Smoking is a major cause of preventable ill health and early death in England, and a big driver of our stark inequalities in life expectancy. While overall rates of smoking are in decline, they remain stubbornly high among those who are more disadvantaged. In recent years we have seen little from the government about how it intends to tackle this and achieve its target of going ‘smokefree’ by 2030, announced in 2019.
If implemented, the independent tobacco review published last week would mark a significant step forward, showing the government is serious about improving and levelling up the nation’s health. Designed to inform a tobacco control plan later this year, it includes bold recommendations to raise the legal smoking age by one year each year andto make the ‘polluter pay’ for additional investment in tobacco controlif the government cannot find the additional funding itself.
The question now is whether – particularly in the current febrile political context – ministers will follow through and choose to adopt the review’s key proposals. There are already rumours swirling aboutscepticism and splits across government over its recommendations.
But smoking is not the only factor driving the UK’s high burden of preventable ill health, and in many other areas trends are going in the wrong direction. Child obesity rates are at a record high, with the government’s target to halve childhood obesity by 2030 set to be missed. The UK population consumes more highly processed food than any other European country. Alcohol-related hospital admissions and deaths have increased, and rates of harmful drinking have gone up. Physical activity levels have declined even further during the pandemic. The burden of all this falls especially heavily on those who are more disadvantaged, worsening health inequalities.
In contrast to the progress that has historically been made in the UK and internationally in tackling smoking, there has been slow progress on tackling these other major preventable health risks and too much reliance on changing individual behaviour.
The evidence shows population-wide policies that impact everyone and make it easier for people to opt for healthy choices – such as pricing measures, reformulation of unhealthy products, and marketing restrictions – are far more likely to be effective, particularly for people experiencing greater deprivation. Yet mostsuch measures proposed by government to address obesity and tackle alcohol use in recent years – such as banning sales of energy drinks to under 16s – have been abandoned before implementation, even where the evidence base is strong.
This pattern appears to be being repeated at the moment, with the government recently announcing a delay topolicies restricting junk food advertising and buy-one-get-one-free promotions on unhealthy food. Cost of living pressures were cited to justify this climbdown, despite the government’s own impact assessment showing such promotions encourage impulse purchases rather than saving people money. In its food strategy published this week, the government has again shied away from adopting the more ambitious population-level policies – such as a sugar and salt reformulation tax – recommended by Henry Dimbleby.
There has also been strikingly little action to tackle harmful alcohol use in England, with no national strategy produced since 2012. The interventions promised in that strategy, such as minimum unit pricing and a ban on multibuy promotions for alcohol, were subsequently cast aside. A decade on, no new preventative policies to directly reduce alcohol harm have been introduced at a national level.
Government must now follow through and commit to implementing the proposals outlined in the independent tobacco review. But it must also start learning from previous success in reducing smoking rates, adopting a similarly bold, multi-pronged approach to combat poor diets, physical inactivity and alcohol use.
As with smoking, these other major risk factors driving ill health are influenced by a complex mix of factors. The focus should be on population-wide interventions that aim to alter the environments people live in. These should be implemented alongside more targeted interventions for individuals in need of advice and support. Wider action is needed to address the root causes of ill health, too – reducing factors such as poverty and poor housing that make it harder for people to adopt healthy behaviours.
We must also start recognising the strong role played by corporations in shaping environments and influencing individual behaviour, addressing this more consistently through government policy. As with the tobacco industry, clearer regulations and frameworks could be developed to prevent manufacturers of harmful food and drink from interfering in policymaking – along similar lines to the WHO framework convention on tobacco control. More could be done to encourage businesses to play a positive role in supporting healthy behaviours, including ensuring that health impacts are considered as part of environmental, social and governance investment frameworks.
COVID-19 showed us the consequences of government and wider society failing to act ambitiously enough to address the nation’s poor health. 2022 is a crunch point when the public will be able to judge whether those lessons have been learnt. As well as an upcoming tobacco control plan, a new ‘health disparities’ white paper is expected this year. Government must seize these opportunities to present a more coherent strategy to tackle not only smoking but poor diets, lack of physical activity and harmful alcohol use.