mnmlist: Rebalancing the public’s health over food and drink industry interests

How much do the government and the market affect people’s ability to pursue a healthier life? The Conservatives generally think that the answer is not much.  Andrew Lansley, the health secretary, believes that reducing nutrition-related chronic diseases such as obesity, coronary heart disease, type 2 diabetes mellitus, and cancer, can be achieved by individuals taking personal responsibility to eat less and move more. In the UK, socioeconomic inequalities in avoidable illness and premature deaths for chronic diseases are directly attributable to socioeconomic differences in dietary patterns.  Research has demonstrated that lower income households generally consume more energy-dense, nutrient-poor foods and beverages compared to more affluent households, rather than a diet mainly consisting of fruit and vegetables, whole grains, lean meats and fish. Consequently, a lower socioeconomic position is associated with greater a greater overweight/obesity prevalence, with the socioeconomic gradient established in childhood and tracking into adulthood.

At a time when Labour is thinking about developing progressive policies in the context of there being less money to spend, reducing the burden of NHS healthcare spending is an important consideration. Last summer, the Lancet reported that if the current obesity trends are extrapolated, by 2030 there will be approximately 8.5 million incident cases of diabetes mellitus, 7.3 million incident cases of cardiovascular disease and more than half a million new cancer cases; with treatment costs approximately £2 billion per year.

The food and drinks industry’s response to this has a sense of déjà vu. The tobacco industry systematically undermined tobacco control policies, claiming that increasing the price of tobacco via taxation was regressive, that regulating tobacco interfered with individual freedom, opted for self-regulation and aggressively lobbied government. The current government has mollycoddled the food and drinks industry, suggesting that it will not let widening social inequalities in health obstruct big business to maintain its profits. In upholding commercial interests over the public’s health, the Conservatives are at least consistent with their ideology. However, this does not mean Labour can be too pleased with its own record.

More than any previous government, the tobacco control policies implemented by Labour maintained and strengthened smoking prevalence reductions across all socioeconomic groups. However, experts think greater and faster progress was hindered by overt industry influence. Similarly, reducing over-nutrition has been constrained by the industry. It was right for Labour to become more business friendly. However, it failed to foresee that enduring social inequalities in chronic diseases would result from the intersection between a compliant government and unfettered market. When Labour left office, a sign of this unhealthy relationship was that forty of England’s 170 NHS trusts had signed long term commercial leases to fast food restaurants and high street coffee shops.

To reform the current obesiogenic food environment, an unhealthy food tax is needed alongside advocating reform for the EU Common Agricultural Policy, product reformulation, marketing restrictions to children and unambiguous food labelling. The Institute of Fiscal Studies has recommended that rather than taxing fats and sugars, a more feasible approach involves taxing energy-dense nutrient-poor snack foods and drinks, with exemptions to products that meet certain threshold nutritional requirements. This would shift food purchasing behaviour towards healthier foods and encourage industry to produce healthier products. Recently, Hungary has implemented a tax on unhealthy pre-packaged foods, whilst Denmark now taxes foods containing more than 2.3% saturated fat. France, Finland and Romania are also considering similar taxes to reduce their national overweight/obesity prevalence. In the US, some states have implemented snack food taxes only for them to be later repealed due to strong opposition from lobbyists.

Given many low-to-middle income households are understandably wary of food price increases, a food tax may be considered regressive since individuals on lower incomes generally spend proportionally more of their income on food, purchasing more energy-dense, nutrient-poor foods than relatively affluent individuals. However, a tax aimed at unhealthy snack food and drinks combined with subsidies for fruit and vegetables or improving the nutrition of school meals, would not be regressive as there would be a range of cheap, healthier alternatives. Furthermore, a reduction in the consumption of less healthier foods would decrease the proportion of individuals with lower socioeconomic position suffering from nutrition-related chronic diseases.

To what extent is the Public Health Responsibility Deal wishful thinking rather than an acceptance of industry power over government? There is a severe conflict of interest with industry co-funding the “Change4Life” public health campaign. When Phillip Morris was allowed to participate in social marketing to reduce teenage smoking, it produced the “Think. Don’t smoke” campaign which was generally ineffective and, at worst, counter-productive to tobacco control efforts.  Retail food outlet companies are not troubled by voluntarily committing to the out-of-home calorie labelling pledge. Research demonstrates that changes in the information environment by itself will not markedly reduce consumption of unhealthy foods. Such policies neglect tackling the constraints in the food environment for having a healthier diet. Furthermore, evidence shows that health education campaigns are more likely to be adopted by more socioeconomically advantaged individuals, thereby maintaining social inequalities in health.

Labour’s new generation cannot see the problems it sees and not try to change population health for the better. There will be fierce opposition to any effective policies aimed to rebalance industry interests over public health engendering a fear of electoral reprisals. But this is the time to find the spirit of past public health movements which had responded to the widespread health problems created by rapid industrialization.

We must make the argument that effective government action to reduce inequalities in chronic disease is a pro health and economic choice. If public health is defined as what we, as a society do to collectively assure the conditions for all to be healthy, then clearly we have not done enough.

Dr Amrit Caleyachetty (Executive Officer, Nottinghamshire Fabian Society)

This article was written by Dr Amrit Caleyachetty in his personal capacity. The opinions expressed in this article are the author’s own and do not reflect the views of the Fabian Society or any institution the author is affiliated to.