Smoking, obesity and alcohol

How should government tackle public health issues such as smoking, obesity or alcohol misuse?

To begin with, it is essential to define public health. Discussed by Lart (2013), public health was rediscovered in the 1980s as a way of conceptualizing the health of the population. However, it has been apparent since the 19^th century. The Victorians associated civil engineering with the health outcomes of poor water quality and drains, later thinking about social housing and what this had to do with cholera epidemics of the time. Public health is usually thought about in regards to what the major problems with the health of society are at one given time, like in the 19^th century with cholera, and the HIV epidemics of the 1980s. Lart goes on to discuss how public health has “the ability to conceptualise, measure, record, and at some level manipulate the health of a population, and was central to the development of the modern nation state”. What is being explained here is that public health has been a measure by which the population can be seen as ‘healthy’ or ‘unhealthy’, and so naturally means that there is something which makes the population ‘unhealthy’. So the HIV epidemics of the 1980s were a public health issue because they illustrated the biggest cause of mortality and morbidity at the time. And so in order to answer ‘how should the government tackle public health issues such as smoking, obesity or alcohol misuse?’, it is necessary to remember that public health is what characteristically define the health of a nation and that public health issues are the things that need tackling in order to make the population “healthier”.

The main public health issues of today are issues such as smoking, obesity and alcohol misuse. They are public health issues because of the consequences they have on individuals and mortality/morbidity rates. The top cause of death in today’s society is heart disease, often heavily linked to smoking, obesity and alcohol misuse. In England and Wales in 2012, heart disease was the leading cause of death in men at 15.6%, and the second highest at 10.3% (ONS, 2013). There are many reasons which could lead to heart disease, however the NHS Choices (2012) does explain that smoking and diet related illnesses such as type-2 diabetes are influential in heart disease. To assess how the government should tackle these public health issues it is apparent that we need to look at how the government has tackled public health issues in the past in order to understand how to be successful.

As earlier mentioned, the HIV epidemic was a major public health issue in the 1980s. The government responded with committing millions of pounds in 1985 in order to tackle the problem, as well as launching campaigns such as “Don’t aid AIDS” in 1986, and “Don’t Die of Ignorance” in 1987 (HIV Aware, 2011). As Kelly (2011) explains, the “Don’t Die of Ignorance” campaign was used with a television advertisement labelled “shocking” but turned out to be hugely successful in avoiding the prediction of death on a mass scale. Immediately, what this can tell us is that the HIV/Aids public health issue in the 1980s was calmed through imminent government intervention and raising awareness for the issue, interestingly with advertisement playing a key role in solving the epidemic. To assess how the government should tackle the public health issues of today, credit must be given to their response in this particular incidence. Without a cure for the disease and treatment in the early ages of development, they took the issue straight to reducing the risk of spreading rather than attempt to cure. Consequently, the implications for this are bigger than it appears because it shows how the government sending out a message to the whole population rather than those it just affected was successful in preventing the predicted high death toll.

In 1992, the Conservative government issued the “Health of a Nation” White Paper. It was the first of its kind to identify outcomes of public health policy. Before the 1992 white paper, health policy was about inputs and allocating resources. Therefore to question ‘what the biggest factors affecting the health of the population are’, can almost be described as revolutionary, and today it can be seen as an important step in order to try to tackle the public health problems of the day. In 1992, mental health and suicide were big problems, and so the white paper attempted to reduce these targets. They implied a multi-sectorial approach: “health policy is bigger than the NHS”. What is meant by this is that to tackle these public health issues needs attention from more than just health policy, with areas such as education just as important. But being driven by mortality data and with the NHS still given the main responsibilities, suicide rates actually got worse as they were powerless to do much else than detain young men potentially or actually attempting suicide. This tells us a lot about how the government should tackle the problems of today. In 1992, their attempts at reducing suicide and mental health rates were falling because they were too specific, and more importantly, the government focussed too much on what the problems were, and not much on how to solve the problems they found. This already informs today’s government on how best to resolve public health issues as it means that knowing obesity, smoking and alcohol misuse is not enough; research needs to be taken in what leads to these issues, and what is the best way to resolve them.

In 1999, Labour reengaged the focus in public health issues with a new white paper “Our Healthier Nation”. They took a broader narrative in an attempt to improve the health of everyone, with special attention given to the worst off. Instead of shaping policy around specifically targeting one aspect of public health like the Conservatives had done earlier in the decade with mental health and suicide, the government took a more general approach. For example, with one public health issue being smoking, they attempted to reduce the harm of smoking by taking measures to outline where people can smoke, thus lowering the potential for non-smokers to inhale passive smoke. The success of this can be seen in statistics such as reported by Brimelow (2013) in the sharp fall of children admitted to hospital with severe asthma after smoke-free legislation was introduced in England. This adds to the argument that public health issues are better tackled when the government focusses on the population as a whole. By reducing the amount of smoking environments, the effects have been successful in healthcare.

