Re: Can we leave industry to lead efforts to improve population health? No
The BMJ recently ran a poll asking if we can leave industry to lead efforts to improve population health (April 17th 2013). In his book ‘Bad Pharma’ Ben Goldacre asserts that research into life-styles will never have the prominence accorded to drugs because it does not have the backing of a $600 billion pharmaceutical industry (1). Reluctantly, at least in regard to physical activity I agree and find it perplexing that the UK Government has failed to even use the data it has.
Approximately 80% of GP consultations are for Long-term Conditions (LTCs). The benefits of physical activity are well known. These include helping to prevent and manage over 20 chronic conditions that impact upon the UK healthy life-expectancy (2) and an approximately 30% risk reduction in all-cause mortality. Small wonder it was described by the previous Chief Medical Officer as a ‘wonder drug’ (3). If a drug were invented that had the same effect it is hard to imagine the demand (or profit) that would ensue.
Unfortunately physical activity can be free (gardening, housework etc) or as active travel even cost-saving (4) and therefore does not have the commercial incentives afforded to pharmaceutical solutions except where it can be commercialised e.g. gyms, leisure centres etc. The lack of emphasis on active travel is emphasised by the reaction to the recent London Mayor’s Vision for Cycling by cycle campaigners. Pledging £913 million over the next 10 years to make cycling a ‘normal part of everyday life’ it was described by the London Cycle Campaign as ‘ground breaking’ and the national cycling charity CTC as ‘breathtakingly ambitious’. However, this represents approximately 1/50th of Transport for London’s annual £5 billion budget. Similarly, the Sports England Active People Survey perpetuates and reinforces this by only reporting on physical activity within Local Authorities that is “for the purpose of health, recreation, training or competition not to get from place to place” (5). Accordingly someone who cycles or walks to work everyday (known as active transport) is reported as less active than someone who plays competitive bowls once a month. Although active transport data is recorded the Active People survey, now in its seventh year, does not report it, nor release it without agreement to a data user license.
In terms of population health this is a missed opportunity. If you are interested in how physical activity may be incorporated into everyday life google bicycle parking at any Dutch railway station. In the face of a financial and obesity crisis this would seem to be a policy own-goal.
(1) Goldacre B. Bad Pharma. How drug companies mislead doctors and harm patients. 1st ed. London: Fourth Estate; 2012.
(2) Murray CJL, Richards MA, Newton JN. UK health performance: findings of the Global Burden of Disease Study 2010. Lancet 2013 5th March 2013;doi:10.1016/S0140-6736(13)60355-4.
(3) Department of Health. 2009 Annual Report of the Chief Medical Officer. 2010.
(4) Cavill N, Kahlmeier S, Rutter H, Racioppi F, Oja P. Economic analyses of transport infrastructure and policies including health effects related to cycling and walking: A systematic review. Transp Policy 2008 09;15(5):291-304.
(5) Sport England. Explanation of the different sport participation indicators. Available at: http://www.sportengland.org/idoc.ashx?docid=d65addc2-db76-473f-92b5-12ae.... Accessed 10th March, 2013.
Competing interests: Reading for a Doctorate in Public Health (DrPH)