While there has been much focus on the challenges faced by the NHS of an ageing population, there has been less discussion at the other end of the spectrum. Children are the adults, and parents, of tomorrow – they represent the future. Their health in childhood is critical to their physical and mental wellbeing later in life. Protecting their health could translate into a healthier, sustainable NHS.
To that end, ahead of the election, Labour have launched their proposals for public health, which bring child health into focus. Specifically, they have proposed legislative measures to limit fat, sugar and salt content in foods marketed to children, and the introduction of standardised cigarette packaging.
These aren't new ideas, but they have been characterised as an attack on personal liberty by UKIP's Nigel Farage and as an attack on parents in the Telegraph. But are these critiques warranted? In our personal view, political parties should not shy away from tackling these ‘nanny state’ views and having an open and honest dialogue with the public if there is evidence based action that will help improve the public’s health.
A ‘helping hand’ or a ‘nanny state’?
Navigating a careful line between taking a tough stance through imposing legislative ‘nanny-state’ health measures versus leaving individuals to make their own lifestyle choices is a difficult one for any political party. Labour’s focus is on empowering people to make healthy choices with a firmer steer directed at measures promoting children’s health. Legislative measures to protect children are likely to be more acceptable to the public than more general measures.
Changing lifestyles to make lasting, healthier choices is difficult for anyone. And for children and young people, setting out on the right foot isn’t just down to them. Young children depend on their parents to make healthy choices for them. Older children are influenced by their parents, teachers and friends. And all of us are influenced by industry (through advertising) and the environment in which we live. It seems to us that the government has a role in shaping that environment through taxation and legislative changes, and that this should be seen as a ‘helping hand’ rather than as ‘nanny state’ interference.
Limiting sugar, salt and fat content of foods marketed to children
In the UK a worrying one in three 10/11 year olds are overweight or obese. This puts children at higher risk of conditions such as diabetes and heart disease later in life. Key to tackling this problem is ensuring children get a healthy diet along with sufficient physical activity.
The food industry plays an important role in this, but so does government. The Faculty of Public Health withdrew from the Responsibility Deal (a voluntary collaboration between government and industry) in 2013 because the “softly softly approach” had not effectively improved health. Labour now propose limiting sugar, salt and fat content of foods marketed to children as a way of taking firm action against the influence of advertising on children, a measure is endorsed by the Faculty of Public Health’s manifesto Start Well, Live Better.
However, children do not just consume food and drinks marketed specifically to them. The Five Year Forward View highlights that, “our young people have the highest consumption of sugary soft drinks in Europe”. This is a clear contributor to high levels of childhood obesity, as well as tooth decay.
In 2014, Mexico implemented a duty on sugar-sweetened beverages in response to a high level of obesity and type 2 diabetes. While it is too early to assess its effectiveness, survey results indicate Mexicans have lowered their consumption of sugary drinks. A similar sugar-sweetened beverage tax, a proposal that would go beyond Labour’s recent pledges but is supported by the UK Faculty of Public Health, is one way that political parties could make a big difference.
Introducing standardised cigarette packaging
Standardised cigarette packaging is aimed at preventing children from taking up smoking. The Coalition government have also now announced that a vote would be brought before Parliament on this issue before the election. Long called for by health campaigners, this is a worthy aim because we know that approximately two thirds of adult smokers start before the age of 18. Commitment to this measure is a solid step forward.
Emerging evidence from Australia, who implemented a similar measure in 2012, shows that it may have contributed to the gradual reduction in overall smoking prevalence. In 2013, 95% of 12-17 year olds in Australia had never smoked.
While the proportion of young people (11-15 year olds) smoking cigarettes has slowly declined over recent years in the UK – in 2013, approximately eight in every 10 children had never smoked – continued action is still needed to further reduce smoking and to tackle the harms of second-hand smoke. In addition, a careful eye will need to be kept on the emerging evidence of the impact of e-cigarettes.
Giving children’s health a voice
The Five Year Forward View recognised that a radical upgrade in prevention is needed to ensure a sustainable NHS. Amidst the huge challenges posed by keeping our growing, ageing population healthy, the importance of our children’s health can sometimes be side-lined. But this is key to sustaining the NHS by preventing demand over the years ahead.
We all have a role to play in keeping our children healthy – including the government. Fears about ‘nanny state’ interventions should not prevent us from supporting the measures that make a difference to the health of our young people. We need to be prepared to discuss these issues openly and honestly.
Currie C and Davies A (2015) ‘The health of our children, the health of the NHS’. Nuffield Trust comment, 29 January 2015. https://www.nuffieldtrust.org.uk/news-item/the-health-of-our-children-the-health-of-the-nhs