Categorising the different ways in which the government can approach the public health issues of smoking, obesity and alcohol misuse is an important step in knowing how best to tackle the problems. McDaid and Suhrcke (2012) outline a key distinction between upstream and downstream interventions for which governmental intervention can take. First of all, upstream interventions are all about promoting good health. For example, promoting good health along with other goals; income support, housing improvements, better/longer education and so forth. They argue that it is critical that health systems liaise with other bodies to emphasise health impacts of their policies. This compares to downstream interventions which are specific to health. This includes interventions on diet and lifestyle advice programmes, tobacco and alcohol control policies, water and air quality monitoring, and legislative, regulatory safety measures against accidents and injuries. Downstream interventions are more common, such as the Change4Life programme operating currently, a programme attempting to improve the diet and lifestyle of the population. Nonetheless, the two interventions have an important relationship. Kelly et al (2005) describe the relationship as very interconnected; an upstream intervention to improve the general health of the population may be a “necessary precondition for other downstream interventions to be effective”. The implications of this distinction and categorisation of interventions appear to provide sufficient evidence that for governments to tackle public health issues they must tackle the situation with all the important means to do so. Basically, the government cannot tackle an issue such as obesity without educating the population on the reasons as to why diet and healthy lifestyle are of importance.

Returning to McDaid and Suhrcke (2012), they believe that public health experts forget the importance of market failure as a justification for government intervention by arguing that market failures highlight scenarios of individuals making mistakes and causing implications for society because of the free-market. A classic example of this is smoking; the cost of an individual smoking bares no comparison to the cost the smoker has on the NHS and so without government intervention with added tobacco taxes, the market would fail. Therefore, when arguing how the government should tackle public health issues, it seems vital to remember the significance of how important their intervention is.

One such measure the current government has taken in order to tackle today’s public health issues of smoking, obesity and alcohol misuse has been public health responsibility deals. Outlined by the Department of Health (2013), the public health responsibility deals are pledges committed by organisations to take responsibility in improving public health at either national or local level. Two of the biggest responsibility deals are the food pledges and alcohol pledges. The main food pledges consist of companies making healthier food products by reducing salt content and removing trans fats, whilst also providing better quality information about their products such as calorie information. With the biggest food and drink company in the UK, Unilever UK Ltd (Secomak Solutions, 2012), committing to the food pledges, some can argue that the government have taken a strategic effort in their attempt to tackle the obesity public health issue. But there are those which argue the public health responsibility deals are not and will not work. Panjawi and Caraher (2013) say that the responsibility deal approach is “fundamentally flawed in its expectation that the industry will take voluntary actions that prioritise public health interests above its own. Being government-led counts for little in the absence of sanctions to drive compliance”. The best way in which this argument can be tested is through a more explicit example of the food pledges in the responsibility deals.

Another way in which the government has attempted to tackle the obesity public health issue is through the Front of Pack Nutrition Labelling Scheme 2013. Whilst front of pack labelling has been popular for many years now, the new scheme is part of the voluntary food pledges outlined in the public health responsibility deals. The new scheme attempts to get all food and drink manufacturers to use the traffic light coding system to inform the consumer of things such as salt and energy content. The Department of Health (2013) explained how there is a need for consistency in the labelling amid the concern that “the majority of us should aim to limit our diets”. The British Heart Foundation (2013) carried out an investigation into portion sizes and labelling schemes, concluding that not only have portion sizes doubled, but most are unrealistic. However, the most important aspect to acknowledge is the fact that the research demonstrated difficulties in people’s knowledge of how much a portion actually is. Participants were “44-50% over when asked to measure out a 30g serving of Cornflakes”. What this can tell us is that despite best efforts to solve the obesity issue, it is pointless without the knowledge of how much one serving actually looks like. This lack of knowledge is where many argue the government should be focussing their attention on. This could lead to the argument that to tackle the public health issue of obesity, the government needs to remember how success in the past can be seen at directly informing or stopping the population with regards to the issue. For example, raising awareness of HIV in the 80s or creating smoke-free environments to reduce passive smoking. Linking back to Panjawi and Caraher’s argument (2013), the implications for this are that the government isn’t necessarily failing in their attempts to reduce obesity, they are just not sufficient enough to lead to real success. Even though the food pledges have successfully been voluntary actions to be taken by food manufacturers, the lack of hard-law legislation limits the ability for the public health responsibility deals to be of success also. Thereby, to tackle the public issue, the government should extend their efforts to reduce obesity by taking more verifiable action.

