Unveiled: radical prescription for our health crisis

A radical plan to persuade people to stop smoking, take more exercise and change their diets was proposed last night by a leading Government adviser.

As new figures were published yesterday showing that England tops the European league as the fattest nation in the EU, Professor Julian Le Grand, chair of Health England and a former senior Downing Street aide to Tony Blair, said a completely fresh approach was required by Government to reverse the epidemic of obesity and to tackle similar ills caused by "excess consumption".

In a speech to the Royal Statistical Society last night, Professor Le Grand said instead of requiring people to make healthy choices – by giving up smoking, taking more exercise and eating less salt – policies should be framed so the healthy option is automatic and people have to choose deliberately to depart from it.

Among his suggestions are a proposal for a smoking permit, which smokers would have to produce when buying cigarettes, an "exercise hour" to be provided by all large companies for their employees and a ban on salt in processed food.

The idea, dubbed "libertarian paternalism", reverses the traditional government approach that requires individuals to opt in to healthy schemes. Instead, they would have to opt out to make the unhealthy choice, by buying a smoking permit, choosing not to participate in the exercise hour or adding salt at the table.

By preserving individual choice, the approach could be defended against charges of a "nanny state," he said. "Some people say this is paternalism squared. But at a fundamental level, you are not being made to do anything. It is not like banning something, it is not prohibition. It is a softer form of paternalism."

The proposal is in line with plans under consideration at the Department of Health. Yesterday, it was revealed Alan Johnson, the Health Secretary, is considering routinely sending parents details of height and weight measurements of their children at ages 5 and 10, so they are aware if their children are becoming obese. Under the current arrangements, parents are only given the information if they request it.

A report published yesterday shows England has the highest proportion of heavyweight adults in the European Union with 24.2 per cent of the population designated obese. The Health Profile of England 2007, published yesterday, reveals the obesity rate in this country is almost twice that in Germany (12.9 per cent) and two and a half times that in France (9.4 per cent.) An obese person dies on average nine years earlier than a person of normal weight and those who are extremely obese (with a body mass index over 45) have their lives cut short by an average of 13 years.

In his speech, Professor Le Grand attacked the report from the Foresight group of scientific experts published last week, which blamed the obesity explosion on an "obesogenic" environment where energy dense cheap food was readily available and sedentary lifestyles were the norm and said individuals could no longer be held responsible.

He said the analysis was "not very helpful" and presented the growth of obesity as so enormous and complex a problem that solving it seemed impossible.

"Saying it is all the fault of society invites a nihilistic response, that nothing can work short of a revolution. We need new thinking and new ideas. We face new health challenges from obesity and old ones from smoking which add up to something of a crisis. There is a real risk that our children will die at a younger age than us," he said.

On smoking, he said permits could be issued annually and the signature of a doctor might even be needed. This would require individuals to "opt-in" each year to being a smoker, rather than "opting out" by choosing to give up.

"Sellers of tobacco from supermarkets to tobacconists would have to see the permit before any sale. To get a permit would involve filling out a form and supplying a photograph as well as paying the required fee. Permits would only be issued to those over 18 and evidence of age would have to be provided. The money raised for the permits would go to the NHS."

Time for employees to take exercise during the working day, a ban on salt in processed food, restrictions on the sale of alcohol, and an extension of the free fruit scheme for children, are also among ideas that deserve investigation, he added.

Professor Le Grand said the public health challenge was very different from half a century ago when William Beveridge founded the welfare state to tackle the "five giants" of want, disease, squalor, ignorance and idleness.

"His giants could be described as the giants of too little: too little income, too little work, too little education, too little housing, too little health care. Today's giants are the giants of too much."

Betty McBride, public affairs manager of the British Heart Foundation said: "This sounds like nanny as Major General. We would have a problem with the smoking permit because it might suggest smoking was alright once you had the permit. But overall this is exactly the kind of thinking we need to be doing, asking tough questions and turning things on their head."

Changing the nation's health habits

* Smoking permits

Individuals would be required to buy a smoking permit, renewable each year, which they would have to show in supermarkets and tobacconists before buying tobacco. Instead of making a New Year's resolution not to smoke, individuals would have to choose to be smokers. The permit fee would be re-invested in the National Health Service.

* The exercise hour

Companies with more than 500 employees would be required to designate an hour in the working day as the "exercise hour" and to provide facilities to enable workers to take exercise. Employees could then "opt out" by choosing not to participate, rather than opting in as they have to do now.

* Zero tolerance on salt

Food manufacturers would be banned from adding salt to processed foods which is a major cause of high blood pressure. This would hand control of the salt content to the consumer who could choose to "opt out" of the healthy product by adding salt at the table

* Restricting alcohol sales

Supermarkets could be required to sell alcohol separately from groceries requiringconsumers to queue twice.Alternatively, the sale ofalcohol could be restricted to off licences (as used to be the case in the US), requiring an extra journey – and extra effort – by the consumer.

* Free fruit

The scheme for handing out free fruit to primary school children each day could be extended to secondary school children. Companies could also be enrolled to provide free fruit to employees. The UK is below the European average for consumption of fruit and vegetables.

* Letters to parents

Alan Johnson, the Health Secretary, is considering sending parents details of their children's weight measurements at the ages of 5 and 10. This is so that parents can make an assessment as to whether their kids are becoming obese. The information is currently only provided on request.