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Health must be embedded across all government policy, MPs say

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4715 (Published 01 September 2016) Cite this as: BMJ 2016;354:i4715

Re: Health must be embedded across all government policy, MPs say

The Health Select Committee report is very clear about why public health is important.(1) It also emphasises the growing mismatch between funding on public health and the significance attached to prevention in the NHS. At the forefront of the case is the ubiquitous problem of health inequalities that is linked to many pressing public health issues including: obesity; problem drinking; smoking; physical inactivity and infectious diseases. However, the authors also stress that public health matters not only for its role in improving health but because it is crucial to reducing future demand on an overstretched health service. The report provides much to consider for Government, the NHS, PHE and public health specialists.

In relation to the NHS its key roles in promoting health are stressed and that more should be done to embed public health across the health service as a whole. A better balance between prevention and treatment is recommended. It is important to note that this re-orientation of the health service is in line with a proposal within a seminal document of public health – The Ottawa Charter that was published 30 years ago.(2,3) However in order for this proposal to become a reality staff will need support and time to carry out more health promotion. Public health specialists could be key staff in providing the NHS workforce with skills to deliver preventative advice as part of routine care.

The report also highlights the important expertise that public health specialists can bring to commissioning. Needs assessment is an integral part of public health specialists training and includes different perspectives and multiple methods.(4) We strongly feel that to enhance capability and capacity each CCG must include a public health specialist on its board.(5)

We welcome the report’s focus on data. However, instead of concentrating on negative indicators, such as deaths, positive indicators are also needed.(6,7) Positive health indicators can be identified that relate to individual health knowledge and behaviour, socioeconomic conditions, and the physical environment. Such indicators could be used for planning, evaluation and promoting health.

We agree that “cuts to public health are a false economy” and that the Government must commit to protecting funding for public health. We also endorse the comment that the removal of ring fencing in 2018/19 must be managed so as not to further disadvantage areas with high deprivation. Furthermore, we think that funding should be increased so it is commensurate with the substantial public health issues the country is facing.(5,8-10) We have previously mentioned that the DPH leadership role is pivotal to the health of our communities, but directors now face considerable challenges.(11) If the directors of public health are to have a substantial level of influence, then they will need to be given both the power and the resources: further investment is needed.

When the Government responds to this report it should be ambitious and develop an evidence based long term public health strategy that not only focuses on priorities including smoking, sensible drinking and mental health but also prioritises the reduction of inequalities. Coordinated action across hospitals, primary care, workplaces, schools and other settings is required. Well-resourced and robust public health departments will be vital to effective coordinated action across settings.(11)

References
1) House of Commons Health Committee. Public health post-2013: second report of session 2016-17. www.parliament.uk/business/committees/committees-a-z/commons-select/heal...

2) World Health Organization. Ottawa Charter for Health Promotion. Copenhagen: World Health Organization, 1986.

3) Wise M and Nutbeam D. Enabling health systems transformation: what progress has been made in re-orienting health services? Promotion & Education, 2007, Supplement (2):23-27.

4) Watson M. C. Normative needs assessment: Is this an appropriate way in which to meet the new public health agenda? International Journal of Health Promotion and Education. 2002; 40(1): 4-8.

5) BMA. Public health and healthcare delivery task and finish group. Final report. London: BMA, 2015.

6) Catford JC. Positive health indicators – towards a new information base for health promotion. Community Medicine. 1983; 5: 125-132.

7) Watson M C and Watson E C. Premature deaths across England. Time to focus on positive health indicators to reduce health inequalities BMJ 2013;347:f4210.

8) Wanless D. Securing our future health: taking a long-term view. Final report. London: HM Treasury, 2002.

9) Marmot M, chair. Fair society, healthy lives (the Marmot review). UCL Institute of Equity, 2010. http://www.instituteofhealthequity.org/projects/fair-society-healthy-liv...

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

11) Watson MC and Lloyd J. Re: BMJ briefing: meet the new masters of public health British Medical Journal Rapid Response 8th July 2013

Competing interests: No competing interests

07 September 2016
Michael Craig Watson
Associate Professor in Public Health
Professor Sylvia Tilford (President, Institute of Health Promotion and Education, Welwyn AL6 0UD, UK. http://ihpe.org.uk/)
University of Nottingham, Faculty of Medicine and Health Sciences, D86, Queen's Medical Centre, Nottingham. NG7 2HA