Path for public health policy remains unclear

A new government whitepaper on health and social care proposes new powers to change food labels but lacks detail on other policies. Nick Hughes reports.

It is five months and counting since the government announced Public Health England (PHE), the agency responsible for delivering obesity and other public health policies in England, was to be axed.

At the time many commentators questioned the timing of a decision to relieve the agency tasked with steering a course through the deadly coronavirus pandemic of its duties. Those same questions were being posed again last week when the government published a whitepaper setting out proposals to overhaul health and social care less than a decade after the sweeping reforms initiated by then health secretary Andrew Lansley.

At the heart of the new proposals, which will be formalised in a new health and care bill, is a desire to make health prevention, treatment and social care more integrated and less bureaucratic, in part by giving more power to ministers.

The focus on greater integration has been welcomed by public health body the Royal Society for Public Health (RSPH), but for those businesses and health campaigners expecting further clarity on the future of policy to tackle obesity, there was little that could count as news to be found in the whitepaper. There was still no clarity either on who will assume responsibility for PHE’s flagship (though failing) food reformulation programmes.

So what did the whitepaper tell us?

There were hints in some of the terminology used of a return to a more relaxed approach to market intervention from a government that has previously shown itself unafraid to impose legislation on the food sector – or at least threaten to. Language speaking of the need for “care that focuses not just on treating particular conditions, but also on lifestyles, on healthy behaviours, prevention and helping people live more independent lives for longer”, doesn’t scream of a government planning to give the industry both legislative barrels.

Yet ministers also reaffirmed their commitment to “several changes to legislation” set out in last summer’s childhood obesity strategy, including mandatory out of home calorie labelling and advertising restrictions to prohibit adverts for products high in fat, sugar or salt (HFSS) being shown on TV before 9pm.

Other legislative measures are so far down the road that backsliding would cause severe embarrassment for a government keen to move on from the succession of U-turns that dogged its response to the pandemic last year. A plan to ban volume promotions of unhealthy foods from April 2022 wasn’t mentioned in the whitepaper but a recent consultation on the effective implementation of the regulation made clear that “this is not seeking to revisit policy decisions”, despite the protestations of the Food and Drink Federation.

Perhaps most newsworthy is the proposal to amend the Food Safety Act 1990 to give ministers the power to change EU laws that have previously governed nutritional labelling. This clears the path for ministers to introduce “new strengthened labelling requirements that best meet the needs of the consumer to make more informed, healthier choices subject to approval by Parliament”.

As Footprint reported in December, campaigners have already indicated they will push for front-of-pack labels to become mandatory (they are currently voluntary) and will also push for changes in how sugar content is displayed, with major potential consequences for suppliers of sugar-laden foods and drinks.

The real gap remains around reformulation on which nothing has been said publicly since the latest update on sugar reduction was published in October. Concerns were raised back in August that food reformulation programmes faced being shelved when PHE is wound down in the spring. Vera Zakharov, coordinator of Sustain’s Sugar Smart campaign, said at the time that PHE’s work with the food industry on sugar reduction and reformulation had been instrumental in providing healthier food options. “The health secretary has made no indications on the future of this work, and that is worrying,” she added.

It is understood that reformulation remains a key government commitment and work is set to continue as planned, but almost half a year on there is no still clarity on where that work will sit. A Department of Health and Social Care spokesperson says: “We are consulting with staff and engaging with an external stakeholder advisory group on where Public Health England’s health improvement functions would be best placed in order to continue supporting the UK’s public health system and helping people live longer, healthier and happier lives.”

As for wider public health policy, the government has said it will publish “in due course” an update on proposals for the future design of the public health system. Professionals, however, question why plans for greater health integration have been drafted before the new public health arrangements have even been consulted on. “An ‘integrated system’ is being legislated for before a major component has even been designed,” said Christina Marriott, chief executive of RSPH.

As the clock ticks down to the day of PHE’s demise we are still no closer to being able to answer a fundamental question: what comes next?

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