Action by government
Most of us don’t like to be told what to do with our lives
And most governments don’t want to be accused of taking a Nanny State approach – for example by determining what we should eat and drink. So they tend to prefer a voluntary approach to public health, providing information and advice, like the Change4Life health information programme.
However, companies that produce or sell ’junk food’ and sugary drinks, that produce or sell cigarettes and high strength alcohol, and that create pollution (whether through factories or vehicle exhausts) all increase the risks to health.
So sometimes government needs to take action
In practice, governments can and do legitimately take action when it:
- Is in the public interest
- Protects people who would otherwise be placed at harm’s risk as a result of actions by others
- Ensures the protection of those who can’t protect themselves, like young children
Over the years this has enabled governments to take action in a variety of areas. This has included:
- Banning smoking in workplaces and public spaces (to avoid harm to others through passive smoking)
- Compulsory car seat belts (to avoid harm to passengers as well as drivers in the event of an accident)
- Banning female circumcision (having regard to the safety of the child even where the parents have deeply held beliefs that their daughter should be circumcised)
Having established that government has a potential role to play let us look at some examples where action could make a significant contribution to public health:
Child health is particularly important. That’s because research shows that what happens to us in the first thousand days of our life (from conception onwards) can have a big impact on our long term mental and physical health prospects.
So, government action to help parents help their children make the best start in life is likely to prove particularly effective.
We also know that social inequality leads to health inequality. People in less affluent areas tend to die younger and enjoy fewer years of good health. So, action by the government to reduce these inequalities is likely to be good for public health.
Tackling childhood obesity
The first thousand days of life, from conception onwards are particularly important. What happens to us during this time can affect whether or not we are likely to become obese and can also affect our long- term health.
Children who are obese are much more likely to become obese adults – and to die earlier, after years of poor health.
‘We need to tackle the causes. An obese child is going to become an obese adult and an obese adult is going to have obese children, so we’ve got a very, very vicious downward generational spiral that we need to nip in the bud’.
Professor Neena Modi, President, Royal College of Paediatrics and Child Health
Sadly, we know that obese parents are more likely to have obese children and increasingly don’t recognise that their children are obese. This means that other people (their children) are being placed at risk as a result of their parents’ actions and that these people, being young children, particularly deserve protection.
This raises possibly difficult questions about the right of parents to bring up their children as they wish.
However, the three example we have given earlier are useful precedents (when governments acted to prevent the effects of passive smoking, introduce seat belts and ban female circumcision). In each case the rights of adults to make lifestyle choices for themselves and their families were tempered by action to avoid harm to others, including their children.
There is also one other time of particular risk during childhood i.e. adolescence. This is time when young people start to become consumers in their own right but without yet having adult maturity or tastes and while vulnerable to online marketing in particular. Hence the importance of ensuring they are not targeted by advertising for products that increase health risks.
To tackle childhood obesity we recommend the government:
1. Fully implement the proposals in its Childhood Obesity Plans of 2016 and 2018.
2. Consider what further action is needed – including what can be learned from initiatives which have successfully reduced levels of childhood obesity in parts of France, the Netherlands, Australia, Denmark and (most recently) Leeds.
Binge drinking doesn’t just harm binge drinkers. It is also responsible for alcohol fuelled violence and anti-social behaviour, drink driving accidents and significant pressure on hospital A&E departments.
To tackle binge drinking we recommend the government:
We know that social inequality leads to health inequality. On average people in less affluent areas die younger and enjoy fewer years of good health.
For example, the UK’s Office for National Statistics reported that the number of years of good health enjoyed by people in the affluent London borough of Richmond upon Thames is around 70 years for males and females, compared with just 54 years for females in the less affluent London Borough of Tower Hamlets.
We recognise there is no quick fix here but government action to reduce these inequalities is likely to be good for public health.
One starting point might be the huge pay, pension and benefits divide there often is between those at the bottom and top of organisations. This has often been commented on but not yet successfully addressed here in the UK and so is continuing to fuel social inequality.
This divide does not appear to be performance related. For example, a report by research firm Income Data Services found that between 2000 and 2010 the pay of Chief Executives at the 350 largest quoted companies rose by 108% - whereas the value of the 350 companies rose by just 8%.
The remuneration committees of large companies, which decide senior executive pay, to include at least one third staff representatives – to help begin to address the issue of income inequality.
Resisting business lobbying
It is also worth considering who is most vocal in opposition to the actions we have set out above. If this is companies with a vested commercial interest in selling unhealthy products, who claim that any legislation is an infringement of personal liberty, the government is entitled to draw its own conclusions as to the real reason for their opposition.
Governments may also wish to consider what legacy they are leaving. We now know enough about the causes of obesity, for example, to start to address these causes, as opposed to just managing the symptoms. There is an opportunity to turn back the tide and start to reduce obesity levels. This would make us the first country in the world to achieve this – a major achievement any government could be rightly proud of.
Public opinion also seems to be moving in this direction. From MPs, policy shapers, journalists and NGOs to ordinary people we’ve undertaken pilot research with, there seems to be an increasing understanding that we need to tackle the root causes of ill health not simply wait until people are ill and then treat the symptoms – and that, where voluntary initiatives have proved insufficient, government may need to step in.