Policymakers that want to boost the country’s stalling life expectancy and reduce yawning health inequalities are doomed to fail unless they get over their aversion to bans, taxes and regulation, a think tank warns today.
New research from the Social Market Foundation suggests that policies like higher taxes on cigarettes, alcohol and junk food, stricter licensing regulations to limit places to buy such products and regulations on marketing like banning ads before a 9pm TV watershed could all help save lives. By contrast, ‘softer’ approaches like educational and information campaigns are likely to have less of an impact.
The SMF paper gathers evidence on a range of policies that can help reduce harm from smoking, drinking, obesity and gambling – comparing them on effectiveness (See Note 2). On obesity, the review found that regulatory interventions saved 1.7 times as many healthy years of life as choice-based interventions. Educational interventions to inform people of the risks of harmful drinking have little to no evidence of effectiveness, and the same was true when it came to gambling.
In general, more ‘interventionist’ policies that restrict access to harmful products and make them more expensive tend to be more effective – though it admits they may be more politically challenging to implement (See Note 3). Wider interventions – like taxes – had the advantage of being more cost-effective, at times raising money for the government, because they reached the whole population.
Habits like smoking, drinking diet and lack of exercise are believed to account for 40% of all premature deaths, and have contributed to life expectancy falling in recent years. However, government action has been inconsistent. The Tobacco Control Plan that is meant to deliver a smoke free England by 2030 has been delayed, proposed restrictions on junk food advertising and ‘buy on get one free’ deals have been postponed, and alcohol taxes have fallen in real terms.
Meanwhile, Labour has pledged to improve healthy life expectancy and reduce regional health inequalities, as part of its ‘health mission’. The party singled out reducing cardiovascular disease as a particular focus, and 80% of heart attacks in under 75s could be avoided by cutting down smoking, drinking and improving diets. However, Keir Starmer has suggested that minimum pricing for alcohol and taxes on unhealthy foods would be inappropriate during a cost of living crisis.
Earlier this month, Tony Blair called for taxes on foods that are high in sugar and salt, as well as planning regulations to be used to prevent fast food outlets opening near schools.
Dr Aveek Bhattacharya, SMF Research Director and author of the report, said:
“People are increasingly waking up to the scale of the public health challenge facing the country, which means far too many people suffer needlessly and die too soon.
There is a natural tendency towards wishful thinking, and hoping that this can all be solved the ‘easy way’, through education and information. But if politicians remain unwilling to tax and regulate harmful commodities, they leave the most powerful tools at their disposal in the box. Such measures are more politically contentious, but they are necessary and life saving.”
Notes
- The SMF briefing is published at https://www.smf.co.uk/publications/carrots-and-sticks-public-health/ on Thursday 27th July 2023.
- Findings from the SMF’s evidence review:
- Tobacco Control Scorecard – The single best policy, expected to reduce smoking rates by 10% is to implement smokefree legislation (i.e. “smoking bans” in indoor and public places) (source: US Centers for Disease Control and Prevention)
- On gambling: Policies that make gambling less affordable (e.g. banning gambling on credit), restrict advertising (e.g. preventing operators from advertising to self-excluded people) and reduce its accessibility (e.g. adding age verification to gambling websites) were deemed as particularly likely to be effective.
- On obesity, the review found that regulatory interventions saved 1.7 times as many health adjusted life years as choice-based interventions. Educational interventions to inform people of the risks of harmful drinking have little to no evidence of effectiveness, and the same was true when it came to gambling.
- Figure: General Effectiveness and perceived political feasibility of approaches to public health
Source: SMF analysis
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