Appendix 1

We analysed national-level policies that have been proposed or committed to by the UK government in England that explicitly set out to address smoking, poor diet, physical inactivity and harmful alcohol use. We examined the headline policies included in key government strategy documents and government-commissioned reviews published between 2016 and 2021 (except for alcohol, where we went back to 2012 due to the lack of government strategies published since). We summarised information on policy aims, approach, agencies involved in implementation, and other factors. We also tracked whether policies had been implemented or not.

Our focus was on strategies that have principally aimed to improve health. As a result, our review provides an overview of government’s policy positions related to the prevention of smoking, poor diet, physical inactivity and harmful alcohol use, but does not provide an exhaustive account of all policies related to these risk factors across all government departments.

Table of UK government policies proposed or committed to in England for smoking, diet, physical activity and alcohol (2016–2021)

Policy initiative

Date

Summary

Strategy

Responsible body

Intended impact

Lever; targeting; degree of agency

Smoking

‘Polluter pays’ policy

2019

Commitment to consider placing a ‘polluter pays’ levy on tobacco companies, with funds used to support groups most in need and crack down on the illicit tobacco market.

Advancing our health: prevention in the 2020s (July 2019)

DHSC and Cabinet Office

Intended to support raising of revenues to fund smoking cessation efforts.

Lever: Regulation (fee)

Population-level; low agency

Implemented? No further details on the policy have been published by the government.

All people admitted to hospital who smoke offered NHS-funded tobacco treatment services by 2023/24

2019

Pledge to ensure that by 2023/24, all people admitted to hospital who smoke are offered NHS-funded tobacco treatment services – across both physical and mental health services.

NHS Long Term Plan(January 2019)

NHSE; local health systems (Integrated Care Systems – ICSs)

Aimed at ensuring the NHS helps deliver a ‘smoke-free generation’.

Designed to guide local development and delivery.

Lever: service provision

Individual-level; high agency; targeted at high-risk groups

Implemented? ‘Early implementer sites’ for inpatient tobacco treatment services are due to be in place from 2020/21 and services rolled out up to 2024.

Smoke-free pregnancy pathway for expectant mothers and their partners

2019

Commitment to adapt the Ottawa Model for Smoking Cessation for expectant mothers and their partners, with a new ‘smoke-free pregnancy pathway’ established incorporating focused sessions and treatments.

NHS Long Term Plan(January 2019)

NHSE; local health systems

Aimed at ensuring the NHS helps deliver a ‘smoke-free generation’.

Designed to guide local development and delivery.

Lever: Service provision

Individual-level; high agency; targeted at high-risk groups

Implemented? Implementer sites for ‘smoke-free pregnancy’ services are supposed to be place from 2020/21 and then rolled out further from 2021/22.

Smoking cessation offer for long-term users of mental health services

2019

Promise to introduce a new universal smoking cessation offer for long-term users of specialist mental health and learning disability services.

NHS Long Term Plan (January 2019)

NHS England (NHSE); local health systems

Aimed at ensuring the NHS helps deliver a ‘smoke-free generation’.

Designed to guide local development and delivery.

Lever: Service provision

Individual-level; high agency

Implemented? In November 2020, NHSE/I indicated early implementer sites to test and refine outpatient tobacco treatment services would be in place from 2022/23 and then rolled out further from 2023/24.

Diet

Sugar and salt reformulation tax

2021

Recommendation for a sugar and salt reformulation tax, with revenue used to provide fresh fruit and vegetables to low-income families. Designed to build on and replace the Soft Drinks Industry Levy (SDIL).

National Food Strategy

Commissioned by Defra

Aiming to help break the ‘junk food cycle’ and reduce pressure on the NHS. Designed to incentivise manufacturers to reduce sugar and salt in their products.

Lever: Taxation

Population-level; low agency

Implemented? Government has promised to respond formally with a white paper within 6 months of the NFS’s publication.

Mandatory reporting for large food companies on sales of food and drink

2021

Proposal to require food companies with 250+ employees to publish annual reports on food and drink sales numbers. Data by company would be publicly available and form part of the Food Standards Agency’s annual report to parliament on the state of the food system.

National Food Strategy

Commissioned by Defra

Aimed at enabling better scrutiny of business activity and maintaining public pressure on companies to support healthy eating.

