Bold goals, missed levers: Will the NHS 10-Year Health Plan go far enough?
The Health Plan can help build a stronger NHS provided policymakers have access to the latest evidence in order to make informed decisions and address inequalities.
Healthy diets, exercise and healthy habits 鈥 the goals are deceptively simple but persuading the public is complicated. The NHS鈥檚 new 10-Year Health Plan for England signals a welcome focus on prevention rather than cure, tackling tobacco, alcohol, junk food and other causes of ill health. But could the plan go further?听听
Could the UK build on its success with the pioneering "sugar tax" to help slash consumption of sugary foods 鈥 and extend a similar levy more widely? Research by , Director of the Centre for Health Economics & Policy Innovation (CHEPI) at Imperial Business School, indicates the government could be bolder still.听听
CHEPI鈥檚 research reveals that not all proposals within the plan are backed by research. A focus on low alcohol drinks for instance could be counterproductive as the advertising of branded low alcohol alternatives is fuelling appetites for their alcoholic counterparts.听
But the plan heralds a welcome shift in mindset and an urgent attempt to nip health problems in the bud. Ending the obesity epidemic is a 鈥渕oonshot鈥, but inaction already costs the .听听
Subscribe for faculty-led insights
Fiscal tools for prevention 听
Are policy makers neglecting fiscal tools in tackling the crisis?听
The UK鈥檚 sugar tax showed how effective economic incentives can be. More than half of drink manufacturers cut sugar content before the levy was introduced, and sales of sugary drinks fell afterwards.听听
CHEPI鈥檚 research has shown that an expansion of a tax similar to the Soft Drinks Industry Levy to encompass sugary foods more widely could cut sugar purchases by as much as 38 per cent in some foods. Other fiscal measures identified by Professor Sassi and CHEPI鈥檚 research that the government could deploy 鈥 such as a tax based on nutrient thresholds鈥 .听
Companies that heavily advertise their low or no alcohol alternatives go on to increase sales of their same-brand alcoholic beer 鈥 in other words, encouraging low alcohol brands inadvertently fuels alcohol consumption, among light drinkers, according to by Dr Stijn Maesen at Imperial Business School.听
Policy makers could avoid this 鈥渉alo effect鈥 by restricting ads for both low and high alcohol products, while emphasising genuine health benefits such as fewer calories. Low alcohol alternatives still play a role, particularly for anyone trying to cut back as it鈥檚 the heavy drinkers who are most likely to consume them. 听听
But there are equity concerns: low alcohol drinks are often more expensive, meaning the heaviest health burdens 鈥 which fall on deprived groups 鈥 are not alleviated. Ensuring affordability must be part of the strategy if inequity is to be addressed.听
Navigating the junk food market and corporate accountability听
Proposed restrictions on the marketing of junk food and sale of caffeinated drinks to young people are overdue. shows that reducing exposure to unhealthy food and drink reduces consumption of these products, especially in young people. Regulation could be even more effective if it were to extend to brand marketing and digital media and incentivise the promotion of healthy products听
In a world first, the plan requires large food companies to report the healthiness of the food they sell 鈥 this will inform new mandatory healthiness targets on food sales. This is ambitious and welcome 鈥 鈥淥ur research shows that policies must tackle both demand and supply factors behind poor diets,鈥 says Professor Sassi, 鈥渨hich means not only educating and incentivising consumers but also mandating reformulation and responsible marketing by industry.鈥澨
Today, the poorest 20 per cent of households need to spend half of their disposable income to eat a recommended healthy diet, compared with . Better access to free school meals, food vouchers and higher nutritional standards in schools outlined in the plan are a promising step towards redressing the imbalance.听听听
Weight loss drugs for obesity embraced by the plan show strong short-term results but should only complement rather than replace policies such as encouraging physical activity and healthier diets which yield longer term benefits.听听
Digital tools and behaviour change 听
New health rewards and ambitious partnerships with fitness experts proposed in the plan could encourage people to become more active. CHEPI鈥檚 research reveals that the wearables and digital health technology embraced here do indeed help people get and stay fitter.听听
Research by Professor Marisa Miraldo shows that programmes that tap into peer support and existing social networks can amplify the impact of rewards for healthy choices. But these schemes must be accessible to the people who need them most 鈥 not just the healthy 鈥 with interventions designed for specific communities, or with higher rewards and incentives for those at greater risk of unhealthy lifestyles.听听
The reasons people choose to smoke, drink, or eat poorly are complex, and behavioural science reveals the risk that individuals will revert to former unhealthy habits once a scheme ends. This can be avoided with the careful design of a programme which draws on behavioural insights and fosters intrinsic motivation - gradually building stable habits by combining rewards with education and social recognition for instance, or by making healthy activities enjoyable.听听
Preventative healthcare investment can result in a more productive workforce听
Poor health is a human tragedy but also an economic drain. Obesity and related diseases cut the UK鈥檚 economic output by 3.4 per cent of GDP - that鈥檚 equivalent to an .听听
Investing in prevention is not just good for health; it strengthens the economy by creating a more productive workforce and reducing healthcare costs. But prevention requires sustained funding, political will and collaboration across sectors 鈥 all of which have too often been sidelined by short-term crises.听
The NHS 10-Year Health Plan heralds a significant shift of mindset from reactive care to proactive prevention, but the question is not whether the UK can afford to invest in prevention, but whether it can afford not to. 听
听
This piece brings expertise from across CHEPI and Imperial Business School, including Professor Franco Sassi, Professor Marisa Miraldo and Dr Stijn Maesen.