Re: BMJ briefing: meet the new masters of public health
The new masters of public health now face titanic challenges. In terms of topics it is easy to list a few that are putting a huge strain on our health service: obesity, alcohol abuse, smoking and heart disease. However, cutting across all these is the ubiquitous problem of health inequalities. In addition and at the same time, directors of public health are being expected to contest with: new roles and methods of working; structural changes; a very high workload; and the under-resourcing of public health.
It needs to be noted that they are not alone, there is a wide range of key people who either are or could be working on some of these pressing public health topics.(1) This includes: teachers; nurses; environmental health officers; trading standards; police and doctors. In the past many areas of the country had relatively well stocked health education/promotion units that would have as one of their roles – enabling and facilitating action from these key people. The health promotion specialists would be involved in training, coordination, campaigns, and research and evaluation. However in many parts of the country these resources have been reduced. “Raids” on public health budgets were highlighted in a CMO report but since then there has been further evidence of reductions in public health capacity at local, regional and national levels. (2,3)
In respect of schools the Department for Education is unequivocal ‘Personal, social and health education (PSHE) is not part of the National Curriculum’. The government insist that PSHE is an important and necessary part of pupils’ education BUT PSHE will remain non-statutory. They argue that teachers will have flexibility to deliver high quality education.
In addition, despite the rhetoric that ‘children can benefit from high quality personal, social and health education which supports making safe and informed choices’ (4) and that ‘good schools will be active promoters of health’ (5) there is a serious dichotomy between the current aspirations for Public Health England and the Department for Education’s view of the purpose of schools, the curriculum and the place of PSHE. Central funding was discontinued for the Healthy Schools Programme in March 2011 and since then it has been the government’s intention that the programme should be ‘schools led’ and determined by local needs and priorities.
The DPH leadership role is pivotal to the health of our communities. Their own actions and those of their staff are vital for motivating and supporting the vast array of current and potential health promoters. We agree with both Wanless and Marmot that there needs to be an increased investment in ill health prevention and health promotion. (6,7) We think that this would have health and economic benefits, as a healthier more equal population would result in for example, fewer treatment costs and lower welfare payments. If the directors of public health are truly to become the “masters” and have a substantial level of influence, then they will need to be given both the power and the resources: further investment is needed.
1) Department of Health. The Report of the Chief Medical Officer’s Project to Strengthen the Public Health Function. London: Department of Health, 2001.
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) 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.
4) Department for Education. The importance of teaching: The Schools White Paper. London, Department for Education, 2010.
5) Department of Health. White paper: Healthy Lives, Healthy People: our strategy for public health. London, Department of Health, 2010.
6) Wanless D. Securing our future health: taking a long-term view. Final report. London: HM Treasury, 2002.
7) Marmot M, chair. Fair society, healthy lives (the Marmot review). UCL Institute of Equity, 2010. www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-....
Competing interests: No competing interests