Lever: Regulation

Population-level; high agency

Implemented? Government has promised to respond formally with a white paper within 6 months of the NFS’s publication.

‘Eat and Learn’ initiative for schools

2021

Recommendation for an ‘Eat and Learn’ schools initiative, with measures including reinstatement of food A level; more rigorous inspection for school cookery and nutrition lessons in schools; and doubling funding for the School Fruit and Vegetable Scheme.

National Food Strategy

Commissioned by Defra

Proposed to ensure food education is taken more seriously and ensure everyone has the culinary skills and knowledge needed to eat well.

Levers: Information and funding

Population-level; medium agency

Implemented? Government has promised to respond formally with a white paper within 6 months of the NFS’s publication.

In February 2022 government committed to invest up to £5m to launch a ‘school cooking revolution’, including development of new curriculum content and bursaries for teacher training and leadership.

Extend eligibility for free school meals

2021

Recommendation to increase the earnings threshold for free school meals to £20,000 before benefits, ensuring 82% of children in households with very low food security would be eligible for free school meals and 70% of those with low food security.

National Food Strategy

Commissioned by Defra

Aimed at addressing current situation whereby children older than Key Stage 1 must live in a household with an annual income of <£7,400 before benefits to qualify for free school meals.

Lever: Regulation and funding (subsidy)

Population-level; medium agency; targeted at higher risk groups

Implemented? Government has promised to respond formally with a white paper within 6 months of the NFS’s publication.

Funding the Holiday Activities and Food programme

2021

Recommendation for government to fund the Holiday Activities and Food programme for at least the next three years or until the next Spending Review (rather than end of 2021 as planned). Proposed that children in households on qualifying benefits earning less than £20,000 should also be allowed access.

National Food Strategy

Commissioned by Defra

Aimed at ensuring the poorest children get at least one freshly cooked meal a day as well as social contact, exercise and enrichment activities, during the school holidays.

Lever: Regulation (subsidy) and service provision

Individual-level; medium agency

Implemented? Government has promised to respond formally with a white paper within 6 months of the NFS’s publication.

Expansion of Healthy Start scheme

2021

Recommendation for proceeds from a sugar and salt reformulation tax to be used to expand eligibility for Healthy Start vouchers. Proposed raising the earnings threshold to £20,000 per year (pre-benefits) and extending the age limit to cover children younger than five.

National Food Strategy

Commissioned by Defra

Aimed at ensuring more low-income pregnant women and their children can access healthy foods. (Through means-tested vouchers redeemable for specific healthy foods.) Designed to expand eligibility.

Lever: Fiscal (subsidy)

Individual-level; medium agency

Implemented? Government has promised to respond formally with a white paper within 6 months of the NFS’s publication.

‘Community Eatwell’ programme, supporting those on low incomes to improve their diets.

2021

Recommendation for a programme to be trialled enabling GPs to prescribe fruit and vegetables, food education and social support to patients suffering from poor diet or food insecurity. Proposed inviting PCNs to design pilot programmes tailored to local needs, with funds invested in local healthy food infrastructure and facilities.

National Food Strategy

Commissioned by Defra

Primary care networks (PCNs)

Aimed at improving the diet and health of participants, while ‘reducing the cost of medication’.

Levers: Regulation (subsidy) and service provision

Individual-level; medium agency

Implemented? Government has promised to respond formally with a white paper within 6 months of the NFS’s publication.

In February 2022 government confirmed it would trial a Community Eatwell programme by running a 3-year pilot, building on successful models from around the world.

Ban on high fat, sugar and salt (HFSS) products being shown on TV before 9pm

2020

2019

Announcement of a ban on some HFSS products shown on TV and online before 9pm, to be applied to all TV channels regardless of audience size.

Tackling Obesity: government strategy

DHSC

With evidence showing advertising can shape children’s food choices and lead to short and longer term increases in the amount of food they eat, the ban is intended to limit the amount of advertising children see on television for HFSS products.

Lever: Regulation (marketing)

Population-level; low-agency

Implemented? Legislation to restrict advertising of HFSS products on TV before 9pm was introduced as part of the Health and Care Bill 2021–22. Subject to parliamentary approval, the policy is due to be implemented from the beginning of 2023. It does not cover all media where advertising could be time-restricted such as cinema and radio.

