Agenda item

This report introduces to the Board the substantial evidence emerging within health and social policy research on what are termed the ‘Commercial Determinants of Health’ (CDOH). This concept, applied locally, refers to the way unhealthy commodity industries, for instance those selling tobacco, alcohol, unhealthy food, or gambling products, are undermining our local Health and Wellbeing Strategy objective to ‘become a health-generating city’ and have a negative impact on goals improve healthy life expectancy and reduce the gap between the richest and poorest in the city.

The report was presented by the Director of Public Health, who was joined by the Associate Director, Humber and North Yorkshire Centre for Excellence in Tobacco Control and the Public Health Specialist Practitioner (Advanced). This was accompanied by a presentation on the Commercial Determinants of Health, which showcased recent examples of gambling, junk food and alcohol advertising in public spaces within the city.

He concluded with the recommendation that the board consider how partners think about educational or promotional materials, partnerships, sponsorships and their approach to advertising/marketing. He noted that the council probably had more scope here than other organisations, but there were straightforward ways to monitor websites and social media posts and everyone could consider who they were partnering with.

The board asked what actions were currently being taken by the council in York – would they be tackling licensing as other authorities were and if so how was the private sector being involved in this.

The Director of Public Health responded that the new National Planning Policy Framework had positive provisions within it that would make it easier for the council to include 400-metre buffer zones. This had not been included in the last Local Plan, meaning a supplementary planning document could not be written on it, but a planning review process was underway.

Regarding licensing, he said that per the advice of the Chief Medical Officer, the focus of the Authority should be off-premises rather than on-premises licencing since the most harmful drinking came from people buying cheap alcohol from supermarkets and corner shops, often drinking alone. He said that the hospitality industry were very much in favour of minimum unit pricing, which would encourage social drinking and drive more people towards pubs and restaurants. Price restrictions could not be set locally, but he said he would strongly advocate for a national minimum unit price being set. The Chair agreed that the people living in poverty were often likely to drink cheap alcohol, which was worse from a health perspective, often leading to dependency.

In addition to tobacco and alcohol, the board noted the inclusion of gambling advertising in the presentation. The Director of Public Health had cited the “No Such thing as a Free Bet” campaign. Board members suggested people with gambling addiction were often “invisible” to health and social care providers, similar to those drinking alone at home, people were also gambling in the home or on a mobile phone app, which could push them further into poverty and impact their mental health. The board queried whether it might be possible to obtain any statistics regarding these people and how partners might best reach them.

The Associate Director, Humber and North Yorkshire Centre for Excellence in Tobacco Control responded that there were two prongs in dealing with these issues; firstly, to treat/support those already affected and secondly to protect the next generation.

He emphasised that York was the first Health and Wellbeing Board to take on this challenge. He advised that the products discussed cause 80% of non-communicable diseases, such as cancer, frailty and mental health. He stated that around inequality, authorities needed to target the communities who buy these products and more than anything else these are poorer communities. He warned that it was crucial to monitor who goes into our schools - there would be outcry if the tobacco industry went into schools these days, yet alcohol and gambling corporations still get in with sponsorship and promotion.

The board discussed that this was a controversial and political issue and a choice between personal freedom for people enjoying “the odd drink or cigarette” versus how much everybody else might end up paying to look after those people due to the way they chosen to live their life. It was recognised that this “nanny state” contention was likely what had prevented other authorities tackling the issue. The aim of this plan was to give people the option to make an informed choice, without an insidious influence permeating people’s consciousness from childhood through advertising and more subtle messaging.

The board suggested that this linked to traumain the system and the choices people made to deal with awful things that had happened, led them to do something unhealthy. If the thing that they used for support was taken away, this may actually increase the problem and deepen the sense of trauma/disengagement. It was suggested that if brilliant minds within corporations and advertising are persuading people to live in a way that damages them, board members should collectively try to do something about that damage in a way that doesn't do more damage. Dual diagnosis support of mental health was linked to the addiction.

The Director of Public Health said this was a good point – early death and early illness was what he was there to prevent, and these issues were underlying factors to that. He advised that cigarettes were as addictive as heroin and people typically became addicted at an age (as children/teens) where they lack the decision-making skills they would acquire at a later age, and that older age is the point that we ask them to make a choice. He added that a similar issue was faced with regard to ultra-processed food which was also highly addictive. He made an open offer that anyone could come and speak to Public Health or the Centre for Excellence to

The board suggested that partners would benefit from consistent, agreed messaging, since there were currently some mixed messages out there. It was stressed that unified messaging in schools would be beneficial, and was particularly sensitive in York due to the tourist economy driving York and the Racecourse, which had partnered with schools in the past. It was suggested that the nature of the corporate world often made such influence difficult to track and the approach taken must be mindful of this and consistent.

The board also noted the importance of getting messaging out about infant formula and breastfeeding in the UK. The Public Health Specialist Practitioner (Advanced) responded that this was something that was actively being promoted.

The board discussed the current relationships the council has, including how the procurement process might be refined  via discussion with the Public Health team.

Board members stated that choice always happens in a context – some people can afford to have more choice, and people on a specific bus route may receive messaging on bus stops; TV shows sponsored by a gambling company mention alcohol or gambling 11 times in an hour. It was suggested that rather than focus efforts exclusively on negative recommendations (stopping or banning things), the board might find positive encouragement such as incentivising of advertising non-ultra processed food would be a good idea.

The board then

Resolved:

i.        To note the Association of Director of Public Health Yorkshire and the Humber Consensus statement on the CDOH.

ii.       To consider avoiding use of educational or promotion materials produced by organisations established or funded by (whether entirely or in part) unhealthy commodity industry bodies in our educational settings or communities.

iii.      To consider ending any partnerships, sponsored or funded work which has links to unhealthy commodity industries, using the Good Governance Toolkit as guidance.

iv.      To consider the approach to advertising and marketing, and adopting a policy which matches the City of York Advertising and Marketing Policy.

Reason:                The Health and Wellbeing Strategy 2022-2032 contains an aspiration to become a ‘Health Generating City’, and this paper supports this goal.