SCHOOL CHILDREN WALKING along the roads with their friends invariably have two things in their hands – their smart phone and a plastic bottle of a sugary drink, often topped up with caffeine. Workplace canteen tables overflow with shop cakes, biscuits and chocolate. Throwaway bubble gum- flavoured vapes are widely available, while city streets are rife with the sickly-sweet smell of cannabis and shared needles thrown in the gutters.

Pre-teens download pornography on the ubiquitous smartphone that leave them vulnerable to grooming and the addictive taste of social media. Legislation to ensure alcohol harms are clearly outlined on every bottle is passed, then delayed. Laws to ensure speed limits in cities are limited to 30km/h are inexplicably passed to city councils to individually decide whether they will enact them or not.

All around us, we see the pervasive influence of the profit- driven capitalistic culture delaying, denying and obfuscating the harm caused by their products while the ‘wellbeing industry’ rakes in profits and mops up the damage caused by food, alcohol, tobacco, smartphones, and bigger and heavier cars.

At the Health Service Executive’s Integrated Care Conference month, Minister for Health Jennifer Carroll McNeill said it was “not sustainable” for health spending to continue at current high rates and that her priority for the next budget is infrastructure not recruitment.

“What we need is extra capacity, we need extra infrastructure. There is no point in recruiting extra surgeons if they don’t have a place to do surgical activity.”

Taoiseach Micheál Martin also addressed the conference suggesting that the government approach through the Enhanced Community Care Programme seeks to reduce dependency on the hospital system by delivering increased levels of healthcare provision in the community setting, with service delivery reoriented towards general practice, primary care and community-based services.

While enhanced integration of health services aligned with boosting community services is important, what is rarely mentioned is the reality that the vast majority (about 80%) of chronic disease is preventable.

The crux of the problem: the evidence-based measures that prevent chronic disease compete with industry-led measures to promote food, alcohol, smoking, vaping and sedentary lifestyles.

A healthy diet aligned with regular physical activity, avoiding smoking and excess alcohol consumption, and regulation of smartphone content available to children and young teens, would radically change the risk profile of citizens of all ages. These measures are not as eye catching or newsworthy as opening more hospitals or surgical hubs but their impact on health would be monumental.

Scant attention was paid to a report released this month outlining the news that Coca- Cola was once again the number one brand in Ireland, the latest Checkout Top 100 Brands for 2025 list showed, holding the title for 21 years in a row. Seven of the top ten brands on the list of over 5,000 brands from over 200 product classes – feature products classed as ultra processed – high in saturated fat, sugar, and salt (HFSS).

As food prices in Ireland continue to skyrocket, the Irish preference for unhealthy foods that underpins an epidemic of obesity and chronic disease barely raises an eyebrow. It is mind-boggling that we continue to congratulate ourselves on the buoyancy of the food market while ignoring the impact of this vibrancy on our health and wellbeing.

Apart from Coca Cola, seven of the top ten brands include Lucozade, Dairy Milk, Tayto, Monster, Red Bull and 7 Up.

In terms of alcohol consumption, the Government decision to delay the introduction of labels on alcohol products is a massive retrograde step in the face of intensive lobbying from vested interests that will come at a huge cost to health. Labelling saves lives. It tells the facts, and it plays a role in changing attitudes to consumption.

The question we need to ask is the one raised by English temperance and vegetarianism activist Joseph Malins in 1895. “Some said, ‘Put a fence ‘round the cliff’. Some an ambulance down in the valley.”

Author of Food Fight, Stuart Gillespie, suggests that in order to deal with anything that causes widespread ill-health, we need to prioritise large-scale prevention (the fence) while ensuring accessible and affordable treatment for those who need it (the ambulance).

Gillespie suggests that to arrive at health policy that’s driven by health concerns, not profit, there are four key steps – what he terms, the four ‘Ins’:

Institutions

Governments need to have budgets to procure healthy foods (and restrict ultra-processed foods) for government institutions including schools, hospitals and clinics.

An ideal starting point to make this a reality in Ireland would be a government budget to procure healthy foods for the Hot School Meals programme that is currently being revised.

Incentives

Governments have the power to tax harmful products and practices including taxes on soda and junk foods.

“Taxes work,” writes Gillespie, “especially when governments earmark this tax dividend to subsidise healthy diets for low-income families eg. By using vouchers, food stamps or cash.

A tax on sugary drinks was introduced in both Ireland and the UK in 2018, resulting in a precipitous drop in consumption of drinks that fell into the tax band. Even more impressive was the rapid response of the industry to reformulate drinks products to ensure that sugar levels fell below levels that would fall into the tax band.

Columbia was the first country to introduce a similar tax on ultra-processed foods that is being implemented gradually, beginning at 10% before rising to 15% in 2024 and 20% in 2025.

The tax could be used to provide fruit and vegetables on prescription. A scheme to do just this in the UK has shown that providing fruit and vegetables free of charge to low- income groups improved physical health in the majority (eight out of ten) participants and cut GP visits by 15%.

Information

Governments can use informational interventions (physical and digital) including labels and ingredient lists, while also reining in predatory marketing of unhealthy foods, especially to children.

In 2020, the newly elected Government committed to addressing obesity in Ireland with a Public Health (Obesity) Act including restricting the marketing of unhealthy foods to children.

It never happened. Just like the legislation to introduce health labelling on alcohol, or legislation to reduce speed limits in cities that would facilitate cycling and walking – market- driven forces intervened and the health of children was once again put on the long finger.

Interests

Governments need to banish conflicts of interest from advisory and regulatory bodies and dietary guideline committees – as well as cleaning up lobbying by enforcing transparent disclosure.

“The notion that we just need more ambulances is an abrogation of responsibility,” Sturat Gillespie suggests. “Healthy food environments are the policy and legislative fences that prevent public harm. Building them is the job of government.”

Both prevention and treatment require strong governmental action. Anything less is like trying to empty an overflowing bathtub with a bucket while forgetting to turn off the tap.

The Health Minister is right that we need more infrastructure, but it must be aligned with robust and courageous legislation that takes on the power of profit- driven industries and puts health ahead of profit instead of the other way round.

Dr Catherine Conlon is a public health doctor and former director of human health and nutrition at Safefood.