This is the fifth contribution to CPP’s social infrastructure series. This special edition is concerned with the social infrastructure of public health and focuses on one critical area – obesity in the wake of the pandemic.

The case for action on obesity has long been known, but governments have consistently failed to go far enough in response. Now as Covid-19 exposes huge health inequalities across the country, and the government seeks to level up economic opportunity, there is a new window for serious joined-up action. The prize is a big one – closing the health gap between the North and the rest of the country would deliver £13.2bn in economic output.

Key points

• People living in the most deprived communities have seen double the death rate from Covid-19 as those living in the most well-off. Obesity has been a key driver of this – with the poorest areas having 10% higher rates of obesity and 16% lower rates of physical exercise (see Table 1).
• Prior to the pandemic, income levels explained 30% of the variation in obesity across England. In the wake of Covid-19 and the subsequent economic shock, it will be even more important to take action on low incomes, the price of healthy food and the accessibility of spaces for physical exercise. Our £1.8bn shovel ready package is designed to do exactly that, although this is just a start:
  • Deliver Healthy Lives Programme providing healthy food to the poorest communities (£330m).
  • Ensure access to SureStart centres for all 0-4 year olds in the poorest neighbourhoods (£510m).
  • Introduce a 10% subsidy on healthy food reducing the average cost of a bag of apples from £1.50 to £1.35 (£991million).
• More broadly, the government’s obesity strategy must take a population health approach – seeking to address the socioeconomic, commercial, and environmental causes of poor diets across all age groups alongside the individual and behavioural drivers. This is consistent with a large body of evidence on tackling obesity including the Chief Medical Officer’s 2019 report.
• But government action must be joined up. This means government departments working together to improve diets and increase the level of physical activity, particularly in the poorest communities. Announcing new obesity policies while offering 50% discounts on fast food is not a coherent strategy.
• To demonstrate the government’s commitment to shifting the dial on population health it should start by setting out a new cross government health inequalities strategy (which includes obesity) and doubling the public health grant. Public health expenditure through the grant is three and a half times more productive than healthcare expenditure.
• Continuing on our current path which prioritises healthcare (NHS) is unaffordable. Due to rising healthcare expenditure, our debt to GDP is projected to exceed 200% by 2050. Prevention not cure is an urgent economic and fiscal priority, and policies that are sustained over decades in acknowledgement that the major benefits to population health are for now and the longer term.
• To support a step-change in health including obesity, the Health Secretary and Prime Minister (as well as the Mayors of Combined Authorities) must be held to account for their successes (and failures) in narrowing health inequalities. Table 1 shows there is a long way}to go.

Table 1. Never has the social gradient of health been more relevant [1]

The the next blog in this series will set out the principles for devolving the functions and funding related to social infrastructure.