Helen Salisbury: The commercial determinants of health

Sometimes my job seems impossible. I’m trained to treat individuals with physical and mental health problems, but in my darker moments, what I’m able to offer can feel like an endless series of sticking plasters. So much of the suffering I see is not just due to unlucky biology but is an almost inevitable result of the difficult lives my patients lead.

The patient in front of me may be breathless, have painful joints, and be at risk because of high blood pressure, but the underlying cause is something for which I have few solutions. Nearly two thirds of adults in the UK are overweight or obese, and this is a leading cause of ill health, contributing to cancers, diabetes, hypertension, arthritis, cardiovascular disease, and more.1 The health burden—as with so many other burdens—falls unequally, its greatest effect felt by those in the most economically deprived areas.2

I can advise my patient about weight loss, but there’s probably little I can share that she doesn’t already know. There’s a local weight loss service I can refer patients to, with access to courses run by commercial weight loss companies. Given the scale of the problem, however, the resources available make it feel like trying to dig the Channel Tunnel with a teaspoon. High input psychological support would help some of my patients, and without it their chances of reaching and maintaining a healthy weight are vanishingly small. Ideally, we would have started years ago, changing the food environment in childhood and adolescence, challenging the role of sugar as a cheap treat, a reward, and a comfort.

There are some grounds for optimism, such as significant reductions in lung and heart disease that have followed the dramatic decline in smoking in recent decades. These changed habits are largely attributable to legislation that’s made smoking more expensive, more inconvenient, and less socially acceptable. There’s more to do, but the tools are available, as set out in the recent Khan review, Making Smoking Obsolete.3

The problem of obesity may be more complex, but there’s no reason to suppose that some of the same strategies wouldn’t work. Increasing tax on unhealthy food high in fat, salt, and sugar, while using the revenue to subsidise healthier options, is such an obvious place to start that you have to wonder why there’s been so little intervention. Assuming that those in government do want to improve public health (which I admit is quite an assumption), the only logical explanation for such inaction is that the companies that profit from the sale of ultra-processed, unhealthy foods have undue influence when these matters are considered.4

Commercial determinants of health, in the guise of food, alcohol, and tobacco interests, play a part in holding back the public health reforms we desperately need. I’m not sure who will be health secretary by the time this column is published, but it would be great if they stopped listening to industry and started listening to public health experts and GPs.