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By British Association for Nutrition and Lifestyle Medicine (BANT)

Public health policy should return to the top of Steve Barclay’s priority list

6 min read

After a gap of less than eight weeks, Steve Barclay returned to the Department of Health and Social Care to find NHS waiting lists of more than 7m, a social care system on its knees, record workforce shortages, and the first signs of a flu season arriving in hospitals.

Some of these challenges can be traced back to a decade of NHS budget increases failing to keep pace with demand and the ongoing lack of a funded plan to fix social care. But he also returns to a department that has presided over a 24 per cent cut in public health funding since 2015, and where tackling public health issues like obesity and tobacco have seemingly fallen to the bottom of the policy agenda.

The poorest parts of the country have just a fifth of the amount of green space like parks and playing fields as the richest, but five times the number of fast-food outlets

Between 2010 and 2019, austerity saw real terms cuts across public services and a slow-down in improvements in public health. For example, gains in life-expectancy have stalled and obesity rates continue to rise for both adults and children. Predictably, these have been most acutely felt by the most deprived communities. Whilst life expectancy continued to rise among people living in the richest parts of the country, people in the most deprived areas are dying earlier. And it’s avoidable. The life-expectancy gap between the haves and the have-nots is now nearly a decade, and the difference in how much of that life is spent in good health is closer to 20 years.

What makes us healthy sits largely outside of what goes on in our health and social care system. Instead, things like poor quality housing, poverty, and unstable jobs drive poor health. If someone is unable to afford to heat their home or needs to work multiple jobs to keep up with rising food prices, this has a direct impact on both their physical and mental health, and on the health of their family. Commercial interests also play a major role. For example, the promotion, availability and relative price of food and drinks heavily shapes what we buy and what we consume, with unhealthy food and drinks more likely to be promoted the healthier alternatives.

And health is an asset – it not only results in happier and more fulfilling lives, but it means greater productivity. The number of people out of work with poor health is growing and without improving health – in particular, focusing on improving the health of people living the poorest parts of the country – the government will be unable to meet its growth agenda or ambition to level up.

Yet despite this, Thérèse Coffey’s brief spell as secretary of state included a range of news stories that the government’s policy paper – or white paper – on health inequalities was being shelved, the tobacco control plan may be paused, and Boris Johnson’s obesity strategy was being reviewed. These are the very policy areas that government will need to prioritise if it is to have any chance of economic growth and an NHS recovery.

Many health challenges are complex. For example, drivers of obesity include everything from food-affordability, to advertising, to safe streets. No one policy is going to solve the issue, but significant improvements in health and inequalities can be made using policies that support everyone to stay healthier and are easy to benefit from. Policies such as the soft drinks industry levy that rapidly saw manufacturers reduce the amount of sugar in their drinks. And banning smoking in cars with kids that reduced their exposure to second hand smoke.

It’s this type of public health policy approach that Thérèse Coffey and Liz Truss appeared keen to quash, instead choosing to promote individual responsibility rather than wider government action.

Personal motivation to change behaviour has a role, particularly when helped by targeted support: smokers are up to three times more likely to quit with a specialist stop smoking service than without and the NHS Diabetes Prevention Programme can be hugely beneficial for weight loss. But government’s approach cannot solely rely on individual responsibility given that many factors that determine someone’s health are beyond any one person’s control. For example, the poorest parts of the country have just a fifth of the amount of green space like parks and playing fields as the richest, but five times the number of fast-food outlets.

The public largely supports greater government effort on preventing ill health and thinks that the government is not taking effective action on critical public health issues

The obesity strategy includes evidence-based measures that would reduce children’s exposure to unhealthy food advertising. It would have also limited the use of buy-one-get-one-free deals – deals that do little to save families money but instead simply make us spend more on unhealthy food.

The new tobacco control plan was expected to build on Javed Khan’s independent review setting out how the country can be smokefree by 2030. The review recommended policies such as raising the age that people can buy cigarettes and reducing the number of places where tobacco is sold. Long gone are the days that tobacco control policy was contentious yet despite cigarettes being responsible for over half a million hospital admissions a year, we are still yet to see the plan published.

Unfortunately, our recent Health Foundation review found that political preference for promoting individual responsibility over broader government action to improve health is nothing new. It’s often perceived as politically expedient against a potential public backlash and accusations of ‘nanny-statism’. Yet the public largely supports greater government effort on preventing ill health and thinks that the government is not taking effective action on critical public health issues such as obesity.

If Steve Barclay is to have any hope of finding a sustainable solution to the acute crises in health and social care, he will need to engage with public health policy to help prevent people from getting sick in the first place. This includes immediately recommitting to previously planned public health policy on obesity and tobacco and publishing the health inequalities white paper.

It’s from this platform that a more joined-up health and public health policy agenda can be developed to create a cross government strategy – including areas like housing, employment, and welfare – that supports both health and wealth. A policy agenda that protects the most vulnerable from imminent public sector cuts and then ensures the whole of government works together to create a healthier, happier, and more productive society.

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