Future government should prioritise public health, BMA says

BMJ 2014; 349 doi: (Published 16 September 2014) Cite this as: BMJ 2014;349:g5682

Re: Future government should prioritise public health, BMA says

We think the BMA is right to urge a prospective government to prioritise public health and we are pleased that they have highlighted the issue of public health funding in their manifesto.(1) Urgent action is needed in key areas including smoking, diabetes, obesity and mental health. However, we must not forget that in the past there has been considerable public health success and we now know strategies to confront these key areas.(2-5)

We agree that particular attention needs to be paid to improving child health and one specific target that needs far more attention is unintentional injuries in the home. They are a leading cause of preventable death for children under five years and are a major cause of ill health and disability.(6) Furthermore, many of these injuries are preventable.

However, we do not think that individual topics should be promoted in isolation. What is required is a long term strategic approach that also confronts the ubiquitous problem of inequalities. A new comprehensive public health strategy is needed that not only provides individuals with information but also creates supportive environments so that people from all sections of society are able to improve their health. Public health professionals should be active in creating for example: health promoting schools; health promoting workplaces; health promoting hospitals; and health-promoting general practices.(7)

It has long been recognised that the school is a very important setting for health promotion.(8) A healthy school promotes and develops health literacy in the young and also promotes the health and well-being of its entire staff. A healthy workforce is more likely to be effective in: the delivery of high class teaching; and the management of behaviour and the development of relationships necessary to be effective at every level.

In order to achieve health literacy as an educational outcome young people need through their education and schooling, to be able to assess and evaluate information, manage risk and make lifestyle choices that develop and maintain healthy lifestyles and ultimately good health.(9) The environment in which this should take place is that of a school which promotes health and well-being in all that it does, not just through the curriculum. The subtle messages that pupils receive about health from the daily life of a school are as important as those given in lessons.(10) If we are serious about tackling obesity, sexual health and other health concerns then we need a return to schools which can demonstrate a whole school approach to health involving key members of the community.(11)

Doctors have a pivotal role in promoting the health of the population, particularly those in primary care. Their high status and credibility provide them with the potential to act at an individual and community level on public health matters. However, they will need support and time if they are to overcome the restraints that are currently placed upon them.(7,12,13) There are many other key people who either are or could be involved in promoting the health of individuals, and public health professionals should be galvanizing them into action.

In order for public health professionals to fulfil their crucial roles their status, powers and resources need to be increased. Such actions may also make some of the current vacant DPH posts more attractive. We urge politicians to show national support and leadership on public health so that we can begin to tackle some of our pressing health problems.

1) Iacobucci G. Future government should prioritise public health, BMA says. BMJ 2014;349:g5682
2) CDC. Ten Public Health Achievements of the Twentieth Century - United States, 1900-1999. MMWR Weekly 1999;48(12):241–3
3) Hemenway D. While We Were Sleeping. Success Stories in Injury and Violence, Berkeley: University of California Press, 2009.
4) Gray S, Pilkington P, Pencheon D, Jewell T. Public health in the UK: success or failure? J R Soc Med 2006;99: 107-11.
5) Tones K and Tilford S. Health Promotion: effectiveness, efficiency and equity. Cheltenham: Nelson Thornes, 2001
6) Public Health England. Reducing unintentional injuries in and around the home among children under five years. London: PHE, 2014
7) Watson, M., Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.
8) European Commission. Resolution of the Council of Ministers of Education meeting within Council 23rd November 1988, concerning health education and schools (89/C/S/01). Official Journal of the European Commission. 1989; C3:1-3.
9) Lloyd, J. Improving health outcomes and health literacy for children and young people through Personal, Social and Health education in schools. Paper presented at the 17th EUSUHM Congress. 27th June 2013. London: Royal College of General Practitioners, 2013.
10) National Curriculum Council. Curriculum Guidance 5. Health Education. York: National Curriculum Council, 1990.
11) Department of Health. National Healthy School Status. A guide for schools. Department of Health. London: Department of Health, 2005.
12) Yarnall KS, Pollak KI, Ostbye T. Primary care: is there enough time for prevention? Am J Public Health. 2003;14:635–641.
13) Geense W, van de Glind I, Visscher T, van Achterberg T. Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study. BMC Family Practice. 2013; 14(1): 20.

Competing interests: No competing interests

22 September 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