Winning Hearts and Minds: The Political Battle Over Health
Why a population's health in the age of pandemics should be a national priority.
Posted Jun 30, 2020
Determined to address the key issues driving health inequalities, successive governments have set up a raft of social marketing initiatives targeting smoking, alcohol, obesity and poor diet. However, despite years of concerted effort, results have been mixed. What is going wrong?
It seems that healthy lifestyle advice, support and programmes, are actively taken up by those in higher socio-economic and educational groups. However, this success is not replicated in the poor and less educated. Many maintain or even increase risk-prone lifestyles. Consequently, the efforts of the government rather than reducing social inequality are responsible for helping to increase it.
These results deserve 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%. Studies have shown 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.
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.
What needs to happen? Firstly, the government must ensure a more joined-up approach to the problem. Different departments are often responsible for different risks, which are poorly coordinated and inefficiently funded by central government. This is a recipe for silo thinking, duplication of effort, and a diluted learning process. Secondly, there is a 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.
As the level of obesity continues to grow, pressure on government to take steps to reduce the future healthcare burden is increasing. Costs for preventable diseases need to be contained, and if possible, reduced before they overrun healthcare budgets already struggling with an ageing patient population and now the long-term challenges of COVID-19.
A healthy population should now be more than ever in the age of pandemics be a national government priority.