Mitigating the harms of politics and industry

The UK population’s health is getting worse. Health inequalities are widening and obesity rates rising, particularly among children in deprived areas (doi:10.1136/bmj.q2819 doi:10.1136/bmj.r525 doi:10.1136/bmj.q2457 doi:10.1136/bmj.r593).1234 A new investigation by The BMJ explores the influence of industry on some of these trends (doi:10.1136/bmj.r667).5

The investigation finds that the advertising industry is lobbying local authorities to delay or scrap plans to ban junk food advertising on bus stops and billboards, using well rehearsed industry tactics of “deny, delay, and dilute.” With many local authorities facing significant debts, advertising companies are warning councils of the financial impact of restricting junk food advertising, telling them that they risk a substantial drop in advertising revenues. The areas targeted have some of the highest rates of childhood obesity in England. As a result, some councils have already paused or restricted plans to ban advertising of foods high in fat, salt, or sugar.

The government is leaving local authorities to push back alone against industry interests, despite recent polling by the Health Foundation and Ipsos suggesting that the public would support a tougher public health approach.6 They found that the public would support a tax on companies producing foods high in fat, sugar, and salt and using the revenues to fund healthier food for lower income families. Similarly, Zoe Rostas and Adam Briggs urge the government to take stronger action if it wants to tackle population ill health and reduce inequalities (doi:10.1136/bmj.r777).7

Is a tax on wealth another way the government could achieve these aims? Kate Pickett and David Taylor-Robinson discuss how a 1-2% tax on the wealthiest 0.04% of the population—those with wealth above £10m—would raise £10bn-24bn a year (doi:10.1136/bmj.r720).8 Other forms of wealth taxation could raise as much as £60bn a year, which could be used to reduce poverty and inequalities and improve population health. Given that a record 4.5 million children in the UK are now growing up in poverty, made worse by recent benefit cuts, it’s hard to argue against taxing super-rich individuals—particularly if this took the form of a regime aimed at global wealth, designed to mitigate some of the adverse effects of previous attempts.9

The government’s own sharp focus on its finances has led to a series of recent cuts, including a move to abolish NHS England and reduce integrated care board budgets by 50% (doi:10.1136/bmj.r733).10 The redundancy costs involved—estimated to be as much as £1bn—are so large that NHS leaders are asking the government for financial support to pay for this (doi:10.1136/bmj.r766).11 Will the abolition be worthwhile? The co-chairs of the BMJ Commission on the Future of the NHS consider what plans are needed to make the transformation a success and avoid harming services, but they warn that it risks “replicating the status quo” (doi:10.1136/bmj.r753).12

The reorganisation could, however, provide an opportunity to strengthen public health (doi:10.1136/bmj.r751).13 Emma Wilkinson reports on how Greater Manchester has adopted a “place based approach,” using this to improve uptake of MMR vaccinations, improve child health and educational attainment, and tackle inequalities (doi:10.1136/bmj.r727).14

Parkrun is a community resource widely seen as a success in helping people to be more active and lead a healthier lifestyle. Margaret McCartney, a longtime parkrun participant, has previously extolled its public health benefits. But news that parkrun is to be “prescribed” by GPs causes her concern, not least as it opens the door to more commercial influence of what she believes should remain community focused (doi:10.1136/bmj.r670).15