Sugar, the missing ingredient in election manifestos?

There was plenty to chew on in the party's manifestos on health and the NHS, with promises to cut waiting lists, modernise hospitals and create more GP and dental appointments.

But prevention plans were rare in these policy menus, as were proposals for how to help us stay healthier.

As obesity and diabetes rise, and the number of children requiring emergency care for tooth decay continues to grow, some experts say keeping people out of the hospital is just as important as caring for them once they are sick. A recent report from the Health Foundation think tank concludes that “America’s health is declining, placing a growing burden on public services and limiting future prosperity. Much of this poor health is preventable.”

Tackling sugar consumption would be a vital part of any initiative to improve people's health, but the word “sugar” only appears twice in total in the manifestos of the five main political parties in England. This is surprising, given that policies to limit sugar consumption and regulate unhealthy food products have been the subject of public debate for almost a decade.

In 2015, chef Jamie Oliver launched his own campaign for a sugar tax, after filming a six-year-old boy having rotten teeth pulled under general anaesthetic for a TV documentary.

The government did indeed introduce a tax on high-sugar soft drinks in 2018. Manufacturers, keen to avoid paying it, reduced the sugar levels in their products so that they fell below the tax threshold. The Institute for Government reported that total sugar sold in soft drinks fell by more than 35% between 2015 and 2019.

Attention then turned to sugary foods. Public Health England (which has since been abolished) began publishing rankings of the sugar content of products such as biscuits, cakes and cereals. There was a veiled threat from civil servants and some ministers of a levy.

In his final weeks in power in 2016, then-prime minister David Cameron was set to unveil plans to ban “buy one, get one free” deals on unhealthy products in supermarkets and restrict TV adverts for junk food and other high-sugar products.

But like unwanted leftovers on a plate, these plans were abandoned by his successors at 10 Downing Street. Theresa May and Boris Johnson were unimpressed with the menu of anti-obesity policies and were skeptical of state intervention in public health. The government, it was argued, should not interfere in citizens' decisions about what they should eat and drink.

The pandemic has complicated these debates, with ministers and officials focused solely on tackling Covid-19. And when soaring food price inflation took its toll on households, politicians argued that it would not be fair to add a tax on sugary foods.

The upshot of all this? Restrictions on where unhealthy products can be promoted in supermarkets have been introduced in England. But other measures that have been discussed on and off for a decade have been delayed until October 2025. A ban on advertising such products on broadcast media before 9pm and at any time online will not come into effect until then. Buy-one-get-one-free promotions will also be banned.

The delay was announced in June 2023 by Prime Minister Rishi Sunak, who explained his thinking: “At a time when household budgets are under continued pressure from rising global food prices, it is not right for the government to limit the options available to consumers when they do their weekly shopping.”

In England, the proportion of adults classified as overweight or obese rose from 61.2% in 2015-16 to 63.8% in 2021-22, according to government data.

Opponents of the sugar tax on drinks might use these figures to argue that it has not had enough impact. Supporters will say that the figures would have been worse if the levy had not been imposed. A study published last year in PLOS Medicine concluded that it was “associated with a reduction in the prevalence of obesity in sixth-grade girls, with the greatest differences observed among those living in the most deprived areas.”

Internationally, the statistics are depressing. A report published in February in The Lancet indicated that, based on 2022 data, more than 1 billion people worldwide were living with obesity. The United Kingdom, with 27% of men declared obese, fared worse than Germany (23%), Spain (19%), Italy (18%) and France (10%). .

The financial pressures are evident. Costs associated with diabetes care are increasing rapidly. A University of York study concludes that diabetes cost the UK almost $14 billion in 2021-22, including more than $10 billion for the NHS. The demand for weight loss drugs for diabetics such as Wegovy is expected to increase sharply.

The statistics are clear, but what is the reality for patients? Professor Kamila Hawthorne is president of the Royal College of GPs. A few years ago, she moved to a practice in a deprived area of ​​south Wales, where she sees many overweight and obese patients. They are more likely to develop back and knee pain and so need time off work, she says. They are also at higher risk of developing diabetes, cancer or high blood pressure. GPs can encourage people to eat healthier, adds Professor Hawthorne, but there is only so much they can do.

With many of her patients working multiple jobs while raising their children, “they just don't have the time so they opt for takeout,” she says. “They know what the problem is and they have tried to lose weight but often feel helpless.”

Dr Jack Jacobs, a GP who practices near Ashford in Kent, says the number of diabetics and pre-diabetics has increased by around 50% in five years and mainly among young adults. He says local doctor's offices have hired a health coach to promote activities such as Couch to 5k, but “there seems to be a lack of effort in education around diet and lifestyle – It’s surprising that some teenagers and young adults just don’t seem to understand what exercise is.” East”.

The British Medical Journal reported that one in six integrated care boards, responsible for running health services in their area, have stopped accepting patients for specialist weight management services. Patient numbers are said to have spiralled out of control, with demand far outstripping capacity. An academic expert told the BMJ that where services exist, they are often oversubscribed and at risk of funding cuts.

Other experts believe that only an intergovernmental approach will be adequate to resolve the problems. Professor Jonathan Pearson-Stuttard, head of health analysis at consultancy LCP, says this approach must be a priority for all departments in Whitehall: “The links between poor health and poor economic outcomes are more and more obvious. Preventing the onset of disease is essential to managing the complex demand for health care and supporting health-focused prosperity. »

So why haven't politicians done more? Some clearly fear being accused of acting as a welfare state if restrictions are imposed. Business leaders also tend to oppose the idea of ​​new taxes on food.

The Food and Drink Federation says the taxes will not encourage product reformulation, an industry term for creating new recipes with fewer unhealthy ingredients while trying not to lose customers.

The study adds: “Food and beverage manufacturers have voluntarily reduced the fat, salt and sugar content of their recipes, as well as portion sizes, for decades, but it takes time to change products very appreciated. The study also argues that banning advertising and promotions would “limit the ways in which companies can inform families of exciting new options.” »

The governments of Scotland, Wales and Northern Ireland have developed their own obesity strategies. All four UK countries tended to defend existing policies and report bold ambitions for intervention. But as the debate around the sustainability of the NHS intensifies, a wider debate on health will be needed – and that has not been the case in this campaign.

The problem is that developing common policies between different departments will take time and will not be the subject of manifesto headlines.

But as Amanda Pritchard, chief executive of NHS England, said in a recent speech: “Are we going to tackle the problems at source, or are we going to accept that the NHS becomes an expensive safety net?

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