Raiding the public health budget

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2274 (Published 27 March 2014) Cite this as: BMJ 2014;348:g2274

Re: Raiding the public health budget

We have serious concerns about the capacity and resourcing of public health in England and are pleased that Iacobucci has highlighted these issues.(1) Raids on public health budgets are not new. In 2005 Sir Liam Donaldson devoted a whole chapter of his chief medical officer’s annual report to this area – “Raiding public health budgets can kill.”(2) Since then there has been further evidence of reductions in public health capacity at local, regional and national levels. (3,4) We believe that unless this situation is addressed, it will have considerable consequences in relation to: the health of individuals, life expectancy and the demand for health services.

Perhaps in the past, public health professionals have been too focused on solving immediate health problems rather than documenting success: that is they have failed to convince policy makers of their worth. However, even just studying the 20th century, there have been many notable public health achievements. (5-8) Overall, since 1900, the health and life expectancy of persons residing in the England have improved dramatically and most of this is attributable to developments in public health.

The present CMO has recently discussed some of the current public health challenges, including cancers, liver disease, alcohol, diet, physical activity and obesity.(9) She also comments on the ubiquitous problem of inequalities. For some of these challenges there will need to be coordinated action in many settings including health, schools, workplaces and communities. In her most recent annual report, the CMO referred to Personal, Social and Health education as a 'bridge' between education and health.(10) High-quality PSHE education delivered in schools can drive improvements in a range of key Public Health Outcome Framework indicators. A key task for public health staff will be to motivate and support the vast array of current and potential health promoters. This is particularly important in the health promotion “sleeping giant” – the health service.(11)

We believe that urgent action is needed to tackle the current public health threats, and that an adequately resourced, multi-disciplinary public health system would greatly reduce the burden on individuals and society. A pressing imperative is to stop the raids on budgets. Next, the current public health capacity and future needs of local government must be identified: a rapid review is needed. Also, if vacant posts are to be filled and staff are to be effective at galvanizing other key people, then their working conditions and status needs to be improved; public health needs to be given a higher priority. This is crucial if we are to tackle the major public health problems that are facing us.

1) Iacobucci G. Raiding the public health budget BMJ 2014;348:g2274
2) Department of Health. On the state of the public health: Annual report of the Chief Medical Officer 2005 London, Department of Health, 2006.
3) Faculty of Public Health. Specialist Public Health Workforce in the UK. A report for the Board of the Faculty of Public Health. London: Faculty of Public Health, 2008.
4) House of Commons Health Committee. Public Health. Twelfth Report of Session 2010–1 Volume II Oral and written evidence HC 1048-II. London: The Stationery Office Limited, 2011.
5) CDC. Ten Public Health Achievements of the Twentieth Century - United States, 1900-1999. MMWR Weekly 1999;48(12):241–3
6) Gray S, Pilkington P, Pencheon D, Jewell T. Public health in the UK: success or failure? J R Soc Med 2006;99: 107-11.
7) Hemenway D. While We Were Sleeping. Success Stories in Injury and Violence, Berkeley: University of California Press, 2009.
8) Health Education Authority. Take Heart. Good Practice in Coronary Heart Disease Prevention. London: Health Education Authority, 1990.
9) Davies, S.C. “Annual Report of the Chief Medical Officer, Surveillance Volume, 2012: On the State of the Public’s Health” London: Department of Health, 2014.

10) Department of Health. Annual Report of the Chief Medical Officer, 2012, Our Children Deserve Better: Prevention Pays. London: Department of Health 2013
11) Wise M, Nutbeam D. Enabling the systems transformation: what progress has been made in re-orienting health services? Promot Educ. 2007;Suppl 2:23–27.
Michael C. Watson, Associate Professor in Public Health.

Competing interests: No competing interests

31 March 2014
Michael C. Watson
Associate Professor in Public Health.
Dr John Lloyd (President Institute of Health Promotion and Education).
University of Nottingham
Faculty of Medicine and Health Sciences, D86, Queen's Medical Centre, Nottingham. NG7 2HA
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