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 calorific, nutrient-poor foods and drinks compared to more affluent households, which are more likely to subsist on a diet of healthy fruits and vegetables, whole grains, lean meats and ﬁsh. Therefore, belonging to a lower socioeconomic group carries with it a greater likelihood of becoming overweight and obese.
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 continue into the future, 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 and that regulating tobacco interfered with individual freedoms. They aggressively lobbied government to endorse a policy whereby the industry would regulate itself free from state constraints. The current government has mollycoddled the food and drinks industry, suggesting that it will not let widening social inequalities in health frustrate big business’ pursuit of 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. The party failed to recognise that an unfettered market combined with loose government oversight was a recipe for enduring social inequalities in chronic diseases. When Labour left office, a sign of this unhealthy relationship was that 40 of England’s 170 NHS trusts had signed long term commercial leases to fast food restaurants and high-street coffee shops.
Reform is desperately needed to prevent an obesity epidemic in the future. An unhealthy food tax should be introduced, alongside marketing regulations that restrict advertising to children and put an end to confusing food labelling. The Institute of Fiscal Studies has recommended that rather than taxing fats and sugars, unhealthy snacks should be targeted with exemptions for products that meet certain threshold nutritional requirements. This would shift food purchasing behaviour towards healthier foods and encourage the snack industry to produce healthier products.
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 healthy foods would decrease the proportion of individuals with lower socioeconomic position suffering from nutrition-related chronic diseases.
Labour’s new generation cannot see the problems it sees and not try to change it approach to public health. There will be fierce opposition to any effective policies that aim to rebalance industry interests. But this is the time to find the spirit of past public health movements which 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 pro-economic choice. If public health is defined as what we, as a society, do to assure the conditions for all to be healthy, then clearly we have not done enough.
Amrit Caleyachetty is a member of the Young Fabians