Sian Jarvis has spent more than a decade overseeing communications for the Department of Health. She tells Joshua Chambers about public health policy – and communicating controversial reforms to the NHS.
Interviewing Sian Jarvis (pictured above) is like trying to catch a trout with your bare hands. You can see the answer just below the surface, but it can be difficult to get it in the net. If you do land an answer, though, it’s usually pretty tasty.
Jarvis manages to be impressively impassive, befitting her experience as both a political journalist and a government ‘spinner’ who has spent over ten years in the Department of Health fighting fires – first as head of news, then as director of communications, and finally as director general of communications.
Communication has been particularly important to her department over the past few months. Mostly, this is because the government is seeking to enact controversial NHS reforms while cutting health spending by £20bn over the next four years. But the department is also pushing for a new public health strategy that places greater importance on partnerships with big food and drink providers, while handing some responsibilities to a new public health agency: Public Health England.
Jarvis is leaving the department at the end of the month; a departmental reshuffle means that her position will no longer exist at the same grade. When her departure was announced, she received plaudits for her work on the Change4Life campaign, which pioneered the use in government of ‘nudge’ theories of behavioural economics and has transferable lessons for other departments and civil servants. “It signalled a new approach for government communications, really much more focused on behaviour change,” Jarvis says. “I think it was also a recognition that the old style of mass campaigning and finger-wagging – government telling people what to do – wasn’t going to work any more.”
The language of the campaign was totally different from traditional health campaigns, because the target audience thought fitness was a “middle-class concept” and was remote from their lifestyles, Jarvis explains: “You can’t use the word ‘fit’; you can’t use the word ‘fat’; you can’t use the word ‘obese’; you can’t talk about sport; you can’t talk about health. It was a really big challenge to the advertising agencies.” Instead, the campaign suggested that health problems were the fault of society rather than individuals, in order to avoid victimising people. “Trusted brands”, such as supermarkets and GPs, were brought in to help get the message across.
The Change4Life programme does not appear to have had a marked impact on long-term public health: Jarvis admits that it hasn’t yet managed to reduce the level of obesity in the country, “which we know is still on the rise” – even if obesity levels amongst children have “begun to level off”. Jarvis gamely sticks up for the campaign, however, stating that it has raised awareness of obesity.
On other topics, Jarvis acknowledges, a bit of finger-wagging may be essential in order to achieve policy aims. For example, she also headed up the department’s SmokeFree campaign, which used strong visual imagery to scare people into giving up smoking. “Sometimes we would try to reach parents through their children,” Jarvis says, describing a campaign that showed children breathing out smoke to indicate the effects of passive smoking. “We try to use that guilt hook,” she says, explaining that the smoking habits of manual workers are so deep-rooted that a targeted approach focusing on passive smoking was an important way to get traction.
The government is now using a new approach to achieve public health aims, seeking to make food and drink providers feel more responsible for the way that people consume their products, and to enlist companies’ help in educating the public. ‘Networks’ of large organisations have been built around public health aims: there’s an alcohol group, for example, while other large companies have been signed up to promote physical activity in the workplace. Further, the department announced this month that food sellers including McDonalds and Burger King will display the calories of their products so that customers can see what they are buying. Jarvis calls this “a really big step forward”.
Yet surely there’s a conflict of interest here, for fast food providers in particular? Why would they want to deter people from purchasing their products? “Nobody’s saying that they shouldn’t sell junk food. There’s nothing wrong with junk food; it’s about your diet,” Jarvis replies. “If you’re eating hamburgers every day and that’s your staple diet, then that’s not very healthy.”
It’s doubtful whether McDonalds or Burger King would object if people ate burgers every day; but they have agreed to put calorie counts on their menus, giving people better information. Here’s the conundrum, though: if Change4Life couldn’t use the word ‘fit’ or ‘healthy’ for fear of alienating those most at risk of obesity, will that target group ever count their calories? Jarvis says this is just one element of what they’re trying to do, and other policies will be announced.
So, does Jarvis count her own calories? “Do I? Broadly,” she replies. Broadly? How many calories does she eat a day? “Does it matter? Well, for a woman, the daily recommended intake is around 2,000; I maintain a healthy weight, so I probably eat around 2,000.” Such backward reasoning may not be entirely in the spirit of the DH’s initiative. But perhaps Jarvis, alive as she is to the needs, problems and sensitivities of different sections of society, places herself outside the target group of this kind of public health policy.
Another issue is that of enforcement. Who’s checking that companies abide by the spirit of voluntary agreements? For example, fast food retailers might clearly display calorie counts – or they might hide them away on a discrete notice in the corner. Jarvis says the answer is to have a “trusting but challenging relationship” with providers. She stresses that these will be voluntary agreements, but adds that there are charities which would vocally criticise a company for not sticking to their pledges. Further, companies’ competitors might highlight a breach; and the department is willing, she says, to write to companies to ask why they are not sticking to their end of the deal.
The interview moves on to the biggest health issue of the moment: the Health and Social Care Bill. It is passing through the House of Commons on the day of the interview, following a long listening exercise and some changes to its contents. Health secretary Andrew Lansley admitted earlier in the year that “what I’m setting out to do hasn’t communicated itself.” What caused these communication problems? “I think that when the coalition government came in, they did a lot of things very quickly – a lot of good things very quickly – but one of the things that we didn’t do at the time was something that people had got used to: under the previous administration, our stakeholders had got used to being engaged with. We didn’t do as much of that engagement,” she replies.
Jarvis adds that there had been a big, three-month consultation exercise on the white paper first time around, but “perhaps we didn’t take as much time as we might have done to actually make people feel that they’ve been listened to.” She becomes more defensive when quizzed further. “In Andrew Lansley’s defence, I think he’s been very magnanimous in the way that he’s handled all of this. In his defence, he was shadow health secretary for six-and-a-half years... and I think he really genuinely felt he had talked to so many people about what it was he was trying to do. And the Health Bill, the white paper that he published a couple of months after coming into government, was the kind of paper he had published in opposition.”
The complications saw the department having to work very closely with Number 10 and the deputy prime minister’s office over how to communicate the plans. Jarvis calls this “a very positive experience”, adding that “health reform is both a policy exercise and also a very political exercise, and so they helped to manage the politics across the coalition government.”
Two people were brought into the department from Number 10 to help: special adviser Sean Worth, and press officer Abbie Sampson. Asked about this, Jarvis says: “Basically, we had a huge job to do and we needed more people.” On Sampson in particular, she says: “Seeing as most of the media calls were coming in here, it was good to have her on board.”
As Jarvis details this difficult period for her department – indeed, throughout our interview – she is calm, collected, and tricky to pin down. She says she is in the process of choosing between offers from the private sector – and given her ability to stay professional and unflustered, she will no doubt thrive there.
CV Highlights
1986 Graduates from Loughborough University, joins BBC
1992 Moves to work for morning television show GMTV
1999 Becomes head of news at Department of Health
2004 Promoted to director general of communications
2009 Wins ‘PR Week Professional of the Year’
2010 Awarded a CB in the Queen’s birthday honours list