Failure to tackle health inequalities is a false economy, meeting hears

BMJ 2013; 346 doi: (Published 28 June 2013) Cite this as: BMJ 2013;346:f4236
  1. Matthew Limb
  1. 1London

England’s new public health bodies should not let the “immense” funding difficulties in local government slow their progress in reducing health inequalities, experts have said.

Jessica Allen, deputy director of University College London’s Institute of Health Equity, said that failure to tackle health inequality was costing the country around £70bn (€82bn; $107bn) a year. This was estimated in productivity losses, lost taxes, higher welfare payments, and additional NHS healthcare costs, she said.

Allen said that the new local health and wellbeing boards in local authorities had to take such factors into account. “When you’re required to reduce health inequalities, look at the cost of doing nothing,” she warned.

She was speaking on 26 June at a Westminster Health Forum seminar in London that discussed the problems facing the new boards and Public Health England, which were formally established on 1 April 2013.

Allen worked on Michael Marmot’s review into health inequalities in England, Fair Society, Healthy Lives, published in February 2010.1

She said that although the financial context had changed “dramatically” since then, there was now a “favourable political consensus” for tackling health inequality. Health and wellbeing boards must make it a priority to act on the “reams and reams” of evidence concerning the social determinants of ill health, she said.

Jeanelle de Gruchy, public health director for the London borough of Haringey, said that budgetary pressures in local government were “immense” and that prioritising public health measures was not easy.

For example, she said that some people might question proposals to hold “comedy nights” for Afro-Caribbean men to raise awareness of sexual health issues, when social care support schemes were under threat. “It’s a challenge to tackle health inequalities in a political environment,” she said.

Nick Hicks, a former director of public health now working as a consultant, said that health and wellbeing boards should try to ensure that service commissioners focused on the “outcomes that mattered to people.”

“Commissioners will have to be revolutionaries, and health and wellbeing boards need to be the revolutionary councils,” he said.

The seminar heard concerns about the “fragmented” commissioning of sexual health, drug, and alcohol services and about the growing public health threats posed by malaria, tuberculosis, and gambling.

De Gruchy said that national legislation was needed in some cases, because local councils had limited powers. Examples were measures to tackle the spread of gambling premises, payday loan companies, and fast food outlets.

The seminar heard calls for health and wellbeing boards to do more to involve professionals other than doctors—such as dentists and pharmacists—in public health initiatives.

Ash Soni, vice chairman of the English Pharmacy Board and clinical network lead with NHS Lambeth Clinical Commissioning Group, said that communities valued their local pharmacies, which could do more to help people “before they become patients.”

Tim Baxter, who heads the public health policy and strategy unit at the Department of Health for England, said that the transfer of public health from the NHS to local government had gone “reasonably smoothly.” He added, “We need to ensure it delivers its potential.”


Cite this as: BMJ 2013;346:f4236


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