The 10 Year Health Plan for England arrived last week with stark language and a clear ultimatum for the nation's 76-year-old health service: reform or die. The Plan proposed three main shifts: moving care from hospitals into communities, embracing digital technology, and focusing on preventing illness rather than just treating it. It’s a cliche because it is true. Everyone knows: ‘prevention is better than cure’ - particularly those working in the chronically overwhelmed NHS where staff are leaving in droves and waiting lists continue to grow.

But strip away the language of reform, and what emerges across the plan's prevention agenda is a systematic handover of public health decisions to private companies, dressed up as partnership and collaboration. Companies that profit from making us sick are being invited to shape the policies meant to prevent them doing just that.

One proposal strategically leaked ahead of the plan's publication – a new healthy food standard for retailers, manufacturers and restaurants – illustrates this dynamic. Done right, this could be transformative, creating the regulatory environment where healthy, sustainable food can flourish and become the norm rather than the exception. The government's framing of partnership with industry, however, points to a familiar pattern of regulatory capture; the evidence is clear. Industry collaboration waters down standards before they’re even implemented. The suggestion that companies can meet the standard how they see fit, including tweaks to loyalty schemes, illustrates how this approach shifts responsibility from businesses (to change the food they develop and promote) to individuals (trying to navigate reward schemes).

The plan's broader prevention strategy reveals an intention to make healthcare profitable rather than addressing root causes. The "moonshot to end the obesity epidemic" language borrowed from Silicon Valley treats complex social problems as if they were technological puzzles waiting for the right innovation. The Plan proposes increased access to weight loss drugs, and while for some treatment is important and necessary, pharmaceutical solutions create long-term dependencies, not to mention guaranteed profits for drug companies.

This approach stands in stark contrast to what UK citizens want. Through The Food Conversation, the country's largest-ever public dialogue on food systems involving hundreds of citizens across all four nations, we know that people don’t like being labelled as consumers. They don’t want to have to balance a myriad individual choices in their shopping – all shaped and directed by the R&D, marketing and promotional strategies of the most powerful companies in the world. When we started The Food Conversation, participants talked about personal choices constrained by tight budgets, time pressures, and limited availability. But as they explored how the current food system actually works, their language shifted. As one participant from Scotland put it: "I think we've moved from talking about 'my shopping basket' to 'our food system'. That's been the biggest shift for me personally."

This shift reveals something profound about public appetite for change. When citizens understand how supermarket layouts, advertising strategies, and product formulation actively shape their decisions, they don't want more individual choices. They want structural change, to be involved in designing food policies that prioritise health, fairness, and environmental sustainability. They understand that getting good food to everyone requires tackling power imbalances, not accommodating them.

The economic case for this approach is clear. We've heard multiple times about the cost of obesity in the UK at £98 billion annually. But what if we go beyond obesity, look to the range of health conditions linked to the current dysfunctional food system, lost productivity, social care, burden on individuals? Professor Tim Jackson's analysis shows that this cost is £268 billion annually, almost as much as the entire NHS budget. By contrast, providing everyone with a healthy diet would cost just £57 billion.

These numbers reveal the tragedy of the current approach. The UK is spending more treating food-related disease than it would cost to fix our diet entirely. Yet the 10 Year Health Plan risks being in hock to the very market forces that create the problem, rather than leading the critical work to tackle it.

Citizens in The Food Conversation consistently support policies that address root causes. They back long-term regulation, collaboration across the UK nations, a fairer deal for farmers. When citizens are asked to imagine the food system in 2030 if their recommendations were implemented, they describe irresistible futures of flourishing local food networks, stronger connections between farming and communities, and a fairer system where real, healthy food is the default, the easy, convenient option. They want to see far fewer ultra-processed and junk food and drink, regenerated nature, and a virtuous circle delivering health benefits while protecting the environment.

The 10 Year Health Plan sets out important goals that deserve support. But delivering them requires a whole new approach to partnerships. A real and serious partnership with citizens who – through The Food Conversation - have demonstrated their appetite for change. Of course, industry will have to deliver policy intentions. But they can no longer dominate public health and food policy development, as they have for decades. Citizens from The Food Conversation are now actively involved in shaping the new food strategy. With their continued involvement, we can build the food system they want, one that prioritises health, fairness and sustainability – the public interest over vested interests.