Local death rates should be used to calculate public health funding

BMJ 2012; 344 doi: (Published 19 June 2012) Cite this as: BMJ 2012;344:e4259

Re: Local death rates should be used to calculate public health funding

Current NHS funding to improve public health is based on local consultation and prioritization. This has resulted in much higher levels of spending in poorer areas where the health needs are greatest. Current spending on public health interventions in each local authority area shows a strong correlation with the level of deprivation (1). From 2013 responsibility for public health will be transferred to local authorities and in the future funding will be allocated centrally based on a new formula that is being developed for the government (2,3).

The proposed new formula gives less priority to deprived areas than the existing allocation. Moving from the current level of spending to the proposed allocation will mean that deprived areas will loose out the most. On average the most deprived 20% of councils would get £8 less per head of population and the most affluent would get, on average, £8 more per head than is currently spent (see Figure 1).

Allocating funding to those places with greatest need, to tackle poverty related ill-health, is central to the governments strategy to reduce health inequalities (4). Allocation based on the proposed formula, however, is likely to increase health inequalities by shifting resources away from some of the poorest areas that have currently prioritised public health action. This further compounds the problems faced in the most deprived local authorities that have received the largest overall budget cuts (5).

Less regressive public health funding could be achieved if the proposed formula was used as an indicator of minimum allocation, allowing existing allocation to remain in areas where it is now higher than this minimum. This would “level up” those areas that have given to too little priority to public health, rather than penalizing those areas that are taking action to reduce health inequalities.

1. Department of Health. Baseline spending estimates for the new NHS and Public Health Commissioning Architecture [Internet]. 2012 [cited 2012 Jun 21]. Available from:
2. Limb M. Local death rates should be used to calculate public health funding. BMJ. 2012 Jun 19;344(jun19 4):e4259–e4259.
3. Department of Health. Healthy Lives, Healthy People: Update on Public Health Funding [Internet]. 2012 [cited 2012 Jun 21]. Available from:
4. David Williams. Lansley: CCG allocations should be based on age, not poverty. [cited 2012 May 2]; Available from:
5. Taylor-Robinson D, Gosling R. Local authority budget cuts and health inequalities. BMJ. 2011 Mar 8;342(mar08 3):d1487–d1487.

Competing interests: No competing interests

22 June 2012
Ben Barr
Consultant in Public health / Research Fellow
David Taylor-Robinson, Dominic Harrison
NHS Blackburn with Darwen, University of Liverpool
Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, The Quadrangle, Liverpool L69 3GB, United Kingdom