The Government’s health reforms have rightly come under fire for threatening the future of the National Health Service. And they fail in another fundamental respect.
They do little to tackle the major contributors to premature death in this country: obesity, alcohol misuse and smoking. These can only be addressed effectively by tackling fast food advertising, the marketing of alcohol as glamorous and tobacco displays in large supermarkets.
Somewhat perversely, the Tory-led coalition is seeking the assistance of fast food and drinks corporations to help draft strategy in public health reforms. The idea is to replace state intervention with private and corporate action.
The giants of the food industry, such as Tesco, Mars and PepsiCo, are to be assigned the task of behavioural change with a view to “nudging” the public into better choices, instead of having government regulation on public health.
Corporate social responsibility is a good thing, but the reality is that the first responsibility of these companies is always to their shareholders and that means maximising profits from the consumption of sugar, salt and saturated fat in line with consumer demand.
This massive conflict of interest means that, while these companies do have a role to play in promoting healthier lifestyles, the shaping of public health policy must lie with government and with the health professionals who see the negative consequences of their patients’ lifestyle choices on a daily basis. The NHS has never really taken on a serious preventative role. It is still focused on the treatment of acute illnesses. This has to change, because we are now facing shrinking budgets alongside high public expectations of services.
Promoting knowledge of about and adherence to healthy lifestyles is one of the best ways to cut healthcare costs. With problems caused by obesity, alcohol and smoking increasing every day, it is time the NHS took the lead to protect and promote the nation’s public health.
The negative effects of obesity and unhealthy lifestyles in general cannot be overstated. Higher rates of alcohol abuse, obesity and smoking are the reason why people in Tameside (where I work) will die two years younger than the national average. These health inequalities can be seen even more starkly within Tameside itself – those in the poorest parts of the area will die five years before those in the most well-off sections.
From my experience as a GP, I estimate that my patients’ medical costs would have been significantly reduced, if not eliminated, if their diets and exercise regimens were optimised. It is simplistic and unhelpful to suggest that obesity is caused purely by the moral failure of individuals. In fact, obesity is an unintended consequence of our modern culture and powerful advertising. At the very least, people have a right to know what damage many heavily promoted products are doing to them. Better still, we should be restricting such advertising to help young people make the right choices in their formative years. This early learning will then get embedded in a way of life for the years to come.
The misuse of alcohol is responsible for causing severe health problems. There has been a staggering 1,000 per cent increase in deaths from cirrhosis of the liver in the 25-44 age group. Ironically, the pub – which combines alcohol intake with social interaction – is in decline, as more people drink at home with cheap alcohol bought from the supermarket.
I have had patients lose weight and stop smoking, and the changes in their quality of life can be dramatic. We can only really help those who want to help themselves. So individual commitment and responsibility are vital. But it is within the power of government to help to shape healthier habits and thus protect the health of the next generation. Setting a minimum price level per unit of alcohol and increasing taxation in relation to the alcohol strength of particular products would help to reduce alcohol misuse. The taxes would provide revenue toward the immense cost of the health problems caused by these products.
Other steps should include urging restaurants to list calorie counts on their menus; opening school playgrounds and athletics fields to local communities; realigning bus routes and other means of transportation to increase access to supermarkets and grocery stores; developing walking and cycling networks; and increasing access to free, safe drinking water in public places as an alternative to sugar-sweetened drinks. Such steps may be seen as radical and, in some cases, they may be unpopular. But legislation against smoking was once regarded in the same way.
As it stands, Health Secretary Andrew Lansley’s plan to put the food industry and drink industry in the driving seat will reverse any progress made in past two decades on public health, and will further fuel obesity and alcohol abuse.
The NHS bill for the treatment of acute illnesses will keep on soaring and our society will be the poorer for it –in both financial and health terms. Food and drinks companies could play a role in helping change the nation’s health for the better, but only once the Government has used its own powers to ”nudge” them to change their own behaviour around the advertising, promotion and discounting of alcohol, tobacco and unhealthy food.
Kailash Chand is chairman of Tameside and Glossop primary care trust
