Is the UK facing a new wave of interventionist public health policy?Alex Tiley, Consultant
Following until recently in the steps of New Zealand, Prime Minister Rishi Sunak announced that the Government will introduce a generational smoking ban and look at measures to regulate the marketing and sale of vape products, with a particular focus on disposable vapes. Sunak claimed that he was doing so to take action against the rise in recent years of youth vaping and secure a generation without cigarettes.
The announcement was met with outrage from the libertarian-leaning think tanks of Tufton Street, as well as many Conservative politicians on the right of the party. The Nanny State, to them, was back in full force and it would create an enforcement and legal scale minefield in the future that will likely require adult smokers to carry ID cards and see 49 year old secret shoppers conducting operations on the honest shopkeeper at your local newsagent. For health stakeholders however, the generational ban is a good idea: ensuring a whole generation in theory can never purchase cigarettes and prevent subsequent generations becoming addicted to nicotine.
Irrespective of whether one agrees with either groups analysis of the policy, the decision of the Prime Minister to focus on this area and make it a flagship of his premiership is of more interest and how, over the past few years, public health has become a much more politically prescient issue. While it is true that Sunak does not drink or smoke himself, it would be wrong to attribute his policy focus to his personal choices alone. Instead, it is better to understand this focus as both a culmination and potential starting gun of a public health focus driven by political stakeholders seeing merit in directly intervening in the personal choices of individuals to facilitate more positive health outcomes,
This direction of travel has been in process for almost a decade and is much broader than nicotine. In 2016, the Osborne/Cameron budget introduced a sugar tax in the hope that it would motivate manufacturers to reduce the sugars in their products. Statistically soft drink consumption in the UK as of 2022 is at an all-time high, but UK Research and Innovation has found that the sugar tax was associated with an 8% relative reduction in obesity levels in year 6 girls, equivalent to preventing 5,234 cases of obesity per year in this group alone. Yet, the same research found no association between the sugar tax coming into effect and changes in obesity levels in children from reception class and in year 6 boys. There was also no overall change in obesity prevalence. Nonetheless, a levy of excise on a product was shown to be an effective measure in combatting youth consumption – if, perhaps, a slightly blunt one. Taxation, however, remains one of the lighter-touch forms of intervention on these issues.
One area that is of acute scrutiny and at risk of heavy regulation across fast moving consumer goods is their marketing, as it is claimed to encourage the public to make unhealthy choices. In 2019, the DCMS Select Committee recommended removing cartoon characters from boxes of sugary cereal, citing their appeal to children. Fast food chain McDonald’s was criticised by then-Deputy Leader of the Labour Party for their ‘Monopoly’ promotion for encouraging people to eat fast food. Many public health royal societies advocate for health warnings on bottles of alcohol, and “Junk food” advertisements are banned from TFL by the Mayor, leading to a bizarre scenario earlier this year where an advert for a play that featured a wedding cake, was rejected. This, being one of the most practical areas for regulation, is one of the most popular politically, although in practice previously few other than plain packaging for cigarettes have seen fruition.
In Whitehall, before a policy is developed, the civil service and ministers should ask two key questions: can the government help in this area, and should the Government be involved in this area. This is an important guiding principle of Government, as it seeks to take a view whether the state’s involvement is practical and desirable. Over the last year on public health issues, answering yes to both these questions has become easier.
This movement is incongruous for the Conservative party, who have traditionally been more amenable to personal choice and responsibility over state intervention and so the focus in 2023 is of note. These issues should be watched closely, as they seem to be moving to the centre stage and become more active legislative focuses: a shift that could well be in part due to the legacy of the COVID-19 pandemic. Heftier methods of state intervention deployed during the pandemic to protect public health, as well as build public support for the measures, will have shown officials that stricter restrictions for public health are viable, and shifted the Overton window towards greater interventionism, opening up new political levers.
For policymakers, it is vital this form of policymaking does not metastasise across public health policy and lead to the likes of “one and done” policies in bars and pubs to combat binge drinking. These policies are not without their risks, as many could risk setting back progress that more pragmatic policy could make or losing consent from the British public. As the sugar tax has shown, though these interventions can be effective, greater thought might be required about how they can be better targeted, or refined against the issue they are trying to solve. If excessive intervention and unintended outcomes become de rigeur, Tufton Street might be proved right all along, and we could be about to see a Nanny State Nightmare here in the UK.