“Living Longer, Living Well” puts forward 12 interventions that might be used to reduce avoidable deaths and improve quality of life for those with multiple long-term conditions. This blog looks at these interventions through the lens of BritainThinks’ public opinion research and considers how members of the public might respond to them.
The interventions fall into four areas: alcohol, diet, physical activity and smoking. From a public perspective these feel like the right areas to address. Our focus group work suggests that there is relatively high awareness of the negative impact on health of poor choices in each of these areas, meaning that the public would not have to be “sold” on the need to act. Looking specifically at diet, several projects we have been involved in suggest that there is a real appetite amongst many for decisive action to improve the nation’s nutrition.
Moreover, many of the specific interventions are unlikely to be controversial from a public perspective. For example, tackling the illicit trade in cigarettes will feel like common sense to many, as will supporting community groups that encourage physical activity.
Increasing restrictions on marketing of alcohol and unhealthy food may be unpopular in some areas – and no doubt reference will be made to the “nanny state”. However, opposition is not a given. If the public is convinced of the need to act, and of the efficacy of the limiting marketing, then they may well support such a step. Indeed, at a deliberative event we conducted for the Healthy London Partnership, Londoners were so shocked by the statistics on childhood obesity that they called for a ban on marketing of food high in fat, salt or sugar to children and also for a range of other restrictions, including limitations on the operation of fast food outlets.
However, one area where caution might be advised is adjusting the price of goods. In three of the four intervention areas (alcohol, diet and smoking) the report recommends either tax increases or regulation to increase cost. Indeed, in the case of diet, a tax on sugar-sweetened drinks has already been announced. Yet whilst the appeal of taxation is clear from a public health perspective, winning public support may be trickier. In our research, when the issue of increased taxation is raised, the public often express the view that it is an easy way out for politicians: they look like they are taking action on an issue, whilst the burden of increased tax falls on ordinary people with moderate habits who can ill-afford to “punished for things we didn’t do”. Convincing the public that this is not the case will be key to winning support.
This point about winning support raises a wider question about how those working in public health might talk about these interventions. When talking about any, or indeed all of them, it will be important that professionals speak with one voice. Conflicting information causes confusion, raises questions about who to trust, and risks turning people off altogether. We are seeing this particularly strongly at the moment in relation to the debate about sugar. In a recent workshop on early years nutrition mothers told us that, having thought for years that fruit juice counts as one of their children’s five a day, they were both upset and puzzled to have noticed recent reports highlighting its unhealthily high sugar content.
“Living longer, living well” calls, rightly, for “brave action” on public health. The public has an important part to play in this – not only because it is public behaviour that we are seeking to change, but also because widespread public support or opposition to a proposed intervention will be a decisive factor in shaping the political response. Evaluating the probable public response, thinking about how to harness support, and crafting messages accordingly is therefore crucial.