Online advertising restriction for HFSS products high in fat, sugar and salt

2020

Commitment to consult on how to introduce advertising restrictions online for foods high in fat, sugar and salt.

Tackling Obesity: government strategy

DHSC

Aimed at limiting children’s exposure to advertising for unhealthy food and drink online (where children consume an increasing amount of media) to help reduce consumption of HFSS products.

Lever: Regulation (marketing)

Population-level; low agency

Implemented? The government published a consultation in June 2021 and has confirmed it would introduce the ban by the end of 2022. Subject to parliamentary approval, it is now due to be implemented from the beginning of 2023. It does not cover brand advertising, owned content or advertising by small and medium sized businesses.

Restrictions on promotion of unhealthy food and drinks in retail outlets and online

2020

Announcement of a ban on promotions of HFSS products by location and price. Location restrictions will be applied to store entrances, aisle ends and checkouts and their online equivalents. Volume price restrictions prohibit retailers from offering promotions such as ‘buy-one-get-one-free’ or ‘three-for-two’ offers on HFSS products.

Tackling Obesity: government strategy

DHSC

Aimed at supporting shoppers to purchase healthier options and shifting the balance of promotions towards healthier options, as well as maximising availability of healthier products on promotion.

Lever: Regulation (marketing)

Population-level; low agency

Implemented? A consultation ran from 12 January to 6 April 2019. The new promotion regulations are supposed to be introduced from October 2022.

The regulations only cover medium and large outlets (50+ employees) and do not cover the out-of-home sector.

Calorie labelling in large out-of-home sector businesses

2020

2018

Following an earlier (2018) consultation, government committed to require large out-of-home sector businesses (restaurants, cafes and takeaways with 250+ employees) to provide calorie labels on food. Smaller businesses will also be encouraged to voluntarily provide calorie information and government promised to consider extending the requirement to include them in future.

Tackling Obesity: government strategy; Childhood obesity: a plan for action, chapter 2

DHSC

Aimed at providing people with clear information about the calorie content of food and drink (often higher in the out-of-home sector). Focused on enabling people to make informed decisions, to support a healthier weight.

Lever: Regulation (information provision)

Population-level; high agency

Implemented? A consultation subsequently ran from September–December 2018. The government introduced legislation for out-of-home sector calorie labelling during summer 2021. The regulations come into force from April 2022.

Implementation guidance for the policy was published in September 2021.

Front-of-pack nutrition labelling

2020

2019

2016 & 2018

Commitment to consult on how to improve the UK’s voluntary front of pack nutrition labelling scheme to reflect latest dietary guidance and international good practice. Previously committed to in chapters 1 and chapter 2 of the childhood obesity plan (2016 and 2018) and in the 2019 prevention green paper.

Tackling Obesity: government strategy

DHSC

Aimed at ensuring labelling of products in stores and cafes is helpful and easy to understand; supporting people to make informed and healthier food and drink choices.

Lever: Regulation (provision of information/warnings)

Population-level; high agency

Implemented? A consultation ran from July to November 2020. No government response to the consultation has been published.

The consultation did not indicate an intention to make labels mandatory.

‘Better Health’ campaign

2020

Announcement of a new campaign based around a 12-week NHS weight loss app for people with obesity. Includes guides offering healthy eating, diet and exercise advice and weekly charts recording calories, exercise and fruit and vegetable intake. Targeted in particular at 40+ men, more socioeconomically disadvantaged groups, people from minority ethnic backgrounds and those with long-term health conditions.

Tackling Obesity: government strategy

DHSC

PHE (now OHID)

Aimed at reaching millions of people who need to lose weight, encouraging them to eat better and move more to prevent or delay onset of serious diseases.

Lever: Information provision (mass media campaign)

Population-level; high agency

Implemented? The government implemented three ‘Better Health’ adult obesity campaign advertising bursts during 2020 and 2021.

PHE’s evaluation of the impact of the 12-week weight loss app found most users did not complete it but among those who did, weight loss was relatively high compared with outcomes reported elsewhere.

