All public-health challenges – be it cancer, obesity or even Covid-19 – have one thing in common: the need for a "two-pronged" approach to tackle them, as first described by Geoffrey Rose in Sick Individuals and Sick Populations, a paper so important in epidemiology that they published it twice.
You take population-level measures to reduce disease risk on the one hand, while helping those who are already affected on the other. So, we take measures to reduce smoking in the population, but if someone develops lung cancer, they get the clinical care they need. Exercise prevents heart disease, but if you’re having a heart attack, you’ll need a stent.
Covid-19 and obesity are the two major public-health crises of our time and both require the same two-pronged approach. Up until now, the decisiveness, coherence and effectiveness of the response to Covid-19 has contrasted sharply with the handling of obesity.
Recent indignation at the “scenes” of people congregating in public to enjoy cold beer on a warm day have ignited a “personal responsibility” narrative that is all-too familiar to those with an interest in obesity. If it wasn’t entirely predictable that making takeaway pints available would lead to demand for those pints, it should have been. The absence of adequate public space and municipal facilities is hardly the fault of people who up to now have been sensible about Covid-19.
Despite the outcry, drinking on the street does not represent a collapse of collective societal responsibility any more than the global obesity crisis does
The vast majority have adhered to public-health guidance, so opening the pubs for takeaway pints and then lamenting the collective loss of moral integrity when the inevitable queues form is the sort of mixed messaging that has diminished other public-health strategies. It is reminiscent of the failure to adopt population-level strategies against obesity such as restricting the online marketing of junk food to children, or clearer food labelling.
A key threat to effective public-health legislation in Ireland has been the relentless, heavily-resourced and highly effective lobbying to government from industry, such as discrediting effective obesity policies like sugar taxes and advertising bans which are known to reduce junk food consumption in kids, just like the alcohol industry has delayed the Public Health Alcohol Bill.
Has the same started to happen with Covid-19?
Takeaway alcohol
Compared to the success of the initial population-wide measures to tackle it, recent developments – for example pubs serving takeaway alcohol that can only be consumed 100 metres away from the premises, or the delay in implementing mandatory hotel quarantining suggest that otherwise effective public-health strategies may have been “fudged” after political influence from industry representatives – with the result that the policies aren’t strong enough and just don’t work. We’ve seen it with the half-baked compromises on the separation of alcohol products after intensive industry lobbying.
Public-health measures need to be proportionate and mindful of commercial interests and the potential economic hazards they create, but we cannot allow those interests to unduly diminish the effectiveness of the measures. The emergence of the finger-wagging personal responsibility narrative that ensues when it all goes wrong suits nobody except the purveyors of the products that one way or another are making our environment less conducive to health. Despite the outcry, drinking on the street does not represent a collapse of collective societal responsibility any more than the global obesity crisis does.
Commercial interests
Rather, both phenomena are a result of changes at an environmental level that have influenced population behaviour. You can’t start a firework display and then express surprise when everyone looks up. Pulling back on sensible, proportionate and necessary public-health measures to serve the commercial interests of a small minority just leads to flawed, illogical and ineffectual policy, whether it’s Covid-19 or any other health crisis.
Now more than ever, we need coherent, transparent and logical public-health policy that is developed with an awareness of the importance and validity of commercial interests, but which is mindful also of the potential conflicts that lobbying creates.
– Dr John F Brazil, clinical fellow, Galway University Hospitals and NUI Galway; Dr Norah Campbell, associate professor of marketing, Trinity Business School, TCD; and Prof Francis M Finucane, consultant endocrinologist, Galway University Hospitals and NUI Galway.