Government changes are jeopardising public health

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1662 (Published 29 March 2016) Cite this as: BMJ 2016;352:i1662

Re: Government changes are jeopardising public health

Devakumar and colleagues are right to highlight many of the major public health challenges facing this country as well as identifying the need for a stronger and more capable public health workforce.(1) In the past senior public health figures including chief medical officers have also commented on raids to public health budgets and the need to strengthen the public health function.(2,3) We believe that an increased investment in ill health prevention through health promotion would have health and economic benefits, and result in for example, fewer treatment costs and lower welfare payments.

There is a developing consensus that public health action is needed to improve health and wellbeing, and relieve some of the burden on our overloaded NHS.(4-6) The case for action includes information about mortality, morbidity, and costs to individuals, the NHS and wider society. The case is further strengthened by evidence about effectiveness and cost-effectiveness. For example, tools are available to create health promoting schools and hospitals, and tackle the obesity crisis.

We are pleased to see that there has just been a review of public health in Scotland where the recommendations are very positive and include strengthening the roles of Directors of Public Health and developing a new public health strategy for Scotland.(7) In England, the Commons Health Committee is now reviewing public health, its delivery, effectiveness, workforce capacity, and spending. We hope that they will recommend similar actions to those proposed for Scotland.

Our major public health challenges including alcohol, obesity, mental health problems and health inequalities, do not simply require small scale didactic information campaigns and expensive NHS treatments. A long term positive health strategy is needed that includes creating environments that positively promote physical and mental health as well as addressing obesogenic and other risk factors.

To conclude, we make five clear recommendations:
1. A new long term public health strategy is needed that not only focuses on priorities including healthy eating, sensible drinking and mental health but also seeks to address inequalities.
2. There needs to be a paradigm shift in our thinking away from merely treating ill health and towards promoting positive health. Health promoting environments are needed including health promoting schools and hospitals.
3. Academics, practitioners and public health institutes need to be more vocal about the considerable past public health achievements and potential future successes.
4. Robust multi-disciplinary departments of public health need to be created that are able to lead and galvanise others (including doctors and nurses) into action.(8)
5. The role of Directors of Public Health needs to be strengthened if they are truly to become the masters of public health.(9,10)

1) Devakumar D et al. Government changes are jeopardising public health. BMJ 2016;352:i1662

2) Department of Health. The Report of the Chief Medical Officer’s Project to Strengthen the Public Health Function. London: Department of Health, 2001.

3) Department of Health. On the state of the public health: Annual report of the Chief Medical Officer 2005 London, Department of Health, 2006.
4) Wanless D. Securing our future health: taking a long-term view. Final report. 2002. http: //si.easp.es/derechosciudadania/wp-content/uploads/2009/10/4.Informe-Wanless.pdf.

5) Marmot M. Fair society, healthy lives: strategic review of health inequalities in England post-2010. 2010. www.instituteofhealthequity.org/projects/fair-society-healthy-lives-them....

6) NHS England, Public Health England, Monitor, Care Quality Commission, Health Education England. Five year forward view. 2014. www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf.

7) The Scottish Government. 2015 Review of Public Health in Scotland. Strengthening the Function and Re-Focussing Action for a Healthier Scotland. Edinburgh: The Scottish Government, 2016.

8) Watson M C and Lloyd J. Need for increased investment in public health BMJ 2016;352:i761. doi:10.1136/bmj.i761 pmid:26860902.

9) Watson M C and Lloyd J. Re: BMJ briefing: meet the new masters of public health BMJ Rapid Response 8th July 2013 http://www.bmj.com/content/346/bmj.f4242/rr/652995.

10) Vise R. BMJ briefing: meet the new masters of public health. BMJ 2013;346:f4242

Competing interests: No competing interests

05 April 2016
Michael Craig Watson
Associate Professor of Public Health.
Dr John Lloyd (Vice President Institute of Health Promotion and Education, Institute of Health Promotion and Education, http://ihpe.org.uk/).
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA
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