Public Health Measures

Public Health Context

In developed countries such as the UK, 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.

Successive governments have pursued health policies with an aim of curbing these costs, with the former Secretary of State for Health, Jeremy Hunt, stating obesity and diabetes (Type 2 diabetes is often linked to obesity) as 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 also seeks 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, and Wales introduced a similar MUP in March 2020. Research shows that these policies have reduced consumption in the heaviest drinking households, so there are calls for England to follow suit although the government has no current plans to do so.

A report published in 2021 named the UK government’s failure to do more to stop Covid-19 spreading early in the pandemic (including decisions on lockdowns and social distancing) as one of the worst ever public health failures.

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 is forecasted to raise £1.37bn over four years from 2020-24.

Has it worked?

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. Between 2016, when the sugar tax plans were announced, and 2018, when the tax came into effect, over 50% of manufacturers reduced the sugar content of their drinks – the equivalent of 45 million kg of sugar every year.

A study of UK households showed that in the year after the sugar tax was introduced, purchasing of soft drinks remained the same, but the amount of sugar in those drinks fell by around 10%.

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 Type 2 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 would 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 would all try new programmes that may help shape future national policies. For example, Bradford would 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 would 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 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 would 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 were offered an eight-week programme involving lessons on healthy food options and cooking healthy meals from scratch. There was also a push to encourage families to reduce their sugar intake and to get children more active through dance.

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.

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 Type 2 diabetes, heart disease and cancer.
• The money spent on these conditions could be better spent elsewhere.
• It could reduce consumption and encourage people to choose healthier foods.

However, many oppose this because:

• Many people are obese because of medical or mental health issues. For example, people experiencing depression have a 58% increased risk of becoming obese. Hormonal issues and some medication can also contribute to obesity.
• The most disadvantaged people face the greatest obstacles to overcoming obesity, and inequalities in the numbers of people living with obesity have widened.
• It’s hard to eat healthily when you’re stressed.
• Price manipulation is seen as a form of control. Not only does it drive people to a certain decision, but it implies that people are not responsible for their actions.
• It’s likely to affect those on a low income the most – but the least affluent socio-economic groups in the UK have a higher rate of obesity.
• Denying autonomy may be a step backwards for a developed society such as the UK.
• Many people would argue that the cost of implementing the tax could be better spent on improving treatments that don’t infringe on society’s freedoms.

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 included:

• 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.
• A ban on these items being placed in prominent locations in stores. Shops should be encouraged to promote healthier choices and offer more discounts on foods like fruit and vegetables.
• Calorie labelling required by law for large restaurants, cafes and takeaways with more than 250 employees.
• A consultation to determine whether the provision of calorie labelling on alcohol should go ahead. It has been estimated that around 3.4 million adults consume an additional day’s worth of calories each week from alcohol and it is hoped that alcohol labelling could lead to a reduction in consumption.
• Expansion of weight management services from the NHS so that more people can get the support they need to lose weight. Including more apps and online tools for people with obesity-related conditions, and accelerating the NHS Diabetes Prevention Programme.
• A consultation to gather views and evidence on the current ‘traffic light’ labelling system for front-of-pack nutritional labelling to learn more about how it is used and compare it to international examples.

Public Health Questions

Understanding some key public health campaigns will be useful if you’re asked questions about your understanding of Medicine.

Some example questions you could be asked include:

• Have you heard of any public health campaigns recently? (answer guide here)
• What is your opinion of public health campaigns? (answer guide here)
• Do you think the NHS should fund treatment for obese people or smokers? (answer guide here)
• Why is it important to be empathetic to patients? (answer guide here)