Health inequalities post Covid-19

As a country we’re quite good at medical treatment. The NHS is one of the most cost-effective medical treatment services in the developed world. We’re seeing this currently with the roll out of the Covid-19 vaccines.

What we’re not very good at is health – keeping people in good health so they don’t need medical treatment. For example:

  • We’ve had one of the highest number of Covid-19 deaths in Europe, partly due to the high proportion of people with underlying health conditions.
  • We have the second highest obesity rate in Europe after Malta.

It’s no surprise then that health inequality is real and increasing. Already, pre-Covid, on average:

  • If you were a man living in affluent Kensington and Chelsea you lived 11 years longer than a man living in Glasgow.
  • If you were a woman in affluent Richmond upon Thames you enjoyed 18 more years of good health than a woman in Tower Hamlets.

All the signs are that Covid-19 has increased health inequalities, with the lowest paid workers less likely to be able to work from home to reduce risk, more likely to live in cramped, multi-generational accommodation and therefore more likely to catch Covid, be hospitalized and die.

There’s clearly a need for the UK to take a preventative approach to health more seriously.

What Covid has taught us

For all the harm that it has caused, Covid-19 may have taught us a number of important lessons. Let’s take the supposed tension between business and health.

Covid has shown that countries that gave priority to prevention didn’t just save thousands of lives. They also ended up protecting businesses and jobs.

Whereas those countries, like the UK and the US, that tried to do a bit of both, ended up with the worst of both worlds - with record deaths and record recessions. The hospitality industry, for instance, is probably now wishing that the UK had acted more quickly to tackle Covid, like Taiwan, New Zealand and South Korea. This would actually have proved much less damaging to the industry and the people working in it.

So, looking forward, we hope that government - and businesses -will recognise the interrelationship between health and the economy. Taking health seriously is likely to be good for UK PLC, not just the nation’s health.

Obesity – a clear and present danger?

Obesity is a good example of health inequality. It is much more prevalent in deprived areas and increases a range of health risks. Pre-COVID we all knew obesity increased health risks - but the effects seemed a bit distant, some years down the line, leaving obesity not looking like such a priority. COVID has changed that. We now know that people who are obese are more likely to:

  • end up in hospital
  • require intensive care
  • and die.

Suddenly obesity had become an immediate risk to life, not just a distant prospect. That’s something our own Prime Minister almost experienced – and one reason that tackling obesity has moved up the agenda again, as seen in the July 2020 policy paper on Tackling Obesity.

As health campaigners we support the government’s 2018 Childhood Obesity Plan and its more recent policy paper. However, our criticism would be, and we’re not alone in thinking this, that it hasn’t gone far enough or fast enough. For example, so far in the government’s plans:

  • There’s very little about the crucial first 1000 days of life, from conception – a key period when food tastes and habits begin to be formed. 
  • There’s a continuing focus on reduction when it comes to food - less salt, less sugar and fewer calories. What’s lacking is the other side of the coin - effective action to increase the consumption of healthy ingredients, like wholegrains, vegetables, fruit, nuts and seeds. This is an agenda where both health campaigners and the Food and Drink Federation might find common ground e.g. through the FDF’s interest in positive nutrition. 
  • The Plan also significantly underestimates the scale of the forces encouraging obesity and so the scale of the measures needed to counter it.

The government’s recent Obesity Plans and Policy Papers provide some useful initial steps along the way – but to really tackle childhood obesity we need to take prevention seriously and tackle the causes. This means getting everyone working together to tackle the causes - parents, schools, health professionals, communities, businesses (not least the food and drink industry), the media, central and local government. Where other countries, like France and the Netherlands, have done this they have seen obesity rates fall.

What the food and beverage industry can do

The food and beverage industry clearly has a major role to play when it comes to health in general and obesity in particular.

- Developments in food technology (including ways of reducing sugar and salt content without affecting taste and without the use of artificial alternatives) mean that reformulation is becoming easier.

- A focus on positive nutrition i.e. on healthy ingredients, could provide a way forward which works for both the industry and the nation’s health.

- The industry’s survival depends on its ability to meet evolving needs and there’s an increased public desire for healthier food (as reported by consumer research organisations).

- There’s probably also an increasing reputational risk to those food and drink companies perceived to be resisting the move to healthier products.

All this means that the food and drink industry has an important contribution to make, in its own right, to supporting public health in the UK.

But we need a level playing field

Let’s think about the way food and drink are marketed.

Three years ago, the Obesity Health Alliance calculated that 30 times more money was being spent advertising food high in sugar, salt and fat than the government was spending to encourage healthy eating. This fits with our own research which found that in 2018 for example, KitKat was spending more money advertising a single chocolate bar than the entire government funding for its Change4Life healthy snacks campaign.  

Or take the Christmas TV ads companies launched in December. One of most effective Christmas 2020 ads was probably from Coca Cola. There’s a heart-warming storyline, humour and even a cameo appearance from Santa as a Coca Cola truck driver. It’s a very effective piece of marketing.

However, from a public health perspective, what this illustrates yet again is the lack of a level playing field when it comes to messaging. It isn’t just that companies advertising food high in sugar, salt and fat clearly have much bigger budgets. It’s the sophistication of the advertising that this money can buy and the fact that, unlike most public health advertising, there’s no need for facts, no need to be evidence-based. All you need to do is make people feel good and associate this feeling good with your product.

The government appears keen on informed decision-making by consumers - as seen in the proposals for calorie labelling. So the current lack of a level playing field when it comes to messaging is an issue the government now needs to start to take seriously.

Prevention is better than cure

For years politicians have paid lip service to the importance of prevention. What Covid-19 has chillingly shown has been the consequences, for both health and the economy, of not taking prevention seriously.

Michael Baber   January 2021