The Government’s 10 Year Health Plan is a mixed bag on prevention – how can regions help make the shift from treatment to prevention a reality?

The government recently launched the 10 Year Health Plan for England, calling for a shift from treatment to prevention. This is a laudable aim, but it is sadly not entirely matched by the ambition of the policy announcements in the plan – particularly when it comes to preventing the harm caused by alcohol. However, national policy is only one piece of the puzzle – regional and local decision makers have a vital role in prevention. Our recent work sets out a blueprint for regions and local authorities to take coherent action on the three biggest killers – tobacco, alcohol and obesity.


ASH has been working closely with the Alcohol Health Alliance (AHA) and Obesity Health Alliance (OHA) to highlight the impact of the three biggest killers. This work demonstrates that the three industries behind the products that lead to poor health, all use the same underhand ‘playbook’ of tactics to distract from harm and influence policy in their favour, as highlighted in the Killer Tactics report.


As a community we must respond strongly and coherently to these common industry tactics, but all too often our efforts are siloed. In 2023 our Holding us Back report set out a framework for a coherent approach to the three biggest killers, learning lessons from success in tobacco policy.


In response, health leaders in Greater Manchester and Humber and North Yorkshire have taken a lead in driving forward a coherent approach in their regions. We’ve worked with them to develop a regional framework, underpinned by a comprehensive strategy, and brought to life through five high impact action areas. This work builds on the framework developed for the Holding us Back report, and the brilliant Health Foundation framework for local government action.


You can find the full suite of resources we have developed in our Three Biggest Killers Regional Toolkit. The toolkit includes a main document with evidence base and a step-by-step guide, a ‘making the case’ slide deck to be adapted locally, and templates for needs assessment, stakeholder mapping and asset and deficit mapping.


To demonstrate the pioneering work already happening on the five high impact action areas, colleagues across Greater Manchester and Humber and North Yorkshire have shared case studies for the toolkit. Some of these excellent examples, mapped to the high impact action areas, can be found below:

1. Regulate advertising
   
   We know that efforts to restrict the marketing of tobacco products have been highly effective in bringing down smoking prevalence. The same principle applies to alcohol and unhealthy food and drink, and local authorities can take a lead by restricting advertising of these products on their estates. The City of York have done this to great effect – restricting these and other products harmful to health through their Advertising and Sponsorship policy.
2. Shape use and environment
   
   Smoking bans and age of sale restrictions have been key to driving down smoking rates over the years, how can we apply this principle to reduce harm from other harmful products? Local authorities have a variety of planning and licensing levers at their disposal to shape the use of harmful products and commercial environments for residents. For example, Bury and Bolton are using alcohol harm as a factor in licencing decisions, Hull are working to prevent the over proliferation of hot food takeaways, and Trafford have removed vending machines from their leisure centres.
3. Influence price and affordability
   
   We know that price is a key driver of purchasing decisions, and that tobacco price rises through fiscal measures, such as taxation, have been an effective policy tool. While there are limited levers available regionally and locally for price changes, there is power in collective lobbing of national government for changes we know would be effective such as minimum unit pricing for alcohol. For unhealthy food and drink local authorities can make the healthier option more affordable and accessible, as Stockport have done through their enhanced free school meals offer, widening eligibility to a free healthy meal at school for children.
4. Communicate health messages
   
   Communications campaigns on smoking have been an important factor in people’s decisions to stop smoking, and in the public’s awareness of the danger of tobacco. It’s a more nuanced picture in alcohol and unhealthy food and drink, but there are some great community mobilisation efforts to tackle harmful products while minimising stigma and shame, such as Wigan’s use of the Communities in Charge of Alcohol initiative. Big comms campaigns are often more cost-effective over a regional footprint, as demonstrated by the Alcohol Action campaign in Humber and North Yorkshire.
5. Provide treatment
   
   People are three times more likely to quite smoking when using a stop smoking service compared to going it alone. We must ensure that people at risk of harm from alcohol and unhealthy food and drink also have access to evidence based effective treatment services. We know where is a significant overlap of risk factors, so wherever possible, services should be integrated. Oldham, for example, have integrated support for multiple risk factors, helping people to move more, manage their weight, stop smoking and reduce their alcohol consumption.

At our webinar to launch the toolkit to an audience of 400 professionals across local authorities and the NHS, Peter Roderick, Director of Public Health for York, said “it's very important to start, at the off, by not focusing on the individual and individual choice but to think about the environments that these three industries create, and how those environments are often stacked against individuals that are trying to do their best to live healthy lives.”

If we can come together to tackle harmful industries coherently regionally and locally, then we can create the right environment for our communities to be as healthy as we know they want to be.