Following, not leading: politicians and public opinion on action to support better health

Earlier this month, I interviewed Wes Streeting, the Shadow Secretary of State for Health and Social Care, at The King’s Fund Annual Conference. One of the topics was the recent decision by the government to delay the ban on buy one get one free offers, and the Labour Party’s support of this delay. It’s a move that has dismayed many because the evidence of both the scale of the obesity crisis and the impact that the ban could have is so clear. Wes said that politicians care about what the public think and if the public don’t want the ban, it’s right to delay.

This got me thinking about politicians, public opinion and the so-called nanny state. And it brought to mind 3 quotes from my favourite fictional pollster, Joey Lucas from the US political drama, The West Wing.

‘There go my people. I must find out where they are going to so I can lead them’

Wes is the latest – by no means the first and certainly not the last – politician to say that the reason to not act is because the public don’t want action. However, this is simply just not true. The public – on obesity and on many other public health issues – regularly say they want the government to do more.

For example, in 2020, 62 per cent of people supported restrictions on promotional offers (such as buy one get one free deals) on unhealthy foods in supermarkets. So, a majority support taking action – quite a popular measure. And although government claimed that the delay was due to the cost-of-living crisis, the government’s own impact assessment showed that people spend more with promotional offers and research from the Money Advice Service has shown that supermarket buy-one-get-one-free deals can cost consumers £1,300 more a year, with only 2 per cent of people knowing how to spot the best deals.

'The public – on obesity and on many other public health issues – regularly say they want the government to do more.'

This reluctance to act isn’t a new phenomenon. To take just one other example, in the 2000s, politicians were similarly slow to see the direction of public opinion around the smoking ban in public places. Now heralded as the most important public health intervention of the 21st century and such a normal part of our everyday lives, it’s easy from the perspective of 2022 to just assume there was a smooth and inevitable path to its introduction in full. But that was not the case. When the Bill was published in draft, it included exemptions for private clubs and pubs that did not sell food (this was decades before we got used to debating whether a scotch egg counted as a meal for the purposes of Covid-19 regulations). Despite there being overwhelming support in the consultation to remove the exemptions, the Bill when introduced kept them. But public opinion – above 50 per cent support and always on the increase – eventually forced MPs to act more boldly and the exemptions were removed.

‘You say the numbers mean you need to dial it down. I say they mean you need to dial it up’

Research by the Health Foundation shows that action taken by the government on the leading health risk factors is not viewed favourably. Fewer than 1 in 5 people believe the government is working effectively to improve physical activity (19 per cent), improve diets (17 per cent), reduce alcohol-related harm (16 per cent) and reduce obesity (14 per cent). Given this public recognition of failure to lead on these issues, why can politicians be reluctant to act? Why do politicians think the public dislike the so-called nanny state?

There is an important difference between the general concept of government’s intervention in people’s lives and support for specific policies. While there is often public mistrust of a nanny state, people tend to support specific government interventions like the sugar tax. So there is space for politicians to bring the public with them on specific and targeted actions and do more.

'Over decades, countless politicians have shown that they simply aren’t prepared to be bold and take the lead on public health measures.'

Over decades, countless politicians have shown that they simply aren’t prepared to be bold and take the lead on public health measures. Indeed, they can even be relatively slow followers of public opinion. Why might that be? There’s not the space here for a full analysis but it could be the lobbying power of specific vested interests, or the power of the media and the editorial stance of a number of prominent media institutions. It may be that business is asking for less or no new regulation – although this is not always the case with public health measures as many businesses welcome the level playing field of regulation rather than voluntary arrangements (there is a scenario where the nation’s health could be improved and food manufacturers profits maintained but there is no incentive to do so when a competitor could swiftly undercut them). It may also be that while the majority of the public may well support an action, politicians won’t act to alienate specific groups who don’t support action. It could also be that the ever-present political attack line of the so-called nanny state is just too much for the political class to resist, preventing serious debate and progress (see also social care reform and death taxes as a similar irresistible label!).

‘The numbers only tell you where people are now. Not where they could be’

Politicians say they want to improve health, but don’t use the levers available to them. As our recent work on cardiovascular disease shows, the benefits to health and health inequalities could be huge if politicians used the levers of tax and regulation more. Politicians need to be braver and quicker to act boldly on how to help us all improve our health. Far from the public being resistant to that, they are often more keen for the government to act than the politicians themselves realise. Imagine if politicians decided to lead and shape public opinion even further rather than being reluctant and slow followers on measures to support us all to be healthier.