Councils are stepping in to address the public health policy gap

By Adam Briggs | 19 October 2023

Local authorities across the country are leading the way to create healthy places and reduce the impact on residents and communities from tobacco, harmful alcohol use and unhealthy food.

At the Health Foundation, we’ve produced a new framework showing what councils can do across their teams to address these risk factors with the aim of supporting officers and councillors identify opportunities to go further still.

Gains in life expectancy have stalled and inequalities are rising. It’s long known that what makes us healthy lies largely outside of health services and is instead determined by the building blocks of health - which include good housing, a stable job and fair wage, high-quality education, and access to green space.

When these building blocks are weak or missing, our health can suffer, such as when businesses promote unhealthy products like alcohol and unhealthy food.These products remain the leading risk factors for premature death and disease in England. Tobacco is responsible for around 450,000 hospitalisations every year in England and is the single leading cause of differences in life expectancy between the most and least deprived communities. Alcohol causes over 200 illnesses including cancer, heart disease and liver disease, directly resulting in over 20,000 deaths a year. And obesity – partly/largely driven by unhealthy food – now impacts over six in 10 adults at an estimated cost of £58bn to the UK from health and care costs and from lost work productivity.

Tackling these risk factors not only means supporting people to quit smoking or cut down on harmful drinking, it also means preventing harm in the first place.

Tobacco remains clearly in the government’s sights but on alcohol and unhealthy food, successive government policy has focused on supporting individual behaviour change at the expense of creating healthy places and preventing harm. Supporting individuals is clearly important, but its impact is hampered by the flood of wider commercial factors that influence our health – the ubiquitous advertising and availability of unhealthy food in our towns and cities or the ready availability of cheap high-strength alcohol.

In the public health policy gap left by government nationally, local authorities are stepping in to improve health and narrow inequalities driven by these risk factors. To help councillors and officers go further, we set out to understand the breadth of population-level approaches being taken by councils in England to reduce exposure to tobacco, alcohol and unhealthy food.

We reviewed documents and policies from across national and local government, charities, professional organisations and the peer-reviewed literature to identify the policy levers available and to find examples of what’s already being done. Through this and with follow up interviews, we produced a framework containing nine key mechanisms available to councils to take population-level action. Together, these mechanisms cover legislative responsibilities and enforcement, role modelling change, and system leadership and partnerships.

The framework is intended to be a tool for councillors and officers to review existing local approaches and see where there may be additional opportunities to improve health. Local needs and council circumstances will inevitably mean that different mechanisms will be more or less applicable, and so alongside the framework we’ve also provided examples of approaches taken by different local authorities, identified relevant national legislation and listed a range of resources to support implementation.

People’s lives in England are being cut short. Part of the solution lies in creating healthy places for everyone that reduce harm from alcohol, tobacco and unhealthy food. Councils are increasingly taking the policy lead here, despite facing significant financial challenges. Recent Health Foundation polling found that people in England are supportive of councils being given greater responsibility to tackle these risk factors. So we’re now working through what changes to national legislation could potentially help alongside addressing the urgent need to boost local government finances.

We hope our work in this area can contribute to a debate about what’s required to help councils in England maximise their contribution to addressing tobacco, alcohol and unhealthy food – local leadership on this agenda is needed as much as ever.

Adam Briggs is a consultant in public health and a senior policy fellow at the Health Foundation

The Health Foundation have put together a briefing aimed at local government leaders setting out clear actions that can be taken to address the building blocks of health within local government focusing on tobacco, alcohol and junk food consumption.

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