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Knowing about public health measures is one of the hot topics that you have to prepare ahead of your Medical School interview. It could crop up in any number of interview questions, from depth of interest to empathy or ethics!

Public Health Context

In developed countries such as the United Kingdom, most deaths are now caused by non-communicable diseases such as ischaemic heart disease. In particular, cardiovascular diseases cause more than a quarter of all deaths in the UK.

There’s growing evidence that lifestyle choices such as smoking, alcohol and obesity increase the risk of acquiring these types of diseases. Increasingly, more money is being spent on the treatment of obesity and diabetes, with around two-thirds of adults and 1 in 5 children leaving primary school living with obesity.

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Successive governments have pursued health policies with an aim of curbing these costs, with the former Secretary of State for Health, Jeremy Hunt, stating that obesity and diabetes are top priorities. Through the introduction of the sugar tax in 2018 and the drive to educate children on the dangers of binge drinking, the government is seeking to change people’s behaviours and reduce the consumption of unhealthy products.

Whether a government implements a certain health policy depends on the benefits gained by preventing ill-health or deaths, against the human cost of infringing on personal freedoms. As of May 2018, the Scottish Government established a Minimum Unit Price (MUP) of 50p per unit of alcohol. In response to this, Public Health England was commissioned by the Government in July 2018 to review the impact of MUP and consider introducing this policy into England in the future.

Public Health Measures: Sugar Tax

The sugar tax is one of the most high-profile recent public health solutions. Here’s what you need to know about the UK Soft Drinks Industry Levy:

  • It was introduced in April 2018
  • Drinks with over 8g of sugar per 100ml have to pay a tax of 24p per litre
  • Drinks with 5 to 8g of sugar per 100ml have to pay 18p per litre
  • The government said the income generated from the sugar tax would be invested in school sports and breakfast clubs – but that’s not actually the case because the money hasn’t been ringfenced
  • It’s forecasted to raise £1.37bn over four years from 2020-24

Has it worked?

According to the government’s latest review, there was a 3% reduction in the average amount of sugar per 100g in drinks sold in 2019, when compared with 2015.

However, 11% of consumers said that they would stop buying sugary drinks before the tax came into effect – but this has fallen to 1%. Furthermore, the number of people that expressed their intention to continue buying sugary drinks has grown from 31% in February to 44% in June 2018.

The sugar tax does seem to have been successful in raising awareness of the health impacts of excess sugar intake. Manufacturers have started adapting and reformulating carbonated drinks, and most soft drinks now fall below the sugar tax threshold. Since 2016, when the sugar tax plans were announced, the amount of sugar used in drinks each year is 45 million kg less.

The current Prime Minister, Boris Johnson, suggested undertaking a wide-ranging review on taxes such as the sugar tax, based on concerns that they unfairly penalise those who can least afford it and questions to their efficacy.

Combating Childhood Obesity

Data from the National Child Measurement Programme estimated in 2018/19 that 22.6% of children aged 4 to 5 in England were overweight (an increase of 0.2% from the previous year). This rises to a third of 10 to 11-year olds (consistent with the previous year’s data).

Improvements to home entertainment, combined with increased junk food consumption, are some of the primary factors.

The NHS is extremely concerned by childhood obesity, because of the concern that this is likely to cause major healthcare problems in the future. Key concerns include:

  • Obese children are more likely to become obese adults
  • They have an increased risk of developing type 2 diabetes – a condition that 745 children and young people under 25 were treated for in England and Wales in 2017/18.
  • The number of children with diabetes has increased by 47% in the last five years.

Public Health Measure: Local Council Trials

In 2017, the government published a plan for action on childhood obesity to try and significantly reduce it over the next ten years. As part of this plan, in June 2019, it was announced that five local councils will be given £100,000 a year over a three-year period to help test and redefine ideas for addressing childhood obesity and health inequalities.

