The power of big business to undermine public health

Two recent health stories highlight the challenge for public health when sensible measures to tackle tobacco and alcohol abuse run up against the commercial interests of big business

A recent study by Cancer Research shows that almost 20,000 children in Scotland start smoking every year. They have called on the Scottish Government to act quickly on its pledge to introduce legislation on plain packaging for cigarettes. A similar move by the UK Government was put on hold earlier this year with a strong suspicion (subsequently denied) that Tory strategist Lynton Crosby influenced the decision on behalf of his commercial clients. 

The Scottish Government's recently published programme for government confirms that they are still committed to introducing this measure. However, for now, they are promising a consultation and legislation is not likely before 2014/15.

The public health benefits of this measure are clear. The research shows that packaging without branding is less appealing to children and would support other action to discourage young people from starting to smoke. Vicky Crichton said: “Smoking is a serious problem in Scotland with almost 20,000 children, tempted by glitzy, slickly designed packs, being lured into starting smoking every year. It is an addiction that is often life-long and kills more than 4,000 Scots annually. If the Scottish Government is serious about curbing the death toll caused by this lethal habit and meeting its goal for Scotland to become a nation free from tobacco by 2034, then swift action needs to be taken.”

The importance of tackling smoking amongst the young is highlighted by the statistic that  eight out of ten adult smokers start the habit by the age of 19. If the tobacco industry can catch them young, they are likely to have a customer for life. While the rest of us pick up the public health tab.

The second story covered the latest alcohol consumption statistics. Adults in Scotland are continuing to drink more heavily than those south of the Border. Beer, wine and cider sales are similar to England and Wales. However, Scots drink far more spirits, almost three litres per adult per year, compared to less than two litres in England and Wales. Vodka, not whisky is the tipple of preference. It should be said that the good news is that alcohol consumption overall is reducing. However, it remains to be seen if this is more about the economy than a long term shift in consumption. 

NHS Health Scotland also found two-thirds of alcohol sold in 2012 was below the proposed minimum price of 50p per unit. The Scottish Government has taken steps to reduce harmful drinking, with measures such as banning multi-buy discounts, and it wants to create a minimum price to eliminate cheap alcohol from the market. They believe the fact that a quarter of alcohol bought from off-sales in 2012 was below 40p per unit, and two-thirds below 50p, adds weight to its legislation to introduce a minimum price.

Public health minister Michael Matheson said: “We still drink around a fifth more than England and Wales. That is fuelling much higher levels of harm, which results in 100 alcohol-related hospital admissions a day and costs Scotland £3.6 billion each year – £900 for every adult in Scotland.”

And that brings us back to big business because the Scottish Government’s plans have been delayed by a legal challenge from the drinks industry. Even at EU level objections have come in from cheap wine producers. Campbell Evans of the Scotch Whisky Association said: “Minimum unit pricing is not the way to tackle misuse – it does not target the heaviest drinkers, it would be illegal and it would damage the Scotch whisky industry.”

You see it's not about profit, the measure just wouldn't be effective. A familiar refrain from big business to justify their actions over the years. In the case of tobacco and alcohol, a combination of lobbying and legal action is certainly delaying important public health measures.

Still the sick man of Europe?

 
This is the latest report from the Glasgow Centre for Population and Health. It provides a summary of Scotland’s mortality position relative to 19 other mainly Western European countries and highlights emerging trends.
 

Some of the key findings include:

 

·         Scotland’s relative ranking on infant mortality compared to other European countries has become progressively poorer for both sexes

 

·         Mortality rates among Scottish children (aged 1-14 years) have converged and rates for most of the selected European countries are now very similar to Scottish rates.

 

·         Scotland has had the highest mortality in Western Europe among working age men and women since the late 1970s.

 

·         Scotland’s relative ranking in relation to younger working age (aged 15-44 years) mortality compared to other European countries has become progressively worse for both sexes over the last 55 years. It is now the highest in Europe. 46% higher in Scotland for women and 54% higher for men than in England.

 

·         Mortality rates for elderly men (aged 75 years and over) has reduced but remains consistently above the Western European country mean. Elderly female mortality in Scotland has been the highest in Europe.

 

·         Mortality rates for oesophageal cancer are the highest in Europe although other cancers have improved. Lung cancer for women is very high and not improving at the same rate as men.

 

·         Male mortality rates for ischaemic heart disease (IHD), while still among the highest in Western Europe, have reduced and converged toward the Western European mean. Female IHD mortality in Scotland has reduced by over 80% since 1950, but has remained higher than in other Western European countries for the last 55 years.

 

·         Scottish mortality rates from chronic liver disease, including cirrhosis have risen steeply since the early 1990s among men and women. Female mortality is the highest in Western Europe.

 

In summary, mortality in the working age population remains comparatively high and mortality for circulatory diseases and many cancer related diseases is higher than in most other Western European countries. However, there have been notable improvements in Scottish mortality for a range of major conditions – both in terms of absolute trends and in relation to Scotland’s relative position in a Western European context. Growing concerns are evident, however, in relation to all-cause mortality among the younger working age population and elderly women, and for female lung cancer.

 

The report also concludes: “This prevailing economic context, which began with the financial crisis of 2008 and has led to rises in unemployment, job insecurity and widespread financial difficulties, makes it more likely than not that mental health problems, suicide incidence and poverty rates will increase.”

 

The report’s author Bruce Whyte said: "There has been no improvement in Scotland's mortality rates in the younger working age group at a time when other countries have improved. We know there are issues with alcohol, with alcoholic cirrhosis of the liver, accidental poisonings and suicides. There has also been a small contribution from things such as breast cancer and heart disease but we know the contribution of these chronic diseases is less."

 

Sadly, it would appear that the answer to the question "Still the sick man of Europe?" is 'yes'. But women are getting sicker too.