We must change the failing approach to ill health
The UK’s health looks increasingly frayed and unequal. Even prior to the pandemic, people were living more years in poor health, life expectancy gains had stalled, and inequalities were widening.
Smoking, poor diet, physical inactivity and alcohol use are leading risk factors driving ill health and premature death. That burden falls especially heavily on those who are more disadvantaged and perpetuates health inequalities.
Poor underlying health has a costly impact for individuals, public services and the economy. More than a third of those aged 25–64 in areas of England with the lowest healthy life expectancy are economically inactive due to long-term sickness or disability.
Covid-19 has exposed the consequences of government and wider society failing to act ambitiously enough to improve the nation’s underlying health. Our obesity rates – the highest in Europe – left the UK particularly vulnerable to poor outcomes from the virus and contributed to high death rates.
Government has signaled it wants to address this. It has set a levelling up mission to extend healthy life expectancy by five years by 2035, while narrowing the gap between the richest and poorest. Ambitious targets have also been set to go “smoke-free” by 2030 and halve childhood obesity while reducing inequalities. But there are stark warning signs that its current policy approach is insufficient to tackle these challenges.
Fiscal measures, reformulation of unhealthy products and marketing restrictions are far more likely to be effective
Trends are going in the wrong direction for many of the leading preventable health risks, with national targets set to be missed. Child obesity rates are at a record high. Alcohol-related hospital admissions and deaths have increased, and rates of harmful drinking have gone up. Smoking remains stubbornly high among those living in more deprived areas, and physical activity levels declined even further during the pandemic.
This week the Health Foundation published a review of recent government policies in England tackling leading health risks. Our review finds that government’s approach has been uneven, with a heavy reliance on policies aimed at changing individual behaviour – including NHS weight management services, information campaigns and apps that provide people with rewards to incentivise healthy eating. This is despite strong evidence that these interventions will have limited impact in isolation.
Population-wide policies that impact everyone – such as fiscal measures, reformulation of unhealthy products, and marketing restrictions - are far more likely to be effective, particularly for people experiencing greater deprivation.
The government’s approach has also been uneven across different preventable health risks, and decision-making across departments has been disjointed. Action to tackle harmful alcohol use in England has been particularly weak, with no national strategy produced since 2012.
Some population-level fiscal and regulatory policy measures have been proposed by government over the past decade, including minimum unit pricing for alcohol, banning sales of energy drinks to children younger than 16, and adopting a “polluter pays” levy for tobacco companies. But many have been abandoned or not moved beyond consultation stage, even where there is strong evidence of their effectiveness.
There are worrying reports No.10 may be about to repeat this pattern once again by diluting, or dropping, new regulations restricting promotion of foods high in fat, salt or sugar before they even come into force. This would be a backwards step.
It is not a case of government simply needing to wag its fingers, “nanny”, or "ban stuff" – familiar tropes that so often dominate political and media discourse in the UK. The government needs to recognise major risk factors driving ill health are influenced by a complex mix of factors.
A multi-pronged policy approach is needed. Population-level interventions that aim to alter the environments people live in – such as minimum unit pricing for alcohol and a sugar and salt reformulation tax – should be implemented alongside more targeted policies for individuals in need of advice and support. This must be underpinned by wider action to address the root causes of ill health – reducing factors, such as poverty and poor housing, that make it harder for people to adopt healthy behaviours.
The strong role played by corporations in shaping environments and influencing individual behaviour must also be recognised and addressed more consistently through government policy.
A large majority of the public sees the government as having an important role in improving people’s health. Health Foundation/Ipsos polling – conducted between November and December 2021 – found 80 per cent of the public think national government has responsibility for ensuring people stay healthy, compared to 62 per cent in the summer of 2018.
An ambitious long-term vision and whole-government approach is needed to improve the nation’s health. Government has promised a “health disparities” white paper this spring. It must seize this as an opportunity to present a more coherent long-term strategy to tackle poor diet, smoking and the other leading preventable health risks.
As we recover from the pandemic and seek to build greater resilience against future shocks, now is the time to act.
Grace Everest is policy fellow at The Health Foundation.
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