Wednesday, 24 July 2013

NHS Health Checks Compete with tobacco and alcohol policy for headlines

Plain cigarette packaging as has been introduced in Australia. Photo: AFP
July has turned out to be a topsy turvy month for public health. Whilst Public Health England has revealed its plans to drastically scale up the delivery of NHS Health Checks, other policy announcements have delivered significant blows to those campaigning for public health reforms.

Despite a drive to deliver 15 million NHS Health Checks over the next five years, July also saw the shelving of plans to introduce minimum unit pricing on alcohol and a rejection of proposals that would have meant cigarettes needing to be displayed in plain packets.
For many, this contradiction is likely to prove problematic. Whilst the government’s commitment to assess and advise the population on cardiovascular risk is ambitious, the political messages are mixed. Decisions that are likely to have a detrimental effect on people’s health mean that the government’s overall approach cannot really be deemed ‘holistic’.
As David Cameron has stated ‘health inequalities in 21st century Britain are as wide as they were in Victorian times. We can't go on like this.’ Despite sounding decisive, there is arguably a mismatch between the rhetoric and the policies actually being implemented (or not in the case of tobacco and alcohol).
In regard to plain packaging, the government argued last week that there was lack of evidence that such measures would work. This is no longer the case. On the 22nd July a study entitled Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study’ was published by the BMJ. A very brief summary of the study’s conclusion is as follows:
‘‘The early indication is that plain packaging is associated with lower smoking appeal, more support for the policy and more urgency to quit among adult smokers.’’
The above was strongly suspected by many involved in public health. The Faculty of Public Health even felt it appropriate to withdraw from responsibility deals and issue a strongly worded statement when the government decided in favour of allowing cigarette manufacturers to continue branding their goods.
What does seem clear at this stage is that the introduction of plain packaging would constitute an extremely grim medicine for those with vested interest to swallow. The importance of a market identity to cigarette companies is perhaps most potently demonstrated than by the fact that, in 2003, the industry allegedly spent a combined total of $15.12 billion on promotion and advertising. To remove the ability to brand the products is therefore, arguably, to take away one the tobacco industry’s most effective and refined tools.
Given that the evidence has now been published, the government can re-establish the debate armed with the knowledge they were previously lacking. Hopefully in doing so they’ll be able to standardise a consistent approach to promoting healthy living.
That said, if the contradictions ensue, one could argue that the drive to deliver 15 million health checks runs the risk of having its rationale undermined by the detrimental impacts of other big decisions that promote damaging lifestyle behaviours. Despite being a crucial element in the country’s public health programme, the NHS Health Checks need to be part of an overall set of directives that work towards preventing widespread poor health from overwhelming the NHS over the coming decades.
Yes, the issue is ultimately one of education, however the potency that lies within regulating the pricing, advertising and branding of unhealthy, ‘demerit’ goods cannot be underestimated.


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