Britain - The Sick Man and Woman of Europe
The UK is getting sicker and one culprit is our diet. Emily Benn, Audley’s Senior Policy Advisor unpacks the debate around diet-related health and its role in the nation’s productivity crisis.
Retirement ages are firmly in the spotlight again. President Macron faced huge opposition to his plans to increase the state retirement age in France to 64 from 62. While he survived a no-confidence vote in Parliament and has signed the reform into law, protests - sometimes violent - have swept across France.
For those reading in Britain - 64 as a retirement age seems remarkably low. The UK state retirement age is currently 67, having been raised consistently over the past few years with all the expectations of further rises to come amidst a backdrop of rising life expectancy, and pressures on government finances.
Yet the opposite seems to be happening. Quietly, the Government has briefed that it may delay or scrap the move to increase the British state pension to 68 by 2037. Why? Because British life expectancy is now falling - reversing decades of consistent increases.
The UK, for large parts of the 1960s and 1970s, was known as the ‘Sick Man of Europe’ - though for economic reasons. Those decades saw waves of industrial action, an energy crisis, high unemployment, and an IMF bailout. The term is now being used again - but this time, slightly more literally. The UK is getting sicker, and our life expectancy profile is changing as a result. The Covid pandemic and the excess mortality it caused has clearly had a significant impact. Yet there is another culprit to blame: our diet.
The figures are pretty stark. 15 million people in the UK are estimated to be obese. The Government Office for Science all the way back in 2007 estimated the annual cost of obesity in the UK to be £27bn. A recent Frontier Economic report in fact suggested that the total cost to the UK was closer to £28bn and the NHS itself believes that it will cost £10bn a year by 2050. Over a million hospital admissions in 2019/20 had obesity as a primary or secondary diagnosis.
Obesity, like so many other issues in Britain, is interestingly linked to wider social problems and inequalities. Children living in the most deprived areas are more than twice as likely to be obese than those living in the least deprived areas. By the age of 5, 13.3% of children in deprived areas will be obese; by the age of 11, 27.5% of that population will be obese. These social inequalities are particularly stark when looking at life expectancies; there is a difference of 10 years in life expectancy between the most and least deprived areas in England - in no small part due to higher mortality rates from heart and respiratory disease. As The Kings Fund has detailed, these conditions are potentially preventable: smoking and obesity, the main risk factors, are higher among more deprived groups.
Henry Dimbleby is the founder of the LEON food chain and was commissioned by the Government to write an independent review of the food system. Published in 2021 as the National Food Strategy report, it made a number of recommendations, from expanding high-quality free school meals, imposing a sugar and salt tax, and using GPs to prescribe nutritional land diet changes - i.e. more fruit and vegetables. It also recommended there be changes to “buy one get one free” offers and adversities of junk food to children. And yet, the Government has consistently failed to follow those recommendations; to such an extent that last month Henry Dimbleby resigned from his Government position in protest. His recent book, Ravenous, examines in detail the damage to our health, climate, and health service caused by the global food system.
What is it about our diets that is causing such disastrous public health consequences? One answer, according to Dr Chris Van Tulleken, is the proliferation of ultra-processed foods. Van Tulleken recently took part in a BBC experiment that saw him eat ultra-processed foods for a month (a diet followed by 20% of the UK population). He gained 7KG over the month, and described that “I felt ten years older, but didn’t realise it was all [because of] the food until I stopped eating the diet”. In Ravenous, Dimbleby lays out the consequences of our reliance on ultra-processed foods; “10% increase in the proportion of ultra-processed foods in a person’s diet is correlated with a 12% increase in cancers, a 21% increase in depressive symptoms, and a 12% increase in cardiovascular disease risk”.
Eventually, this is an issue the Government is not going to be able to ignore - not least given the huge consequences for the financial health of the public finances, and the health service. Sir Chris Whitby, the Government’s Chief Medical Officer, who also criticised the Government for delaying restrictions on junk food advertising, has noted the huge pressure diet-related diseases will put on NHS budgets. Spending on Type 2 diabetes - a preventable disease - is soaring. As Dimbleby noted, the OECD (Organisation for Economic Co-operation and Development) estimates that the UK economy loses £74 billion a year in lost workforce productivity, shortened lives, and NHS costs because of conditions related to excess weight.
At a time when the UK’s productivity is being examined, the arguments about diet, junk food, and the damage they are doing to our health should be front and centre. It should be no surprise that Britain suffered disproportionately badly in the Covid pandemic; we were an unhealthy country to start with. A health service under significant pressure, already dealing with Covid backlogs, is unlikely to help recent reverses in life expectancy projections.
Yet the political argument is still stuck in obvious, cliched arguments and dividing lines. On the one side, it is so easy to frame this as a “Nanny State” agenda. Those on the more libertarian side object to Government intervention and insist that consumers should make decisions independently. The other side will argue that there is no choice, if the only cheaper food available is unhealthy, and the Government has a wider responsibility to promote healthy eating - not least given the wider costs of diet-related disease. Against the Government’s more relaxed approach, The Labour Party has shown recent signs of being willing to take a slightly more proactive approach; Shadow Health Minister Liz Kendall recently discussed tentative proposals to include calorie content in alcohol (it is already a law to include that information on food).
The challenge for campaigners is to avoid the binary framing of the debate, away from arguments about a nanny state. They would do better to reframe this amid a wider argument about our food system, the nutritional content of food available, and rebalancing the commercial incentives for food companies of producing more junk food.
The UK has suffered from an era of low productivity, low growth, ill health, and significant labour shortages. We should be spending far more time and energy discussing our food system, and diet-related health, which will be critical to addressing our long-term economic and social challenges.
A final thought: by now you might be thinking about a certain drug that has hit the headlines. Is Semaglutide - aka Ozempic - the answer to all our troubles? We will wait and see.
By Emily Benn, Senior Policy Advisor, Audley