Winning Hearts and Minds. The Political Battle in Health.

Determined to address some of the key issues driving health inequalities, New Labour set up a raft of social marketing initiatives targeting smoking, alcohol, obesity and poor diet. However, It seems that despite years of concerted effort the Blair government achieved mixed results. What went wrong?

The report published this month from The King’s Fund provides clear evidence of policy success but also of failure. It seems the healthy lifestyle advice, support and programmes, were actively taken up by those in higher socio-economic and educational groups. Clear reductions in the risk behaviours in these groups were observed between 2003 – 2008. However, this success was not replicated in the poor and less educated. Many maintained or even increased risk prone lifestyles. Consequently, the efforts of the Blair years rather than reducing social inequality were responsible for increasing it.

These results deserve a closer scrutiny. Behavioural change is incredibly hard to achieve and sustain. The reality of today’s lifestyle can be a constant series of temptations, hurdles and pressures, which serve to influence our behaviour increasing our chances of future ill health.

It is a war of attrition in which we have to make constant choices between instant and delayed gratification at a physiological, psychological and sociological level. The World Health Organisation in its report on behavioural health risks in developed countries estimated a 29% increased health burden associated with smoking, obesity, alcohol and insufficient consumption of fruit and vegetables. Moreover, secondary health risks resulting from raised cholesterol levels and obesity contributed a further 15%. A more recent 2008 pan-European study showed a striking four-fold difference in mortality between those engaged in all four risk factors versus those engaged in none. This equates to a reduction in life expectancy of 14 years.

Do the results of the King’s Fund study give an indication of where to apply resources? Not really, as some 75% still engage in two or more health risk behaviours. Moreover, despite poor exercise and diet, these factors do not have the morbidity and mortality impact of smoking. We are left with a complex picture of risk behaviours often in combination and present in individuals with varying degrees of willingness to positively change behaviour.

The report goes on to suggest some important lessons. Firstly, the government must ensure a more joined up approach to the problem. Various departments were responsible for different risks, which were poorly coordinated and inefficiently funded by central government departments. This was a recipe for silo thinking, duplication of effort and a diluted learning process. Secondly, the report points to the need for a comprehensive cognitive and behavioural framework incorporating the multitude of factors that influence the attitudes and behavioural intentions of those in the lower socio-economic groups that have historically been so hard to reach. Some of this information already exists, such as the Healthy Foundations report prepared by the Department of Health back in 2008. However, it appears along with other areas of research not to have been integrated into public health thinking or policy.

There appears to be however a more worrying initiative announced by the coalition that if implemented in other areas of social marketing as part of the government’s austerity measures looks set to derail the progress of the Blair years. The Department of Health’s Change4Life campaign launched in January 2009 represented a major initiative to tackle childhood obesity. It has become a highly recognisable brand achieving significant awareness and bringing childhood obesity to the attention of the public and health professionals. However, it has yet to achieve it’s full behavioural change objectives and recently publishing a three-year revised marketing plan. Buried inside the strategy report is a worrying change of direction with regards funding and stakeholders.

The coalition government intends to install the commercial sector as the majority stakeholder for the funding, and future initiatives of the program. The very companies that have been responsible for the shift towards our obesogenic environment and have been clearly implicated in the rise of childhood obesity levels. Allowing the food multi-nationals to effectively self-regulate does not bode well for achieving substantive long-term change. It is not only consumers who have to play their part in regulating their activity and diet. The manufacturers through clear labelling, product development and responsible promotion must also implement an active policy of contributing positively to the health of their consumers. Going on past history only direct legislative action will bring this about.

The pressure on the current government to take steps to reduce the future healthcare burden is growing. Costs for preventable diseases need to be contained and if possible reduced, before they overrun an NHS already struggling with an ageing patient population and limited resources. When the coalition draws nearer the end of its first term in office, it remains to be seen if successful management of the UK’s preventative health challenges will take centre stage as a key election issue.