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Government must not shy away from bold action on public health, says MP

BMJ 2016; 355 doi: (Published 22 November 2016) Cite this as: BMJ 2016;355:i6319

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Re: Government must not shy away from bold action on public health, says MP

We fully agree with Sarah Wollaston - the government must take bolder action to reduce health inequalities.(1) The gross inequalities between disadvantaged and advantaged groups should be seen as economically, politically and socially, unacceptable.(2)

Over the last 50 years a wealth of evidence has accumulated linking deprivation with poor health status and increased prevalence of disease.(2-7) For example, a baby born in Kensington today can expect to live 8 years longer than a baby born in Blackpool.(8) Children living in the most disadvantaged areas of the country have a 50% higher risk of being burned, scalded or poisoned than those living in the most advantaged areas.(9) Children living in deprivation in England are more than twice as likely to be overweight or obese compared to their counterparts living in more affluent households.(10) Similar trends can be seen throughout the life-course reducing both life expectancy and importantly that period of an individual’s life when they can expect to live free of disability or disease. This should not be acceptable especially when there are effective strategies that could be implemented.

The 2010 Marmot review produced a robust evidence based report with detailed proposals for action.(6) This stated that “reducing health inequalities is a matter of fairness and social justice” and would have multiple benefits including significant ones for the NHS and the economy. The review sets out a framework for action and is clear that the role and impact of ill health prevention should be strengthened. More recently, others have argued strongly for an increase in public health funding.(11-13) The Five Year Forward View is clear 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.”(6)

Directors of Public Health are the frontline leaders of public health and can have a dramatic influence on reducing inequalities.(14) However, they must be empowered to have oversight and influence across many sectors including health, local authorities, education and the media. In addition, they cannot confront this issue on their own - they require sufficiently resourced and qualified Public Health teams.

If we are to tackle the ubiquitous problem of health inequalities it will be vital to ensure that they have sufficient power and resources. An increased investment in public health is needed both for the health of the population and for the sustainability of the NHS.(6,11,12)


1) Limb M. Government must not shy away from bold action on public health, says MP. BMJ 2016;355:i6319

2) World Health Organization. Declaration of Alma-Ata. Geneva: World Health Organization, 1978.

3) Black, D. Inequalities in Health: Report of a Research Working Group. London, DHSS, 1980.

4) Whitehead, M. The Health Divide: Inequalities in Health in the 1980's. London, Health Education Council, 1987.

5) Department of Health. Independent Inquiry into Inequalities of Health: Report (chairman, Sir Donald Acheson). London, The Stationery Office, 1998.

6) Marmot M, chair. Fair society, healthy lives (the Marmot review). UCL Institute of Equity, 2010.

7) The Kings Fund. Inequalities in Life Expectancy. London: The Kings Fund, 2015.

8) Office of National Statistics. Life Expectancy at Birth and at age 65 by Local Areas in England and Wales: 2012-2014.

9) Orton E, Kendrick D, West J, Tata LJ. Independent Risk Factors for Injury in Pre-School Children: Three Population-Based Nested Case-Control Studies Using Routine Primary Care Data. PLoS ONE 2012 7(4): e35193. doi:10.1371/journal.pone.0035193

10) Public Health England. Patterns and trends in childhood obesity. PHE 2016.

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

12) BMA. Public health and healthcare delivery task and finish group: final report. Jan 2015.

13) Watson M C and Lloyd J. Need for increased investment in public health BMJ 2016;352:i761.

14) Watson M and Tilford S. Directors of public health are pivotal in tackling health inequalities BMJ 2016;354:i5013.

Competing interests: No competing interests

25 November 2016
Michael Craig Watson
Associate Professor of Public Health.
Sue Thompson, Secretary Institute of Health Promotion and Education, Welwyn AL6 0UD, UK.
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA