Associate Feature: A deadly delay

Hearing school playgrounds ring out once again with the shrieks and laughter of children has brought cheer to communities across Scotland since lockdown restrictions eased.

But for some observers, that joy has been tempered by alarm. They fear growing numbers of those children are at greater risk of heart disease, diabetes and other preventable illnesses in the years ahead – because of their weight. 

The weight of Scotland’s youngest schoolchildren had been static for 20 years, but last year, following lockdown, the proportion of Primary Ones who were overweight or obese suddenly jumped – by nearly seven per cent. 

Worryingly, the biggest increase was in obesity rates. 

The Scottish Government’s target of halving childhood obesity by 2030 looks more out of reach than ever.

On smoking and alcohol consumption, it’s a similar story of stalling progress. During the pandemic, Scotland recorded the highest number of deaths from alcohol since 2008. 
There are 9,000 deaths in Scotland each year from tobacco and progress to reduce them is grinding to a halt; campaigners fear smoking rates could even start to rise.

For decades, Scotland was labelled the sick man of Europe; at this rate, it could be again.

Enough is enough, says BHF Scotland. The charity has become increasingly troubled by a lack of progress in Scotland on tackling smoking, excessive drinking and unhealthy eating, the principal causes of preventable death. 

It leads a group of 10 health charities which have been campaigning vigorously for the Scottish Government to act. The group says that ministers have been promising action for years on the way health-harming products are advertised and marketed, but have been slow to follow through. They recognise that the pandemic delayed progress on planned work but are worried by the ongoing delays and the mounting number of deaths.

They have issued a report card on the Scottish Government’s progress on six key policy recommendations made by the campaigners last year: it shows that so far, only one has been enacted (an Out of Home food strategy, on healthy food choices when eating out). Another is promised in 2022 (a consultation on restricting alcohol promotion) but there has been little progress on the other four. There is no timescale to review and uprate the minimum unit price of alcohol. 

This, they warn, cannot continue, in the face of 7,800 preventable deaths a year.
They see the forthcoming Public Health Bill, promised by the Scottish Government last autumn, as a critical opportunity to make up lost ground. 

In particular, they want to see action around the advertising, pricing and promotion of tobacco, alcohol and unhealthy food – the so-called “commercial determinants” of ill-health.

“Scotland used to be a world leader on public health, with the ban on smoking in public places and minimum unit price of alcohol – so let’s reclaim that mantra,” says David McColgan of BHF Scotland. “Every delay is resulting in more ill health, morbidity and death, and those bearing the biggest burden are the poorest.”

Perhaps the most worrying trend is in the proportion of people who are overweight or obese. 
Lorraine Tulloch, programme lead of Obesity Action Scotland, says that on childhood obesity, “we are heading in completely the wrong direction”. 

Children in the most deprived areas are nearly three times more likely to be at risk of obesity as those in the wealthiest areas.

“If we want to meet the 2030 target and ensure the children of Scotland have a healthy future, we need to see urgent change in our food environment to tackle the pervasive promotion and advertising of unhealthy foods,” she says.

The trend in children is reflected across society. During lockdown periods, nearly half the population reported that their weight increased. 

“The forthcoming Public Health Bill is the most important opportunity we have to achieve the change we need in the food environment in Scotland,” says Tulloch. “The Bill must introduce the legislation to deal with promotions of foods high in fat, sugar and salt without delay.  

“We know and the Scottish Government have recognised that it will make a difference to what we put in our shopping baskets every week and will make it easier to make the healthy choice.
 “The Bill could also introduce measures to improve the out-of-home food environment and could ensure that the advertising that we see in streets and on bus stops is for the healthy food we need in our diet.”

Campaigners are frustrated that while everyone agrees that tobacco, excessive drinking and unhealthy foods are harming people’s health, the population is still being bombarded by advertising and marketing for those very products. 

Alcohol Focus Scotland wants to see the Scottish Government ban outdoor advertising, and sport and event sponsorship by alcohol brands. 