Expansion of diabetes prevention programme

2020

2019

Commitment to fund a doubling of the number of people accessing support through the NHS diabetes prevention programme (DPP) over the next 5 years. DPP incorporates direct coaching, peer support sessions and education on lifestyle choices. In 2020 the government committed to accelerate expansion of the DPP even further to ensure tens of thousands more people are able to access services.

Tackling Obesity: government strategy; NHS Long Term Plan

NHS England (NHSE)

Intended to identify people at high risk of developing type 2 diabetes, to help them maintain a healthy weight and prevent or delay onset of the disease.

Lever: Service provision and information

Individual level; high agency

Implemented? The number of people offered support via the diabetes prevention programme annually has more than doubled since publication of the NHS LTP. Variation between areas is considerable, however, and not all offers of support translate into access.

Emerging evidence indicates fairly positive results from the programme so far.

Restricting sales of energy drinks to children under 16

2019

The introduction of a ban on sale of energy drinks to under 16s was confirmed in 2019, following a previous commitment in 2018 and a consultation that had shown overwhelming public support for the policy.

Advancing our health: prevention in the 2020s; Childhood obesity: a plan for action, chapter 2

DHSC and Cabinet Office

Aimed at reducing consumption among children of energy drinks, which contain more calories and sugar than regular soft drinks on average.

Lever: Regulation

Population-level; low agency

Implemented? The policy appears to have been abandoned. No government response has been published following release of the prevention green paper.

There was no mention of the policy in the 2020 government obesity strategy.

Primary care weight management services: Increasing access

2020

2019

Building on a previous NHS LTP commitment, in 2020 government committed to expand access to NHS and local authority weight management services centred around ‘behavioural and lifestyle’ coaching. All PCNs have been promised the opportunity for staff to become ‘healthy weight coaches’ and promised incentives to introduce weight management referral pathways in local health care systems.

Tackling Obesity: government strategy; NHS Long Term Plan

NHS England (NHSE); PHE (now OHID); local health systems

Aimed at ensuring more people get access to specialist support to help them lose weight via primary care.

Lever: Service provision

Individual-level; high agency

Implemented? In March 2021 the government announced £100m of funding for councils and the NHS to expand access to weight management services.

An enhanced service specification was published by NHSE in June 2021, setting out what PCNs are expected to do in relation to weight management services.

Adding milk drinks to the soft drinks industry levy (SDIL)

2018

Commitment to consider including sugary milk drinks in the SDIL if insufficient progress on reduction has been made.

Childhood obesity: a plan for action, chapter 2

DHSC

Aimed at closing loopholes within the current SDIL, ensuring that government continues to drive progress on sugar reduction via manufacturer reformulation.

Lever: Taxation

Population-level; low agency

Implemented? The policy appears to have been abandoned. No expansions to the SDIL have been announced.

Voluntary sugar reduction programme: taking out 20% of sugar in products

2016

Introduction of a voluntary sugar reduction programme challenging all sectors of the food and drinks industry to reduce overall sugar across products that contribute to children’s sugar intakes – by at least 20% by 2020, including a 5% reduction in year 1.

Childhood obesity: a plan for action

PHE (now OHID)

Designed to reduce sugar content in the products children eat most to improve their diets without the need for individual behaviour change.

Lever: Voluntary programme

Population-level; low agency

Implemented? Yes. However, to date the programme has not been successful, leading to just a 3% reduction overall in sugar according to PHE’s progress report. Sugar sales also increased overall (by 2.6%). A final report on the programme is yet to be published.

Soft drinks industry levy (SDIL)

2016

Introduction of a Soft Drinks Industry Levy (SDIL) to reduce the amount of sugar in soft drinks, with three tiers of taxation depending on a drink’s sugar content.

Between 2017/18 and 2020, revenue was used to double the value of the Primary PE and Sport Premium.

Sugar reduction: the evidence for action; Budget 2016

Public Health England (PHE); HM Treasury

Designed to change manufacturer behaviour; encouraging reformulation of products to ensure lower sugar content. Aimed at helping to encourage healthier diets and address obesity.

Lever: Taxation

Population-level; low agency

Implemented? Yes – implemented April 2018.

