What can government do?

Most of us don’t like to be told what to do with our lives.

And most governments don’t want to be accused of taking a Nanny State approach – for example by determining what we should eat and drink. So they tend to prefer a voluntary approach to public health, providing information and advice, like the Change4Life health information programme.

However governments can and do legitimately take action when it:

  • Is in the public interest
  • Protects people who would otherwise be placed at harm’s risk as a result of actions by others
  • Ensures the protection of those who can’t protect themselves, like young children

Over the years this has enabled governments to take action in a variety of areas. This has included:

  • Banning smoking in workplaces and public spaces (to avoid harm to others through passive smoking)
  • Compulsory car seat belts (to avoid harm to passengers as well as drivers in the event of an accident)
  • Banning female circumcision (having regard to the safety of the child even where the parents have deeply held beliefs that their daughter should be circumcised)

Having established that government has a potential role to play let us look at some examples where action could make a significant contribution to public health:

Childhood obesity

The first thousand days of life, from conception onwards are particularly important. What happens to us during this time can affect whether or not we are likely to become obese and can also affect our long term health.

Children who are obese are much more likely to become obese adults – and to die earlier, after years of poor health.

 “We need to tackle the causes. An obese child is going to become an obese adult and an obese adult is going to have obese children, so we’ve got a very, very vicious downward generational spiral that we need to nip in the bud.” 

Professor Neena Modi, President, Royal College of Paediatrics and Child Health

The Times 26th May 2015 

Sadly, we know that obese parents are more likely to have obese children and increasingly don’t recognise that their children are obese.

This means that other people (their children) are being placed at risk as a result of their parents’ actions and that these people, being young children, particularly deserve protection.

This raises possibly difficult questions about the right of parents to bring up their children as they wish.

However, the three example we have given earlier are useful precedents (when governments acted to prevent the effects of passive smoking, introduce seat belts and ban female circumcision). In each case the rights of adults to make lifestyle choices for themselves and their families were tempered by action to avoid harm to others, including their children.

‘Between April and July 2011 we conducted a content analysis of food brand and product websites. We found clear evidence of HFSS (High in Fat, Sugar and Salt) products being heavily marketed to children online, with websites employing a variety of techniques to increase their appeal to a young audience.’ 

The 21st century gingerbread house  How companies are marketing junk food to children online  British Heart Foundation  

There is also one other time of particular risk during childhood i.e. adolescence. This is time when young people start to become consumers in their own right but without yet having adult maturity or tastes and while vulnerable to online marketing in particular.

 Recommendations 

To tackle childhood obesity we recommend the government: 

1. Convenes a task force, with representatives from all the key organisations who can make a difference, with a remit to reduce pre-school obesity within the lifetime of a single Parliament. 

2. Updates the Responsibility Deal with the food and drink industries to reduce obesity in adolescence by including – 

  • Targets for sugar reduction, in particular for fizzy drinks
  • A ban on the online advertising of food high in sugar, salt, saturated fat and refined carbohydrates (S3RC) which is targeted at children
  • Arrangements for independent monitoring and assessment 

Binge drinking

Binge drinking doesn’t just harm binge drinkers. It is also responsible for alcohol fuelled violence and anti-social behaviour, drink driving accidents and significant pressure on hospital A&E departments.

For example the Chief Executive of NHS England reports that binge drinking costs at least £5 billion a year – in A&E admissions, road accidents and extra policing.

 Recommendation

To tackle binge drinking we recommend the government update the Responsibility Deal with Alcoholic Drinks companies to:

  • Agree targets to reduce alcohol units, for example through lower alcohol drinks or minimum unit pricing
  • Use advertising to promote responsible drinking and lower alcohol drinks
  • Agree independent assessment and verification arrangements 

Social inequality

We know that social inequality leads to health inequality. On average people in less affluent areas die younger and enjoy fewer years of good health.

For example the UK’s Office for National Statistics reported that healthy life expectancy in the London borough of Richmond upon Thames, is around 70 years for male and females, compared with just 54 years for females in the London Borough of Tower Hamlets. It is surely no coincidence that Richmond’s residents tend to have a higher socio economic status than Tower Hamlets residents.

We recognise there is no quick fix here but anything government can do to reduce these inequalities is likely to be good for public health.

The growing pay divide between those at the bottom and top of organisations has often been commented on but not yet successfully addressed here in the UK and so is continuing to fuel social inequality.

This divide does not appear to be performance related. For example a report by research firm Income Data Services found that between 2000 and 2010 the pay of Chief Executives at the 350 largest quoted companies rose by 108% - whereas the value of the 350 companies rose by just 8%.

 Recommendations 

The remuneration committees of large companies, which decide senior executive pay, to include at least one third staff representatives. 

It is also worth considering who is most vocal in opposition to the actions we have set out above. If this is companies with a vested commercial interest in selling unhealthy products, who claim this is an infringement of personal liberty, we may draw our conclusions as to the real reason for their opposition.  

Governments may also wish to consider what legacy they are leaving. We now know enough about the causes of obesity to start to address these causes, as opposed to just managing the symptoms. There is an opportunity to turn back the tide and start to reduce obesity levels. This would make us the first country in the world to achieve this – a major achievement any government could be rightly proud of.

Public opinion also seems to be moving in this direction. From MPs, policy shapers, journalists and NGOs to ordinary people we’ve undertaken pilot research with, there seems to be an increasing understanding that we need to tackle the root causes of ill health not simply wait until people are ill and then treat the symptoms.