Mission possible if…

In its NHS 10 Year Health Plan published earlier this month, the Government outlined its ambition to prioritise prevention over treatment, and to move away from acute hospital treatment to local, neighbourhood health and social care to make living healthier more accessible, which is a bold and welcome shift in national policy. There were also welcome commitments to reducing obesity and improving physical and mental health and wellbeing for children and young people.

We know illnesses not only take a toll on individuals’ health and wellbeing, but also significantly affect the economy through a combination of lost days at work and the cost of health and social care –  a 2023 OBR report cited this as a reason for concern in terms of our ability to pay national debt.

Currently, there is an average gap in healthy life expectancy of 22 years between different areas of the country and three times more people die by the age of 60 in the most deprived areas than in the least deprived. Most worryingly, 89% of deaths in England are caused by non-communicable diseases which are often preventable.

In its manifesto, the Government set an ambitious goal to halve the gap in healthy life expectancy between the richest and poorest regions of England. Health inequalities are driven by many factors, including housing, education, income, employment, and the environment, and the gap between the most and least deprived areas is widening.

Commercial influences help to drive the consumption of alcohol, tobacco, unhealthy foods, and gambling, which can significantly increase the risk of developing a range of life-limiting, and sometimes fatal, conditions. Moreover, because of the affordability and accessibility of these products, people in deprived areas are disproportionately affected by these influences, making existing inequalities worse.

However, there are ways we can tackle this influence. In fact, we have already seen how to shift the dial – and prevent people from becoming ill as a result of consuming these products – through a powerful combination of policy change and public information in the reduction of smoking in the population. While there is still further to go, this has been a major public health success story with the most recent data showing that in 2019 smoking caused 74,600 deaths in England, a decrease of 9% from 2009.

A joint report published by Action on Smoking (ASH), the Obesity Health Alliance (OHA) and Alcohol Health Alliance (AHA) shows the similarities between tobacco industry tactics and those of other health-harming products, and highlights how these industries are currently profiting from ill-health, while the public pay the price in poor health.

We need to harness the lessons we have learnt from tackling tobacco harm and apply them to tackling the illness – and death – caused by consumption of other harmful products. For example, with around 66% of the population being overweight, the consumption of unhealthy food and drink is a very real public health problem. In fact, Nesta’s blueprint for halving obesity already makes it possible to identify the most effective policy interventions to use and at what scale to reduce obesity.

So, if we know what works, why aren’t we making the progress we want to make and seeing the number of people who are experiencing preventable ill-health fall? How do certain individuals, groups and organisations work to shift the public and political view against the interests of improving health?

Crying ‘nanny state’ is a way of crushing sensible public discussion. People absolutely should have freedom of choice, but the reality is that far from giving people this freedom, industry tactics have taken it away; real freedom of choice is allowing people to live in an environment where choosing to live healthier is affordable, accessible and desirable.

We need not only to recognise and counter the tactics used by industry but also ensure that policy itself is kept free from industry influence so that it can be developed and implemented in a way that will truly improve the public’s health.

At the local level, we have used licencing and planning policy as one of a range of ways to tackle the rising rates of obesity. For example in Gateshead, planning policies to restrict hot food takeaways in areas of deprivation have been shown to reduce childhood obesity. Meanwhile, councils across the UK have taken action to restrict advertising and marketing of harmful products on council owned property as well as introducing policies on event sponsorship and on working and partnering with industry.  

Advocacy at the local level is fundamental to shaping the public and local political view and engaging citizens more in policy-making so that their interests are heard plays a vital role. Interestingly, contrary to what we hear from industry, when asked, the public expect the Government to intervene in many of these areas. For example, a Kings Fund analysis for NHS70  found that a majority of the public support stronger Government action on public health. The recent British Social Attitudes survey also showed strong and consistent support for so-called nanny state policies.

The Government’s 10 Year Health Plan rightly highlights prevention but what is critical now is that everyone involved in developing and delivering initiatives that support prevention on the ground, can work together to make the ambition a reality. Directors of Public Health are ready and willing to do that work and look forward to helping drive forward the changes, but this local work will of course need to be backed by continued and consistent national policy.