Evidence suggests the SDIL has been effective in leading to industry reformulation of products. By February 2019, only 15% of soft drinks were liable for the levy, compared to 52% before its announcement in 2015. This equates to a fall in average sugar content in soft drinks of 29%.

Physical activity

New commissioning body and inspectorate: Active Travel England

2020

Commitment to create a new commissioning body and inspectorate, ‘Active Travel England’, to be led by a new national cycling and walking commissioner. The new body would hold the cycling budget, approve funding applications, inspect schemes, and provide training and good practice on active travel. Government promised Active Travel England would begin inspecting and publish annual reports from 2021.

Gear Change: A bold vision for cycling and walking (July 2020)

Department for Transport (DfT)

Designed to support active and sustainable travel (walking and cycling). Aimed at performing a similar role to Ofsted by raising standards and challenging failure, and influencing funding allocations for local transport schemes.

Lever: Regulation

Population-level; low agency

Implemented? Yes. Active Travel England was launched in January 2022.

Incentivising GPs to prescribe cycling and building cycle facilities in towns with poor health

2020

Commitment to work closely with the NHS to incentivise GPs to prescribe cycling. Several pilot sites were promised in places with poor health and low physical activity rates, with personalised care to be delivered via social prescribing in PCNs and GPs incentivised to prescribe cycling wherever appropriate. A stock of cycles would be available to lend, with training, access to cycling groups and peer support.

Gear Change: A bold vision for cycling and walking

Department for Transport (DfT)

PCNs

Designed to incentivise behaviour change and encourage more cycling in towns where people have poorer health.

Lever: Service provision and regulation (subsidy)

Individual level, high agency

Implemented? It is unclear whether funding has been provided to PCNs to support social prescribing of cycling or whether pilots have been rolled out yet in areas of poor health. No information is publicly available to enable tracking of progress.

Supporting cycling and walking infrastructure

2020

Announcement of £2bn in government funding to improve cycling and walking infrastructure, amounting to a ‘sixfold increase in dedicated cycling and walking funding’. Accompanying statutory guidance was published directing councils to reallocate road space for significantly increased numbers of cyclists and pedestrians.

Gear Change: A bold vision for cycling and walking

Department for Transport (DfT)

Designed to help encourage more people to choose alternatives to public transport when they need to travel, ‘making healthier habits easier’.

Lever: Funding and regulation

Population-level; low agency

Implemented? At the Spending Review in October 2021 the government committed to the promised £2bn investment in walking and cycling – up to 2025.

No updated Cycling and Walking Investment Strategy has yet been published.

‘Moving Healthcare Professionals’ national programme

2019

Launch of the second phase of a national programme supporting healthcare professionals to promote physical activity among their patients. Includes peer-led training courses and pilots testing how to embed conversations about physical activity into clinical practice.

Advancing our health: prevention in the 2020s; Moving Healthcare Professionals (Sport England)

PHE (now OHID) and Sport England

Focused on helping those with health conditions to keep symptoms under control and prevent additional conditions from developing.

Lever: Information

Individual-level; high agency

Implemented? Yes, although extent of roll-out and impact unclear.

Physical activity campaign for people with health conditions

2019

Commitment to launch a new physical activity campaign later in 2019 seeking to empower and inspire those living with health conditions to be more active.

Advancing our health: prevention in the 2020s

DHSC

Sport England

Aimed at providing information to empower and inspire those living with health conditions to be more active.

Lever: Information (mass media)

Individual level; high agency

Implemented? It is unclear whether the physical activity campaign proposed in the prevention green paper was rolled out.

Local pilots testing new ways of delivering sustainable increases in activity levels

2017

Launch of 12 local delivery pilots testing new ways of delivering sustainable increases in activity levels. Includes activity such as creating new housing and infrastructure to lower congestion and shift travel patterns, and building physical activity into NHS care plans for older adults.

Sporting Future: Second Annual Report

DCMS; Sport England

Aimed at tackling challenges within specific areas and communities. Focused on bringing together stakeholders to tackle inactivity and reach under-represented groups.

Lever: Funding

Population-level; low agency targeted in certain areas

Implemented? Yes, £100m allocated over 4 years for 12 local delivery pilots (since January 2018 – ran until September 2020).

Harmful alcohol use

Calorie labelling on alcoholic drinks

2020

Announcement of a consultation to consider making companies provide calorie labelling on alcohol.

