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Key points

  • Health is created by the communities and environments in which we live – the ‘building blocks’ of health – including good quality work, education and housing. These determine our exposure to unhealthy or healthy environments, which impact our behaviours, including our exposure to tobacco, alcohol and unhealthy food.
  • Both national and local government have key roles in improving people’s health. In recent years, national policy action on these risk factors has lacked ambition, leaving local government to provide much of the leadership in creating healthier places.
  • This briefing outlines five proposals for national policy that would allow local government in England to do more to reduce harm from tobacco, alcohol and unhealthy food.
  • For these proposals to be most effective, national government needs to address shortfalls in local government funding and staffing. If these are not addressed urgently, local authorities will not be able to maintain existing service levels, let alone take forward new opportunities arising from these proposals. 
  • Government policy aims to add five years to healthy life expectancy by 2035 and reduce health inequalities – ambitions currently on track to be missed. Improving health on this scale will require bold policy action across national and local government. Measures to empower local government and support further population-level action on tobacco, alcohol and unhealthy food will be an important part of a renewed agenda for health.

Health in England is fraying. Life expectancy is flatlining, ill health is increasing and health inequalities are widening. Tobacco, alcohol and unhealthy food are the leading preventable risk factors driving ill health. 

Tobacco is the leading cause of illness and death in England, causing early death in up to two-thirds of lifelong smokers and around 450,000 hospitalisations a year. There has been a sustained rise in alcohol use at harmful levels since early 2020, and deaths from alcohol are now at record levels, up a third between 2019 and 2022 to just under 8,000. Unhealthy food is a key driver of overweight and obesity. In 2017, Public Health England estimated that the direct health care costs associated with obesity in England were around £6bn a year.

While the government's announcement in 2023 to create a 'smokefree generation' by incrementally raising the age of sales for tobacco products marks a positive shift away from past policy trends, national approaches to tackle alcohol and unhealthy food still lack ambition. Recent attempts to promote good health have focused on supporting individual behaviour change rather than implementing population-level measures that support everyone to be healthier, and bolder action is needed. 

In this briefing, we present five proposals aiming to inform central government on what changes to national policy could support further local government action in England to reduce harm from alcohol, tobacco and unhealthy food:

  1. introduce a license for retailers to sell tobacco products 
  2. include public health as an objective for alcohol licensing decisions 
  3. create powers for local authorities to limit advertising of unhealthy food and alcohol on non-council-owned premises 
  4. enable local authorities to make planning decisions for hot food takeaways based on healthiness
  5. closer integration of planning and public health at the national and local levels. 

Cite this publication

Dun-Campbell K, Ewbank L, Burale H, Briggs A. Addressing the leading risk factors for ill health – supporting local government to do more. The Health Foundation; 2024 (https://doi.org/10.37829/HF-2023-HL03).

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