This morning I was at Demos to hear from Shadow Secretary of State for Health Andy Burnham and Shadow Minister for Public Health Luciana Berger on Labour’s approach to public health policy, launched in its paper Protecting children, empowering all. I’ve not yet had a chance to read the detail, but here are my reflections on the big messages communicated at the launch.
The launch set out a distinction between public health policies for children and for adults. On the former, Labour are pledging to be much stronger on the regulation of the levels of sugar, salt and fat in foods ‘marketed substantially to children,’ and the advertisement of these products. On the latter they intend to support adults to make better decisions about their food choices through clearer and more uniform nutritional information and labelling. This of course raises the thorny question of which products are childrens’ and which are adults’, and who decides childrens’ diets: children or adults.
It was also very clear that Labour remain sensitive to accusations of ‘nanny-statism’. So, whilst Labour will commit to acting more strongly in a range of narrowly-defined fields, for instance possibly changing the way that specific products – such as high strength, low cost ciders – are taxed, they are very wary of pulling tax levers and prices more generally to alter people’s behaviour. This means a firm no to ‘fat taxes’ and seemingly, a distancing from the minimum unit pricing of alcohol too.
The decision against pulling tax levers more generally will disappoint many in the public health field. The main argument put forward for not doing this is that such moves are regressive, penalizing the poor, who spend a much higher proportion of their household budget on food. But as we have argued before, the science behind the effects of levying a ‘fat tax’ are not clear cut, in particular the more effective taxes are in changing behaviour, the less regressive they are. There was also no mention of the Local Government Association’s proposals to devolve more of the tax-take from alcohol and tobacco to local government prevention budgets.
Physical activity was also a central theme of the launch discussions. Anyone familiar with Andy Burnham’s tenure at the Department of Health will not be surprised, and Labour have an ambition for 50 per cent of adults to meet the recommended levels of physical activity by 2025, and for children born in 2015 to become the first ‘smoke-free generation’ in hundreds of years. Somewhat surprisingly, there was nothing specific on the role, or challenge, of e-cigarettes in relation to tobacco policy, either from the speakers, or from the floor.
But, the area that leapt out for me was a commitment to 'Health in All Policies' (HiAP). At the local level, Andy Burnham pointed to his intention to bring together health and local authority budgets, ‘collapsing the silos’ as a mechanism to facilitate HiAP – increasing the incentives so that every pound works for public health. While these shared budgets would only cover the social care elements of local authority budgets, they may break down some of the barriers to a more joined-up approach. However, it is at a national level that we have consistently argued more needs to be done, particularly in the lack of assessment of wider government policies on health. We mourned the passing of the Sub-committee on Public Health when it disappeared with a whimper after Andrew Lansley’s reign; we therefore welcome its planned reinstatement.
In Labour’s new future for public health we believe there are many ways in particular that Public Health England could help take forward a wider commitment on HiAP: first by giving away its expertise and capability free to other government departments, and second by undertaking and publishing the ‘Health Impact Assessments’ of major prospective government policies under the aegis of the Cabinet Office. Overall Labour say they are serious about HiAP and we look forward to finding out more details of what that could look like in practice.