Tackling Obesity: government strategy

DHSC

Designed to ensure consumers are aware how many calories alcoholic drinks contain.

Aimed at tackling the significant additional consumption of calories that occurs through drinking.

Lever: Regulation (for provision of information)

Population-level, high agency

Implemented? In November 2021 the government confirmed it will consult on the introduction of mandatory calorie labelling on pre-packed alcohol and alcohol sold in shops.

The consultation will also seek views on mandatory provision of the UK CMO’s low-risk drinking guidelines and a drink-drive warning.

Alcohol-free descriptor threshold increases

2019

Commitment to ‘review the evidence’ on increasing the alcohol-free descriptor threshold from 0.05% abv up to 0.5% abv, in line with some other countries in Europe.

Advancing our health: prevention in the 2020s

DHSC

Aimed at supporting further industry innovation and encouraging people to move towards alcohol-free products. Designed to help nudge the general drinking population towards lower strength alternatives.

Lever: Regulation

Population-level, low agency

Implemented? No further information has been published setting out the government’s next steps on alcohol-free descriptor threshold increases.

Increasing availability of alcohol-free and low-alcohol products

2019

Proposal for government to work with industry to deliver a significant increase in availability of alcohol-free and low-alcohol products by 2025.

Advancing our health: prevention in the 2020s

DHSC

Designed to make alcohol-free and low-alcohol products more widely available, to help nudge the drinking population towards lower strength alternatives.

Lever: Voluntary programme

Population-level; low agency

Implemented? No further information has been published about the government’s progress in implementing the policy.

Alcohol care teams (ACTs)

2019

Commitment to ensure hospitals with the highest rate of alcohol dependence-related admissions are supported to establish alcohol care teams. ACTs will be delivered in the 25% worst affected hospitals.

NHS Long Term Plan

NHSE

Trusts, local health systems

ACTs are aimed at preventing up to 50,000 alcohol-related hospital admissions over 5 years.

Focused on reducing A&E attendances.

Lever: Service provision

Individual-level; high agency

Implemented? Activity to roll out ACTs was suspended in April 2020, with funding for the first round of early implementor sites pushed back to October 2020. Few data are available tracking establishment of ACTs or recording impact.

Minimum unit pricing (MUP) for alcohol

2012

Announcement of an intention to introduce MUP for alcohol in England, making it illegal for shops to sell alcohol for less than a certain defined price per unit.

The Government’s Alcohol Strategy

Home Office

An MUP for alcohol would be aimed at tackling the availability of cheap alcohol and ending its irresponsible promotion and discounting. It is designed to reduce demand for alcohol and thereby reduce harm.

Lever: Regulation (pricing)

Population-level; low agency

Implemented? No. Implemented in Scotland and Wales, but not in England.

Ban on multi-buy promotions for alcohol in shops

2012

Commitment to consult on a ban on multi-buy promotions in the off-trade (shops), which would mean multiple bottles or cans could not be sold cheaper than the multiple of one bottle or can.

The Government’s Alcohol Strategy

Home Office

Aimed at putting an end to any alcohol promotion or sale that offers customers a discount for buying multiple products in stores. Designed to restrict advertising that encourages and incentivises customers to buy larger quantities than they want.

Lever: Regulation (marketing)

Population-level; medium agency

Implemented? No ban on multi-buy promotions for alcohol in shops has been introduced. In July 2013 the government stated it believed evidence for its effectiveness in reducing hazardous and harmful consumption ‘remains inconclusive’.

Health as a local alcohol licensing objective

2012

Promise to consult on a requirement for local authorities to consider health as an objective when making alcohol licensing decisions. Public health would be considered alongside prevention of crime and disorder, public nuisance, public safety and protection of children from harm.

The Government’s Alcohol Strategy

Home Office

Aimed at controlling density of premises selling alcohol to reduce health and crime-related harms from alcohol. Focused on contributing to wellbeing in deprived communities in particular.

Lever: Regulation

Population-level; low agency

Implemented? Health has not been incorporated as a local alcohol licensing objective.

In July 2013 the government confirmed the policy would not be adopted due to insufficient ‘local processes and data collection’ to support its implementation.

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