Intended for healthcare professionals

Rapid response to:


Government’s response to inquiry on public health raises fears of more cuts

BMJ 2016; 355 doi: (Published 30 December 2016) Cite this as: BMJ 2016;355:i6853

Rapid Response:

Re: Government’s response to inquiry on public health raises fears of more cuts

There should be investment – not cuts.

In 1992 the Conservative government was bold and introduced The Health of the Nation (HOTN), the first public health strategy for England (1). Initially it was widely welcomed and in some parts of the country it enabled increased funding to be put into public health and innovative projects were developed (2,3). The Department of Health highly commended some alliances for their work (4). However, the national evaluation indicated that: in general it did not cause a major readjustment in investment priorities by health authorities; it did not adequately address inequalities; and it lacked local government ownership and was seen as principally a health service strategy (5).

Twenty five years later public health departments are back in local authorities and the Conservative Prime Minister at the start of her premiership made a commitment to fight “against the burning injustice” of poverty. Moreover there is a growing consensus that there needs to be a “radical upgrade in prevention and public health” (6-9). Perhaps it is now time for the Conservative government to be bold again, to learn lessons from the past, and develop a new public health strategy for England that works for everyone.

For this strategy to be effective we recommend an increased investment in public health in order to allow Directors of Public Health to develop robust multi-disciplinary teams with the potential to make a significant impact on the reduction of health inequalities. Such teams will be able to galvanise and support the range of current and potential health promoters who work in different settings.

In recent years some Directors of Public Health posts have been downgraded within local authorities. We strongly believe that they should be in the most senior positions so that they will be empowered to have the maximum oversight and influence both within their organisation and in other sectors. They must have an independent voice so that they can advocate for their populations and challenge policy makers at local and national levels.

Primary care is one setting where there is enormous potential to promote the health of individuals and communities but, it has never truly been tapped - it is the "sleeping giant" of public health (10,11). Public health specialists could support doctors and nurses in further developing their health promoting roles but the issues of staffing and funding within primary care also need to be addressed (12).

Schools, are another setting where there is significant potential for improving the health and well-being of young people and in the task of reducing inequalities (13). Over the years the extent and nature of health promotion in schools has been variable and recently there has been a decline in input (14). Teachers, pupils, parents and ancillary staff all need to be involved in school health promotion - but they will also need support. Nationally the introduction of compulsory PSHE, accompanied by mandatory teacher training, would be a tremendous step forward, as would enabling public health practitioners to support schools locally.

In making the case for further investment in public health in order to face new challenges, practitioners often focus on: current mortality and morbidity data; and effective approaches that are available. We think it is also important to highlight the considerable success that public health practitioners have had in the past. Control of infectious diseases, motor-vehicle safety, safer workplaces, vaccination and tobacco control are just a few areas where there have been substantial public health achievements (15-18). Many lives have been saved, illness has been prevented…..

1) Secretary of State for Health. The health of the nation: a strategy for health in England. Cm 1986. London: HMSO, 1992.

2) Jones K. Annual Report 1993 of the Director of Public Health for North Lincolnshire. Lincoln: Lincolnshire Health Authority.

3) Lincolnshire Health for All Group. Newsletter. Issue 3, September 1993. Lincoln: Lincolnshire Health.

4) Lincolnshire Health for All Group. Newsletter. Issue 8, April 1996. Lincoln: Lincolnshire Health.

5) Department of Health. The health of the nation: a policy assessed. London: The Stationery Office, 1998.

6) Wanless D. Securing our future health: taking a long-term view. Final report. 2002. http: //

7) Marmot M. Fair society, healthy lives: strategic review of health inequalities in England post-2010. 2010.

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

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

10) Watson, M., Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.

11) WATSON M C and WATSON E C, 2014. Re: Future shape of general practice in England British Medical Journal Rapid Response 26th October 2014.

12) Royal College of General Practitioners. Patient safety in general practice could be ‘at risk’ – unless chronic shortage of GPs is turned around, with nearly 600 practices at risk of closure Publication date: 18 September 2016
[Accessed 8 January 2017]

13) Schools for Health in Europe. School health promotion: evidence for effective action SHE Factsheet 2. 2013 [Accessed 8 January 2017].

14) PSHE Association. PSHE Association raises concerns about drop in PSHE provision in schools. [Accessed 10 January 2017].

15) Health Education Authority. Take Heart. Good Practice in Coronary Heart Disease Prevention. London: Health Education Authority, 1990.

16) CDC. Ten Public Health Achievements of the Twentieth Century - United States, 1900-1999. MMWR Weekly 1999;48(12):241–3

17) Gray S, Pilkington P, Pencheon D, Jewell T. Public health in the UK: success or failure? J R Soc Med 2006;99: 107-11.

18) Hemenway D. While We Were Sleeping. Success Stories in Injury and Violence, Berkeley: University of California Press, 2009.

Competing interests: No competing interests

10 January 2017
Michael Craig Watson
Associate Professor in Public Health.
Professor Sylvia Tilford (President, Institute of Health Promotion and Education, Welwyn AL6 0UD, UK.
University of Nottingham, Faculty of Medicine and Health Sciences, D86, Queen's Medical Centre, Nottingham. NG7 2HA