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Editor's Choice

Taking action against industry influence

BMJ 2024; 385 doi: (Published 02 May 2024) Cite this as: BMJ 2024;385:q989

Rapid Response:

Food industry’s far-reaching influence and our need to act - NOW

Dear Editor,

Thank you for highlighting the influence of the industry and corporate interference in health care (1). As individuals rooted in public health, we often have to confront the influence and the power exerted by this sector which has the potential to detrimentally affect the health of our communities. Commercial determinants of health defined as “strategies and approaches used by the private sector to promote products and choices that are detrimental to health” and its impact on the health of the population is well known (2).

The impending opening of MacDonald’s ninth restaurant in Stoke-on-Trent where the authors work (3) is relevant as the food industry has great potential to influence eating habits and its consequences at a population level. The health risks associated with excessive consumption of fast foods has been linked to increased prevalence of obesity, cardiovascular diseases and Type 2 diabetes (4,5). In Stoke-on-Trent, the population levels of overweight and obesity has been rising over the last five years, with the latest statistics showing an alarming 73.8% classified as overweight or obese surpassing the national average of 64% (6).

In addition, Stoke-on-Trent has a higher density of fast-food ratio per 100, 000 when compared to the national average - 123.0 per 100,000 compared to 96.5 (7). This disproportionate concentration in an area that is already deprived exacerbates existing health inequalities and perpetuates the cycle of ill health and deprivation (8).

Possible options to limit the impact of fast-food chains could be to incentivise healthy food retailers to establish outlets that promote nutritional options. However, creating new businesses is not always a viable option and working with existing businesses to create ways in which we can combat ill health collaboratively should be considered. Another possibility could be to implement regulation zones where there is a limit to the number of fast-food outlets that can be opened in deprived areas restricting access. This could be reinforced through education and subsidised by healthy food initiatives.

Inspiration can be drawn from other Local Authorities that have taken a systemic approach by introducing an integrated Public Health Policy to try and tackle the access to fast-food outlets, in an attempt to reduce overweight and obesity within the local population (9). The results of this initiative are yet to be reported and are due to be reviewed after 2025 but this initiative does highlight the resolve of the local authority to support and where possible address potential causes for ill health.

One of the tools available to local authorities to stem the mushrooming of fast-food restaurants is the Planning Practice Guidance (10). According to this guidance through planning decisions fast food outlets can be restricted in areas with high levels of obesity, deprivation and general poor health and also in areas with over-concentration and clustering of outlets within a specified area. Our City Council’s corporate strategy (11) is prevention focussed and has adopted the model of “preventative local democracy” and has seven priorities. These are healthier, wealthier, safer, greener, cleaner, fairer and skilled city. Under the healthier city one of the key actions is to “ensure that securing access to affordable, healthy food is a key goal in all relevant strategies, including the Local Plan”.

One has to tread a fine line as the criticism of “Nanny state” is always lurking around the corner (12). The battle for easy population access to affordable healthy food will not be won overnight as confronting the powerful food industry is no small feat but, in the end, Public Health will prevail as happened in the case of the victory against the smoking sector.

Saarah Khalid, Foundation Year 2 trainee,
Libby Kelsey, Public Health Placement intern,
Stephen Gunther, Director of Public Health,
Padmanabhan Badrinath, Interim consultant in Public Health Medicine,

Directorate of Public Health, Stoke-on-Trent City Council, Civic Centre, Glebe Street, Stoke-on-Trent, ST4 1HH

Disclaimer: The views expressed here are the professional views of the authors and in no way represent the views of Stoke-on-Trent City council

1. Dobson, J. Taking action against industry influence. BMJ. 2024; 385: q989. doi: 10.1136/bmj.q989 [Accessed 13th May 2024].
2. Kickbusch I, Allen L, Franz C. The commercial determinants of health. The Lancet Global Health. 2016;4(12):e895-e896. doi: 10.1016/s2214-109x(16)30217-0 [Accessed 13th May 2024].
3. Andrews, R. McDonald’s wants to open NINTH Stoke-on-Trent restaurant - here’s where. [Accessed 13th May 2024].
4. Public Health England. Research and Analysis: Fast food outlets: density by local authority in England. [Accessed 13th May 2024].
5. National Health Service (NHS). Overview: Obesity. [Accessed 13th May 2024]
6. Office for Health Improvement and Disparities (OHID). Health Improvement: Overweight (including obesity) prevalence in adults (18+ yrs). [Accessed on 13th May 2024]
7. Local Government Inform. Fast food outlet rate per 100,000 population in Stoke-on-Trent. [Accessed on 13th May 2024].
8. Public Health England. News Story: England’s poorest areas are fast food hotspots. [Accessed on 13th May 2024].
9. Brown H, Xiang H, Albani V, Goffe L, Akhter N, Lake A, et al. No new fast-food outlets allowed! Evaluating the effect of planning policy on the local food environment in the North East of England. Social Science & Medicine. 2022;306:115126. doi: 10.1016/j.socscimed.2022.115126 [Accessed on 13th May 2024].
10. Tedstone A. Putting healthier food environments at the heart of planning. [Accessed on 13th May 2024].
11. City of Stoke-on-Trent. Our City, Our Wellbeing Creating Shared Wealth, Reducing Inequality. Stoke-on-Trent City Council Corporate Strategy 2024-28. (Public Pack) Agenda Document for Cabinet, 23/04/2024 13:00 ( [Accessed on 14th May 2024].
12. Kirkup J. The surprising truth about “Nanny State” Britain. The Spectator., 30th January 2024. The surprising truth about 'Nanny State' Britain | The Spectator [Accessed on 14th May 2024].

Competing interests: All the authors either work or have professional association with Stoke-on-Trent City Council one of the Local authorities in England.

14 May 2024
Padmanabhan Badrinath
Interim Consultant in Public Health Medicine
Saarah Khalid, Libby Kelsey, Stephen Gunther.
Stoke-on-Trent City Council
Directorate of Public Health, Stoke-on-Trent City Council, Civic Centre, Glebe Street, Stoke-on-Trent, ST4 1HH