The councils being trialled are Bradford, Blackburn with Darwen, Nottinghamshire, Lewisham and Birmingham. They will all try new programmes that may help shape future national policies. For example, Bradford will partner with local mosques to help South Asian children (who are at an increased risk of obesity) by giving them places and fun ways to exercise. Blackburn and Darwen will work with local restaurants to improve menus and include healthier options.

Public Health Measure: More Opportunities to Exercise

In July 2019, the government announced plans to ensure children have more opportunities to do 60 minutes of sport and physical activity every day, under the School Sport and Activity Action Plan. The Department of Education has committed £2.5m in 2019/20 for more training for PE teachers and to enable schools to open their facilities during holidays and at weekends. Also, Sport England will give £2m to create 400 new after-school clubs in disadvantaged areas to encourage children to get active.

Public Health Measure: Leeds Example

In spite of a rising trend of childhood obesity nationally, Leeds has become the first UK city to see a drop, likely due to many different actions taken by the council as part of a child-obesity strategy made a decade ago. For example, staff who work with pre-school children and healthcare professionals were all trained to encourage healthy eating.

Also, through the charity Henry, parents have been offered an eight- week programme involving lessons on healthy food options and cooking healthy meals from scratch. There has been a push to encourage families to reduce their sugar intake and trying to get children more active through dance.

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Public Health Measure: Fat Tax

There’s been discussion around a fat tax – but this is much more controversial than the sugar tax because of its connotations of punishment, judgement and blame.

England’s Chief Medical Officer, Dame Sally Davies had been considering placing a tax on all unhealthy foods in a bid to reduce childhood obesity and a report was expected in September 2019, however, no report has yet been issued.

It’s unlikely that the new Prime Minister would be supportive of the fat tax.

Some support the idea of a fat tax because:

  • Obesity costs the government more than any other lifestyle factor
  • It leads to health problems such as diabetes, heart disease and cancer, and is entirely preventable
  • The money spent on these avoidable conditions could be better spent elsewhere
  • There is evidence to suggest that taxing vices such as fat reduces consumption and encourages people to choose healthier foods; the argument was successful for the sugar tax, and many feel that the same is true in this instance

However, many oppose this because:

Public Health Measures: COVID-19 Reaction

The government announced a Better Health campaign to help people lose weight after it was discovered that nearly 8% of critically ill patients with COVID-19 on intensive care units were morbidly obese. That’s compared to 2.9% of the population that is morbidly obese.

The measures in the new obesity strategy include:

  • Banning unhealthy food advertisements (classed as foods high in fat, sugar or salt) on television and online before 9pm, with consideration to extend the online ban to apply at all times.
  • Ending ‘buy one, get one free’ promotions and other promotions of foods high in fat and sugar.
  • There will also be a ban on these items being placed in prominent locations in stores. Shops will be encouraged to promote healthier choices and offer more discounts on foods like fruit and vegetables.
  • Calorie labelling will be required by law for large restaurants, cafes and takeaways with more than 250 employees to enable people to make healthier and more informed choices as part of a balanced diet.
  • A consultation to determine whether the provision of calorie labelling on alcohol should go ahead will be launched before the end of 2020. It has been estimated that around 3.4 million adults consume an additional days’ worth of calories each week from alcohol and it is hoped that alcohol labelling could lead to a reduction in consumption.
  • Weight management services from the NHS will be expanded so that more people can get the support they need to lose weight. This step will include more apps and online tools for people with obesity-related conditions, and accelerating the NHS Diabetes Prevention Programme. GPs will be encouraged to prescribe exercise and more social activities to help keep people fit.
  • A consultation to gather views and evidence on the current ‘traffic light’ labelling system for front-of-pack nutritional labelling will be launched to learn more about how it is used and to compare it to international examples.

Public Health Questions

Understanding some key public health campaigns will be useful if you’re asked questions testing how much you understand about Medicine.

Some example questions you could be asked include:

Test Your Knowledge

Think you’ve nailed remembering all you need to know if public health comes up in your interview? Try our short comprehension quiz and find out!

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