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There was a lot to consider in each party's manifesto on health and the NHS, with promises to reduce waiting lists, modernise hospitals and increase GP and dental appointments.
But prevention plans were lacking in this political menu, as were suggestions on how to help stay healthy.
With the growing crises of obesity and diabetes, and increasing numbers of children needing emergency treatment for tooth decay, some experts say preventing hospital stays is as important as treating people after they get sick. “Our nation's health is deteriorating, putting increasing strain on public services and limiting future prosperity. Much of this ill health is preventable,” concluded a recent report from the Health Foundation think tank.
Tackling sugar consumption will be a key part of any effort to improve the public's health, yet the word 'sugar' appears a combined total of just twice in the manifestos of England's five main political parties – surprising given that policies to curb sugar consumption and regulate unhealthy foods have been publicly debated for nearly a decade.
In 2015, chef Jamie Oliver launched his own campaign for a sugar tax after being filmed extracting a rotten tooth from a six-year-old boy under general anaesthetic for a TV documentary.
The government introduced a tax on high-sugar soft drinks in 2018. Manufacturers hoping to avoid the tax cut the sugar content of their products until they were below the tax threshold. A government institute reported that the total amount of sugar sold in soft drinks fell by more than 35% between 2015 and 2019.
Then attention shifted to sugary foods: Public Health England (now defunct) began publishing tables ranking foods such as biscuits, cakes and cereals by their sugar content, and officials and some ministers threatened to impose taxes.
In his final weeks in office in 2016, then-Prime Minister David Cameron was on the brink of announcing plans to ban “buy one, get one free” sales on unhealthy items in supermarkets and limit TV advertising for junk food and other high-sugar items.
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Jamie Oliver gave evidence to MPs in 2015 as part of an anti-obesity campaign.
But these plans were ignored by his successors at No. 10 Downing Street, like unwanted leftovers on a plate. Prime Ministers Theresa May and Boris Johnson were unimpressed with the anti-obesity menu and were sceptical of government intervention in public health. Governments, it was argued, should not interfere with people's decisions about what they eat and drink.
The pandemic has complicated those debates as ministers and officials have been single-mindedly focused on tackling the coronavirus pandemic, and as rising food prices hit household budgets, politicians have argued that taxing sugary foods is unfair.
As a result, restrictions have been introduced in Britain on where unhealthy products can be advertised in supermarkets, but other policies that have been debated on and off for a decade have been delayed until October 2025. A ban on advertising these products on air or online at any time before 9pm will not start until then. “Buy one, get one free” promotions will also be banned.
The extension was announced in June 2023 by Chancellor Rishi Sunak, who explained his thinking that “it is not fair for the Government to restrict consumers' weekly shopping choices at a time when rising global food prices are putting continuing pressure on household finances”.
Rapid Rise
Government data shows the proportion of adults in England classed as overweight or obese has increased from 61.2% in 2015-2016 to 63.8% in 2021-22.
Opponents of a sugar tax on drinks might point to these figures and argue that it hasn't had a significant effect; proponents would say the figures would be worse without the tax. A study published in PLOS Medicine last year concluded that a sugar tax “was associated with reduced obesity rates among sixth-grade girls, with the largest difference seen among girls living in the most deprived areas.”
Internationally, the statistics are depressing: A report published in The Lancet in February said that over one billion people worldwide will suffer from obesity, with data for 2022. In the UK, 27% of men are reported to be obese, worse than Germany (23%), Spain (19%), Italy (18%) and France (10%).
The financial pressures are clear: costs associated with diabetes treatment are rising rapidly. According to a University of York study, diabetes will cost the UK around £14 billion in 2021-22, of which more than £10 billion will go to the NHS. Demand for weight loss drugs for diabetics like Wegovy is expected to soar.
The statistics are clear, but what is the reality for patients? Professor Camilla Hawthorne is president of the British Association of General Practitioners. A few years ago, she moved to a practice in a deprived area of ​​South Wales where she sees many overweight and obese patients. She says overweight and obese patients are more likely to suffer from back and knee pain and need to take time off work. They are also at higher risk of developing diabetes, cancer and high blood pressure. GPs can encourage people to move to healthier eating habits, but there is only so much they can do, Professor Hawthorne adds.
Many of her patients are raising children and working multiple jobs, “so they don't have time and turn to takeout,” she said. “They know what's wrong and have tried to lose weight, but they often feel powerless.”
Dr Jack Jacobs, a GP practicing near Ashford, Kent, says the number of people with diabetes and pre-diabetes has risen by around 50% in five years, most of them young adults. His local GP practice has employed health coaches to encourage exercise such as couch-to-5k, but “there seems to be a lack of focus on education around diet and lifestyle. It's astonishing how some teenagers and young adults don't understand what exercise is,” says Dr Jacobs.
The British Medical Journal reported that one in six integrated care boards, which manage local health services, have stopped accepting patients from specialist weight management services, with patient numbers said to be out of control and demand far exceeding capacity. Academic experts told the British Medical Journal that where services exist, they are often oversubscribed and at risk of budget cuts.
Some other experts say only a whole-of-government approach will be enough to solve the problem. Professor Jonathan Pearson-Stuttered, head of health analysis at consultancy LCP, says it must be a top priority for every Whitehall department. “The link between ill health and poor economic performance is increasingly clear. Preventing the onset of disease is key not only to managing complex demand for healthcare, but also to underpin health-led prosperity.”
Bold Ambition
So why aren't political leaders doing more? Clearly, some worry about being accused of being a “meddlesome state” if regulations are imposed, and business leaders tend to rally when new taxes on food are proposed.
The Food and Drink Federation says the taxes will not encourage “reinvention” – industry jargon for creating new recipes with fewer unhealthy ingredients while avoiding losing customers.
“Food and drink companies have been working for decades to reduce fat, salt and sugar in their recipes and by reducing portion sizes, but changing products that people love takes time,” they added. They also argue that banning advertising and promotions “will limit the ways companies can inform families about attractive new options.”
The governments of Scotland, Wales and Northern Ireland are each developing their own obesity strategies. All four UK nations have tended to defend existing policies and express ambitions for bold interventions. But as debate rages over the sustainability of the NHS, a broader health debate will be needed – and this campaign has failed to deliver.
The problem is that devising coordinated policies across different sectors takes time and does not make for an appealing manifesto headline.
But Amanda Pritchard, head of NHS England, said in a recent speech: “Are we tackling the root of the problem or will we accept the NHS becoming an expensive safety net?”
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