Healthy diets, exercise and healthy habits – the goals are deceptively simple but persuading the public is complicated. The NHS’s new 10-Year Health Plan for England signals a welcome focus on prevention rather than cure, tackling tobacco, alcohol, junk food and other causes of ill health. But could the plan go further?  

Could the UK build on its success with the pioneering "sugar tax" to help slash consumption of sugary foods – and extend a similar levy more widely? Research by Professor Franco Sassi, Director of the Centre for Health Economics & Policy Innovation (CHEPI) at Imperial Business School, indicates the government could be bolder still.  

CHEPI’s research reveals that not all proposals within the plan are backed by research. A focus on low alcohol drinks for instance could be counterproductive as the advertising of branded low alcohol alternatives is fuelling appetites for their alcoholic counterparts. 

But the plan heralds a welcome shift in mindset and an urgent attempt to nip health problems in the bud. Ending the obesity epidemic is a “moonshot”, but inaction already costs the NHS an estimated £19 billion a year.  

Fiscal tools for prevention  

Are policy makers neglecting fiscal tools in tackling the crisis? 

The UK’s sugar tax showed how effective economic incentives can be. More than half of drink manufacturers cut sugar content before the levy was introduced, and sales of sugary drinks fell afterwards.  

CHEPI’s research has shown that an expansion of a tax similar to the Soft Drinks Industry Levy to encompass sugary foods more widely could cut sugar purchases by as much as 38 per cent in some foods. Other fiscal measures identified by Professor Sassi and CHEPI’s research that the government could deploy — such as a tax based on nutrient thresholds— could cut purchases of sugar and calories by up to 15 per cent. 

Companies that heavily advertise their low or no alcohol alternatives go on to increase sales of their same-brand alcoholic beer – in other words, encouraging low alcohol brands inadvertently fuels alcohol consumption, among light drinkers, according to research by Dr Stijn Maesen at Imperial Business School. 

Policy makers could avoid this “halo effect” by restricting ads for both low and high alcohol products, while emphasising genuine health benefits such as fewer calories. Low alcohol alternatives still play a role, particularly for anyone trying to cut back as it’s the heavy drinkers who are most likely to consume them.   

But there are equity concerns: low alcohol drinks are often more expensive, meaning the heaviest health burdens – which fall on deprived groups – are not alleviated. Ensuring affordability must be part of the strategy if inequity is to be addressed. 

Navigating the junk food market and corporate accountability 

Proposed restrictions on the marketing of junk food and sale of caffeinated drinks to young people are overdue. Evidence shows that reducing exposure to unhealthy food and drink reduces consumption of these products, especially in young people. Regulation could be even more effective if it were to extend to brand marketing and digital media and incentivise the promotion of healthy products 

In a world first, the plan requires large food companies to report the healthiness of the food they sell – this will inform new mandatory healthiness targets on food sales. This is ambitious and welcome – “Our research shows that policies must tackle both demand and supply factors behind poor diets,” says Professor Sassi, “which means not only educating and incentivising consumers but also mandating reformulation and responsible marketing by industry.” 

Today, the poorest 20 per cent of households need to spend half of their disposable income to eat a recommended healthy diet, compared with just 11 per cent for the richest 20 per cent. Better access to free school meals, food vouchers and higher nutritional standards in schools outlined in the plan are a promising step towards redressing the imbalance.   

Weight loss drugs for obesity embraced by the plan show strong short-term results but should only complement rather than replace policies such as encouraging physical activity and healthier diets which yield longer term benefits.  

Digital tools and behaviour change  

New health rewards and ambitious partnerships with fitness experts proposed in the plan could encourage people to become more active. CHEPI’s research reveals that the wearables and digital health technology embraced here do indeed help people get and stay fitter.  

Research by Professor Marisa Miraldo shows that programmes that tap into peer support and existing social networks can amplify the impact of rewards for healthy choices. But these schemes must be accessible to the people who need them most – not just the healthy – with interventions designed for specific communities, or with higher rewards and incentives for those at greater risk of unhealthy lifestyles.  

The reasons people choose to smoke, drink, or eat poorly are complex, and behavioural science reveals the risk that individuals will revert to former unhealthy habits once a scheme ends. This can be avoided with the careful design of a programme which draws on behavioural insights and fosters intrinsic motivation - gradually building stable habits by combining rewards with education and social recognition for instance, or by making healthy activities enjoyable.  

Preventative healthcare investment can result in a more productive workforce 

Poor health is a human tragedy but also an economic drain. Obesity and related diseases cut the UK’s economic output by 3.4 per cent of GDP - that’s equivalent to an annual tax per person of £409.  

Investing in prevention is not just good for health; it strengthens the economy by creating a more productive workforce and reducing healthcare costs. But prevention requires sustained funding, political will and collaboration across sectors – all of which have too often been sidelined by short-term crises. 

The NHS 10-Year Health Plan heralds a significant shift of mindset from reactive care to proactive prevention, but the question is not whether the UK can afford to invest in prevention, but whether it can afford not to.  

This piece brings expertise from across CHEPI and Imperial Business School, including Professor Franco Sassi, Professor Marisa Miraldo and Dr Stijn Maesen.