Alcohol misuse is another of today’s public health concerns. The Health and Social Care Information Centre (2013) report that “In 2011/12, there were an estimated 1,220,300 admissions related to alcohol consumption where an alcohol-related disease, injury or condition was the primary reason for hospital admission or a secondary diagnosis (broad measure)”. One way in which the government has responded to the issue is through the “Why Let The Good Times Go Bad?” Campaign. As part of the responsibility deals, the £100m campaign was established with three main recommendations; eating before drinking, alternating soft and alcoholic drinks, and looking after friends. Foottit (2011) argues that the campaign has been successful because she explains how “80% of young adults have adopted one of the recommendations for responsible drinking”. Instantly, the campaign can be seen as a success because of the strong level of response to the recommendations. Nevertheless, there has also been emerging evidence that the campaign posters have worked to their detriment. Morris (2013) found that exposure to Drinkaware posters actually appeared to increase alcohol consumption. What can be taken from this investigation is that it is too early to forecast any sound trending patterns as there is conflicting research over how successful the campaign has been. To contextualise this with earlier success of public health initiatives, it appears that raising awareness to the population as a whole could lead to greater success than specifically aiming the campaign at the target audience. And so even though at an early stage in approaching the drinking culture, it can be seen that the government is doing the right thing to tackle the alcohol misuse public health concern by addressing everyone with their campaign.

Finally, the smoking public health issue has to be assessed in a different manner to how obesity and alcohol misuse are. This is simply because the government does not work alone in attempting to reduce tobacco consumption. At current, global health governance sharply addresses smoking as a serious concern with Gro Harlem Brundtland (Director General of the UN World Health Organization) deeming smoking as one of the biggest global health problems we face (Sugarman, 2001). The World Health Organization has consequently set up the Framework Convention on Tobacco Control. Adopted in 2003, it the treaty is one of the most widely and rapidly embraced treaties in the entire history of the UN (FCTC, 2013) and introduces such provisions as the Protocol to Eliminate Illicit Trade in Tobacco Products. This included establishing better cooperation between the UNODC and WCO as well as implementing and researching tracking and tracing regimes. Other examples of where the FCTC have been succeeding is in persuading many countries to introduce smoking ban legislature, historically being linked to Ireland as the world leaders for the first country with a compulsory workplace smoking ban. And so subsequently, the smoking public health issue should continue being part of the global health efforts to thwart tobacco consumption as they have so far proved to be effective even if they have only been influential.

In conclusion, when looking at how the government should tackle public health issues such as alcohol misuse, obesity and smoking, it is pivotal to assess how they have been successful in the past to assess how successful they can be with current operatives. As analysed, the responsibility deals do not appear to be the best way to tackle the public health concerns over obesity and alcohol misuse because they do not impose any strenuous efforts to tackle the problems. It is easily argued that they are a positive step, but it can also easily be argued that they are not good enough to make a serious challenge at the issues faced, especially because they are voluntary commitments, which means all partners are not tied down to anything. In my opinion, because of the previous successes with smoking and HIV, the best way the government can tackle public health issues, with a good deal of interest in smoking, alcohol and obesity, is for them to put the dangers right at the heart of the entire population. This can be done through things such as television advertisements, but if the population believed that they could be affected by these issues, rather than the population just knowing about them, would be a great step in reducing the public health issues.

References

Brimelow, A. (2013) Childhood Asthma ‘admissions down’ after smoking ban Available at: http://www.bbc.co.uk/news/health-21067532 (Accessed: 12 Jan 2014)

British Heart Foundation (2013) Conclusion of our Portion Sizes Report Available at: http://www.bhf.org.uk/heart-matters-online/july-august-2013/news/portion-sizes/report-conclusions.aspx (Accessed: 13 Nov 2013)

Department of Health (2013) Front of Pack Nutrition Labelling Scheme’ Available at: https://responsibilitydeal.dh.gov.uk/front-of-pack/ (Accessed: 22 Jan 2014)

FCTC (2013) About the WHO Framework Convention on Tobacco Control. Available at: http://www.who.int/fctc/about/en/index.html (Accessed: 7^th Nov 2013)

Foottit, L. (2011) 80% of drinkers respond to the Drinkaware campaign Available at: http://www.morningadvertiser.co.uk/General-News/80-of-drinkers-respond-to-Drinkaware-campaign (Accessed: 13^th Nov 2013)

Health and Social Care Information Centre (2013) Statistics on Alcohol – England, 2013 Available at: http://www.hscic.gov.uk/catalogue/PUB10932 (Accessed: 22 Jan 2014)

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Morris, J. (2013) Drinkaware independent review raises questions for industry funded alcohol charity. Available at: http://www.alcoholpolicy.net/2013/05/drinkaware-independent-review-raises-questions-for-industry-funded-alcohol-charity.html (Accessed: 13 Nov 2013)

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ONS (2013) What are the top causes of death by age and gender? Available at: http://www.ons.gov.uk/ons/rel/vsob1/mortality-statistics--deaths-registered-in-england-and-wales--series-dr-/2012/sty-causes-of-death.html (Accessed: 12 Jan 2014)

Panjawi, C., Caraher, M. (2013) ‘The Public Health Responsibility Deal: brokering a deal for public health, but on whose terms?’, Science Direct [online]. Available at: http://www.sciencedirect.com/science/article/pii/S016885101300290X (Accessed: 25^th Nov 2013)

Secomak Solutions (2012) Top 50 Food and Beverage Manufacturers in the UK Available at: http://secomak-solutions.com/1/company/blog/blog-post/secomak-solutions/2012/08/10/top-50-food-and-beverage-manufacturers-in-the-uk (Accessed: 19 Jan 2014)

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