Government Trails Smoke-free Ambition in Health Proposals

Peter Russell

July 23, 2019

The Government has launched a consultation on proposals to tackle the causes of preventable ill health in England.

It included an "ambition" for England to be smoke-free by 2030, and a ban on the sale of energy drinks to young children.

The green paper, Advancing our health: prevention in the 2020s , was published by the Cabinet Office and the Department of Health and Social Care on Monday.

Labour accused the Secretary of State for Health and Social Care, Matt Hancock, of "trying to bury the bad news" just hours before Prime Minister Theresa May handed over office to the newly elected Conservative leader, Boris Johnson.

Jonathan Ashworth, the shadow health secretary, described the proposals as a "missed opportunity". He said Mr Hancock had abandoned plans to extend its levy on sugar-sweetened beverages to milkshakes, and shelved an expected levy on tobacco firms to fund smoking cessation services.

Health think-tank The King's Fund described the timing of the paper's release as "shabby".

Health Challenges

The green paper set out a series of challenges and opportunities for the years ahead, saying the 2020s would be a decade of "proactive, predictive, and personalised prevention".

The paper was "not about nannying" but helping people to make the best choices.

The three leading risk factors of years lived with disability in England in 2017 were:

  • High body mass index (6.4%)

  • Tobacco use (5.9%)

  • High fasting plasma glucose (5.5%)

Evidence suggested that the biggest challenges were staying smoke-free, eating a healthy diet, being active, and taking care of mental health.

On smoking, the green paper proposed targeting the 14.4% of adults who still smoke. It proposed an "ultimatum for industry" to make smoked tobacco obsolete by 2030.

Tackling higher smoking rates in areas of deprivation and in certain groups such as those with poor mental health, and lesbian, gay, bisexual, and transgender people were also proposed.

The consultation paper acknowledged that obesity was a major challenge to health, and one that the Government had not been successful in tackling. It said that with 1 in 3 Year 6 children, and 2 in 3 adults, overweight or obese, there was cause for serious concern about future population health.

It announced an end to the sale of energy drinks to children under the age of 16, with the full policy to be set out in a consultation "shortly".

If evidence showed that industry had not made enough progress on reducing sugar, the Government could extend the levy on sugar-sweetened beverages to sugary milk drinks, it said.

The Government would also be publishing chapter three of the childhood obesity strategy which sets out plans for infant feeding, clear labelling, food reformulation, improving the nutritional content of foods, and support for individuals to achieve and maintain a healthier weight.

It promised a mental health prevention package, and proposals for a new vaccination strategy.

An ambition to reduce the population's intake of dietary salt to 7g per day would come in a revised salt reduction target next year for industry to achieve by 2023.

Health Opportunities

The consultation also detailed major health opportunities likely to be encountered over the next 10 years that could lead to:

  • Targeted support

  • Tailored lifestyle advice

  • Personalised care

  • Greater protection against future threats

New technologies, including genomics, and artificial intelligence, could help create new prevention techniques.

Smart devices worn by individuals could usher in a new wave of intelligent public health in which people had access to their NHS health information, and personalised health interventions.

Individuals should be "co-creators of their own health" rather than "passive recipients of care", the document envisaged.

The green paper also contained an alternative plan to the original strategy of selling DNA test kits to healthy individuals. Instead, under the Accelerating Detection of Disease (ADD) challenge, up to 5 million healthy volunteers will be recruited to support research, prevention and treatment of major chronic diseases, including cancer, dementia, heart disease and mental health conditions. 

In a written ministerial statement, Seema Kennedy, minister of state for health, said: "For the first 70 years of the NHS, we have been successful in helping people live longer. Life expectancy has increased by almost 30 years over the past century. Cancer survival rates are up, mortality rates from heart disease and stroke are down.

"Despite this progress, over 20% of our lives are spent in poor health. On average, men born today can expect to live 16 years in poor health and women 19 years.

"There is also a clear social gradient, with people in deprived areas living shorter lives in poorer health. Now we must move from thinking about life span to health span: the number of years we can expect to live healthy, independent lives."

Reaction to the Consultation Proposals

The green paper attracted early comments from a number of organisations. Labour described it as a "missed opportunity" which raised "disturbing questions" about the role of lobbyists which it said had watered it down.

Deborah Arnott, chief executive of health charity Action on Smoking and Health, said: "The Government is to be congratulated on setting an ambitious target to end smoking by 2030. However, to achieve this will require innovative new policies and funding."

The British Dietetic Association (BDA) welcomed the plan to ban the sale of energy drinks to under-16s. Annabel Gipp RD, who appeared before the committee on behalf of the BDA, said: "This policy will help ensure that children are not exposed to cheap, high-caffeine drinks which effect their sleep and concentration. These products are already required to be labelled as unsuitable for children by law, so this is a logical step to take.

"Government now needs to support the sales ban with clearer restrictions on the marketing of these products, and clear public health messages to ensure parents recognise that energy drinks are not for children." 

The British Medical Association called for cuts to public health funding to be reversed. Prof Dame Parveen Kumar, board of science chair, commented: "While the paper has a focus on personalised prevention, it has failed to commit to the effective population-wide measures that are required if we are to truly improve the public's health.

"Without effective regulation, such as the extension of a minimum unit pricing for alcohol, and the introduction of legally-binding limits on air pollution, this cannot be a truly effective strategy."

The Royal College of Nursing said the proposals were "short-sighted" and appeared "to have been buried in the dying days of the current government".

The King's Fund said the consultation document was unlikely to meet the significant public health challenges faced by the country. David Buck, senior fellow at the think-tank, urged Boris Johnson to tackle the issues. "The next Prime Minister should move quickly to restore confidence that the population's health will be a key priority for the new government.

"The paper is a missed opportunity to build on the success of the sugar tax by taking a bolder approach to using tax and regulation to improve public health. Rather than seeing this as the nanny state, polling indicates that public support for these kinds of interventions is stronger than politicians often assume.

"The paper includes some welcome initiatives, for example on childhood obesity, mental health in schools, and intentions to move towards a smoke-free society. But overall, it falls short of the scale and ambition needed to address the big health challenges we face as a society, including stalling life expectancy and growing health inequalities."

Consultation on the green paper will run for 12 weeks. A government response is expected in spring 2020 when proposals will be set out in more detail.

Advancing our health: prevention in the 2020s, Cabinet Office, Department of Health and Social Care.  Report .

Editor's Note, 26th July 2019: This article was updated to include changes to Government DNA testing plans.

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