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Public health—the frontline cuts begin

BMJ 2016; 352 doi: (Published 20 January 2016) Cite this as: BMJ 2016;352:i272

Re: Public health—the frontline cuts begin

In 2014 we stated that a pressing imperative was to stop the raids on public health budgets and that a rapid review of the current public health capacity and future needs of local government was required (1). In the same year, NHS England’s Five Year Forward View recognised the enormous burden facing the NHS and emphasised the important roles that public health needed to play in the future (2). The report quite rightly stated that:

“The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

Iacobuccis investigation (3) recently reported in the BMJ is very timely as The Commons Health Committee is now reviewing public health: delivery; effectiveness; workforce capacity; and spending. The BMJ investigation that used freedom of information requests to find extensive cuts to front line services will add further weight to the evidence that has so far been assembled by the Committee.

We strongly believe that our current and future public health challenges require an “industrial scale” (4) upgrade both at national and local levels. However, we do not think that there should just be a focus on individual topics including: obesity; smoking; mental health; and alcohol. Over the years we should not be just “nudging” individuals from one risk factor to another. A more radical approach is needed, one that gets to the roots of the situation (5). A long term comprehensive strategy is required: that doesn’t just provide information but also seeks to tackle environmental factors.

Action is needed in many settings including schools, primary care, workplaces and communities. In the UK there are 220,000 doctors and 300,000 nurses – this in itself is a tremendous resource that could be used to promote health. In addition, teachers, environmental health officers, fire fighters and many more need to be galvanized into action. However without public health support this potential will not be realized. Unfortunately, we are aware of strong anecdotal information from within public health of budgets being raided, unfilled posts, declining numbers of staff, and poor morale.

This negative environment needs to be reversed; the improvements to health cannot be delivered without properly resourced and robust public health services. In order for services to be successful in all three domains of public health (health improvement, health protection and improving health services) they need to ensure they contain a diverse range of: specialist knowledge; skills; and experience. Medical and non-medical staff are needed.

The DPH leadership role is crucial to championing the health of our communities. However, in some areas the role has been downgraded as a result of the transition to local authorities. DPHs should be empowered so that they are more influential within their authorities and local communities.

To conclude, we strongly believe that the cuts must stop and there needs to be a major upgrade in investment in public health, as this will improve people’s health and wellbeing, tackle inequalities and relieve pressure on our overloaded NHS.

1) Watson M C and Lloyd J. Raiding the public health budget. Action is needed to tackle current public health threats BMJ 2014;348:g2721

2) NHS England, Public Health England, Monitor, Care Quality Commission, Health Education England. Five year forward view. October 2014.

3) Iacobucci G. Public health – the frontline cuts begin. BMJ 2016;352:i272

4) Middleton J. Health inequality is worsening as the cuts bite. 2014 [viewed 28 January 2016]. Available from:

5) Tones K and Tilford S. Health Promotion: effectiveness, efficiency and equity. Cheltenham: Nelson Thornes, 2001

Competing interests: No competing interests

31 January 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,
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA