although I am conscious that Deputy Shortall wants to come back in. It is for children all over the State, so it clearly needs to be expanded. We do not have these local dietitians in the CHO 7 area. We are falling on our faces. I am interested in what additional initiatives the Department is pushing.

In the European Regional Obesity Report 2022, the WHO recommended a range of population interventions that focus broadly on diet, physical activity and the food environment, many of which Ireland is currently following. One of these recommendations is to adopt a childhood obesity surveillance initiative, COSI, model of surveillance. The results of the most recent round of COSI, which is the sixth round for Ireland, were published a few weeks ago. They showed that the rates of childhood obesity in Ireland have stabilised, and I have said this already. This is a welcome sign and offers some proof that the wide range of policies that are being implemented are having a positive effect in halting the increase in obesity rates in children. Now, the evaluation is looking at the next report. I will go back to Deputy Shortall’s earlier questions about legislation. This is a matter of looking at how the current programme has worked and then seeing what we need to do in the future. That may very well involve legislation, but the codes to which I referred earlier are being followed through.

Likewise, Coimisiún na Meán is a statutory body that has powers and will be able to regulate advertising. It can deal with instances where a product that is being marketed has adverse immediate or long-term effects, if it is not healthy, or if it has long-term, detrimental effects on a person's health. Under its current powers, Coimisiún na Meán would be able to make sure that advertising is stopped. A lot of positive things are happening.

On childhood obesity, we must look at follow-on care and the need for more expertise in that area so we can give assistance to families. The Cathaoirleach mentioned how a dietician is not available in his area and that is extremely important. This is about making sure we can get the people to fill those roles. As I said, we have already employed 18 people under a particular programme for the whole area of diet, etc., so progress has been made in recruiting additional people.

I think Dr. Walsh wants to speak about CHO 7.

As part of the model of care, in the nine CHOs there can be a multidisciplinary team, including a dietitian, to care for children in the community who are living with obesity. CHO 5 and CHO 7 have been identified as the first two. They started last year, and they are getting up and running now, but the recruitment embargo has had a huge effect and has stalled their ability to start.

We make the argument for a new treatment for obesity. It is a newly-recognised disease and this is a new model of care. We should be resourced and funded separately and we should not be affected by the recruitment embargoes and funding issues like other diseases. If you can treat obesity, you will prevent many other diseases, and if you can treat childhood obesity you will prevent diseases across all the ages.

It is very welcome that there is a model of care for childhood obesity. However, I think, as in most things in health, we need to concentrate on prevention. Treatment is clearly critical but we could do so much more on prevention. Unfortunately, there is no great evidence of that happening. There are certainly parallels between what is happening with regard to over-processed food and junk food generally, and things like tobacco, alcohol and even gambling, where the industry forces its way in and dictates policy on this. Then there is the whole question of codes, and whether they are voluntary or mandatory.

The food reformulation task force has been spoken about. That is a voluntary thing, and we have no data to show us whether that is making any difference or not. I want to request data on this. I am not expecting it here today but I would like to know what exactly the percentages are for the reduction of salt, sugar and saturated fat during the course of the task force's work from 2021 to 2025. What are those targets, and also, what are the percentage reductions for 2023? I would like to request that this data be provided to us.

On the codes we spoke about earlier - the codes related to restrictions on the marketing of high-fat, sugar and salt foods - are these voluntary or mandatory codes? I would like information on that.

Unless some action is taken from the point of view of legislation, we can do all of the promotional and educational stuff that we like but we know it will not make any substantial difference. That is why it is just so disappointing that the Government seems to have backed off the commitment for legislation with regard to an obesity Bill.

Has any progress been made at all on the other programme for Government commitment to introduce planning restrictions on outlets selling high-calorie junk food and beverages close to schools?

With regard to the food reformulation programme, the aim is to reduce calories and sugar by 20%, and saturated fat and salt by 10% in priority food categories. The food industry, including food manufacturers and food services, is being asked to use less of these - in other words, a 20% reduction in sugar and a 10% reduction in salt in priority food categories. That is that one.

The children's commercial communications code is a mandatory code. It is in place already. It was last updated, I think, in 2016. It does not include online content. There will be a review of a number of different codes under Coimisiún na Meán. It has already set out the online safety code itself, which deals with the immediate threat of physical harm and to physical life. The children's commercial communications code is where we hope to see what we will urge to see. In the Department of Health, we have an intersectoral working group on this, bringing together a number of different Departments, and we have Safefood sitting on it as well. We hope the children's commercial communications code will be updated to address online and digital marketing to children, and strengthened in this field too.

I apologise. I know others probably want to come in but I am conscious of the staff here as well. That concludes the committee's meeting. I thank the Minister of State and Safefood for their engagement with the committee on this important matter. This concludes the committee's last meeting before the summer recess.

I thank all the members and witnesses for their contribution to the work of the committee so far this year. I wish all members a pleasant recess, and I look forward to continuing our work in September. I thank all the staff who have contributed and helped us throughout this session. The meeting is now adjourned until 18 September.