Tesco should not be responsible for tackling the UK’s diabetes crisis

This piece first appeared on the Guardian Healthcare Network

Tesco’s Clubcard is heralded as retail’s most successful deployment of big data. Collect data on your customers’ every purchase and you can ruthlessly mine it when you need to push them to spend that extra 50p.

Every month or so, Tesco sends me what they call vouchers and what I call my own personal consumption and gullibility report. Alcohol is profitable, it says, so we’d like to see you buy more of that this quarter. 150 extra points should do it. 45p off potatoes. Exactly 2.272 litres of milk for free. 65 extra points of fake money off coffee. 25p of real money off bread. We have calculated precisely what it will take to make you come back. We have intelligence on your cheese intake and we intend to exploit it.

This week was different. Along with the bonus booze points, my envelope of ‘11 coupons chosen just for you’ contained a voucher for a diabetes check. What does Tesco know that I don’t? And did it just call me a fat drunk?

In fact, Tesco sent the diabetes check voucher to every customer. Launched in 2007, it has a health check service to promote and a new partnership with a diabetes charity.

Taking your risk of developing diabetes seriously makes sense. 3.2 million people in the UK have a diabetes diagnosis, including the former head of the NHS, which spends roughly a tenth of its money on treating diabetes alone. A further 850,000 have the disease but don’t know it yet. And 11.5 million are at high risk.

Some of those numbers I learned from my diabetes check voucher. On the back, the reference for its 11.5 million figure is this BMJ paper, which confirms a rapid rise in our national diabetes risk. It took eight years for prediabetes prevalence to more than treble in England, a phenomenon apparently unexplained by demographic shifts or measurement artefacts. In this respect, our diets and our health are getting worse, fast.

The authors are gloomy about the chances of preventing risk from translating into disease. “A coordinated response” is required to achieve the “possible, although difficult” task of reversing the trend. But “prospects look poor”. What exactly that coordinated response would look like is left to the reader’s imagination, but the paper my Clubcard voucher recommended I read reckons today’s public health policy fixation on dodgy health checks and voluntary action by the food industry is unlikely to be the answer. With obesity and chronic disease becoming the new normal, the state of public health policy is parlous when it comes to food and the people who sell it to us.

The widely criticised Responsibility Deal (to which Tesco was an early signatory) puts the food industry, rather than regulators, in the driving seat. In their review of the literature on voluntary agreements between governments and business, the London School of Hygiene & Tropical Medicine found that while such relationships with industry can be effective, “there is little evidence on whether they are more effective than compulsory approaches”. In the meantime, the Responsibility Deal has been designed in such a way that makes it difficult to evaluate, while experts describe the pledges made so far as “a drop in the ocean”.

The health MOT, another policy pillar delivered by your local hypermarket, doesn’t stand up to much scrutiny either. The legendary Cochrane Centre, which produces mythbusting evidence summaries on everything from whether fans work in heatwaves (they’re rubbish) to the value of spending £424 million on Tamiflu (someone needs to confiscate the government’s eBay account), concludes that health MOTs are a waste of time. Not that you’d know it if you’ve seen the now ubiquitous, scaremongering adverts for private health screening companies, which warn readers that “preventative screenings are not available on the NHS”. One wonders whether this marketing pressure is what is driving the NHS to introduce its own version of the health MOT in the face of advice from the Royal College of GPs.

That’s not to say targeted tests for the early warning signs of certain diseases among at-risk groups are a bad thing. But with a crisis on the horizon, how many of the 11.5 million understand their own diets well enough to even consider they might be at risk? Are they likely to get to grips with the situation quickly enough in an environment that puts the onus on individual responsibility? And are we really leaving it up to the very people who profit from our ill health to run public information campaigns?

We should all play more of a role in managing our own health. The trouble is, there just might not be time for us to learn about what’s really in our food and book our own tests before the NHS has to shoulder the burden of millions more people with avoidable chronic disease. We need there to be more to public health policy than voluntary agreements with industry, dodgy private healthcare marketing campaigns, and diabetes tests with your doughnut vouchers.