It also wants to see alcohol displayed only in designated areas of shops and supermarkets, separated from the rest of the store by a physical barrier, a move which they believe will limit young people’s exposure to drinks marketing and reduce triggers for people who have an alcohol problem.

The minimum unit price for alcohol, they stress, must be increased to 65p.

Alison Douglas, chief executive of Alcohol Focus Scotland, says: “The Public Health Bill gives the Scottish Government an opportunity to continue to put everyone’s right to health above the profits of multinational companies – as they have done with world-leading policies like minimum unit pricing and the multi-buy ban on alcohol.”

ASH Scotland is pleased the Scottish Government has published proposals to tighten the rules on advertising and promoting vaping products, since they believe the tobacco industry is trying to reach new generations of potential customers with these recreational nicotine products. 

But Sheila Duffy, chief executive of ASH Scotland, stresses that there is no time to waste.

She says: “This Scottish Government is now showing encouraging early signs of action but there is a lot of ground to make up if Scotland is to make timely progression towards becoming a tobacco-free generation by 2034.”

Scotland is currently on course to miss that target by 16 years.

All of the charities stress the need to expand access to community services for smoking cessation, alcohol treatment and weight management.

Opposition MSPs are also clamouring for more progress

Paul O’Kane, Scottish Labour’s shadow minister for public health, says he fully endorses the measures campaigners are asking for, and adds that there needs to be a parallel focus on tackling poverty, given the much greater burden of ill-health in deprived communities than wealthy ones.

He says: “I think it’s really fair to say that we had huge challenges pre-pandemic and the pandemic has set us back massively in terms of our public health agenda. 

“The root cause of many of our public health issues is poverty and we know that that has been exacerbated by the pandemic.

“So I think our starting point has to be accepting the context and making sure that the Public Health Bill is a moment where we say we need to lock this very squarely into the recovery from Covid.

“Absolutely, those measures that are being suggested by the coalition of charities I think are worthwhile and we should move these forward. But I think there’s also an opportunity in this to do something more radical.

“All of the evidence I’ve heard points to poverty being the underlying root cause of so much of this ill-health. The experts say, deal with the underlying root causes of poverty and you will start to see the improvement in health on a range of measures.” 

He would like to see the minimum unit price for alcohol raised, but also wants a social responsibility levy on alcohol producers to help fund services aimed to promoting healthier lifestyles, like community facilities and activities for young people – particularly in deprived communities – to divert them away from drinking sessions as a leisure activity.

Alex Cole-Hamilton, the Scottish Lib Dems’ leader and shadow health secretary, accuses the Scottish Government of using the pandemic as an “excuse” to hide their “demonstrable shortcomings” on health. 

He decries the rise in childhood obesity, pointing to a lack of adequate play spaces and affordable healthy food options, and says his party wants to invest in sport and promoting healthy lifestyles from an early age, as well as extending the ability of GPs to offer social prescribing. He too supports increasing the minimum unit price to 65p.

The Scottish Conservatives’ shadow health secretary, Dr Sandesh Gulhane, says that even prior to the pandemic, the SNP’s record on the nation’s health was “simply not good enough”. 
He says: “We hear a lot of warm words from SNP ministers on improving health inequalities and stopping excess deaths spiralling out of control. 

“They need to be far more focused on investing in frontline services and improving the messaging around how people’s health can be harmed by doing things to excess. 

“Humza Yousaf’s recovery plan for our NHS simply isn’t cutting it and he can ill afford to make the same mistakes when he brings forward the Public Health Bill later this year.”

BHF Scotland and its partners know that their recommendations will not, by themselves, solve Scotland’s deep-seated public health problems, but they are confident they will make a significant difference. 

David McColgan says: “Scotland’s reputation when it comes to public health is fading, but it can be turned around. 

“The pandemic has created added challenges, but we need ambition if we’re to tackle them.  There is no need for this innovative and resourceful country to put up with such dire rates of ill-health and premature death from preventable causes. We have led the way with radical new public health measures before and we can do it again.

“Scotland knows where it wants to be, but we must now take the bold action necessary to get there.”   

This article was sponsored by BHF Scotland.