Intended for healthcare professionals


Next government must tackle public health “ticking time bomb,” says BMA

BMJ 2017; 357 doi: (Published 11 May 2017) Cite this as: BMJ 2017;357:j2325

Re: Next government must tackle public health “ticking time bomb,” says BMA

The BMA is right to call on the next government to make tackling the crisis in public health a priority.(1) We believe that a major upgrade in funding is imperative to provide resources to meet the enormity of the public health challenges that the country faces.

The three succinct papers that have been produced by the BMA cover: effective approaches; evidence about cost effectiveness; and current funding.(2-4) Together they highlight key evidence that more should be done and importantly, are in line with the mounting consensus from a range of authoritative individuals and organizations.(5-8) We strongly support the BMA emphasis on early interventions.

The government currently faces significant challenges in relation to the health of the population. Childhood obesity, alcohol abuse, mental health, smoking and inequalities are just some of the well documented areas that need urgent action. Doctors and nurses in their daily activities see first-hand the consequences of a lack of action: individuals and their families suffer and there are significant unnecessary costs for the NHS and social care.

In 1992 the relatively new Major government produced the first public health strategy for England.(9) It had the effect of putting health improvement on the agenda and in some places around the country there were considerable achievements.(10-12) Similar bold action is needed now building on the lessons learnt from that strategy.(13)

A holistic approach is needed and instead of mainly focusing on individuals we also need to change environments. Coordinated action is needed in key environments including schools, hospitals, workplaces and primary care. The aim should be to make all these health promoting. The health promoting general practice for example has considerable potential, but resources and training will be needed.(14)

In schools, the government made a positive step earlier this year by announcing that sex and relationships education is to be made compulsory but the next government must go further. They must make Personal, Social, Health and Economic education compulsory in all schools so that young people are empowered to make positive decisions in relation to a range of public health priorities including alcohol and drugs, mental health, and diet and exercise.

A vital element of a successful future strategy would be well funded robust multidisciplinary public health departments. Public health staff have crucial roles in relation to galvanizing and coordinating action in different settings including schools, workplaces and primary care. But resources are needed.(15,16)

When making the case for further investment in public health, practitioners often focus on current mortality and morbidity data and often do not mention that there has been considerable success in the past.(17-20) Even within recent history there are notable achievements including in the areas of smoking and child accident prevention.(18,20) Illness has been prevented and many lives have been saved and the cost effectiveness of a number of interventions have been demonstrated. While we endorse the call to develop further the evidence base on effective interventions much more could be achieved by the consistent use of the existing evidence.

In conclusion, we strongly believe that the next government must take bold action and tackle this “ticking time bomb”. A comprehensive long term public health strategy is needed both for the health of the population and for the future of the NHS.(7)

1) Wise J. Next government must tackle public health “ticking time bomb,” says BMA. BMJ 2017;357:j2325

2) BMA. Are UK governments utilising the most effective evidence-based policies for ill-health prevention? May 2017.

3) BMA. Exploring the cost effectiveness of early intervention and prevention. May 2017.

4) BMA. Funding for ill-health prevention and public health in the UK. May 2017.

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

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

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

8) Watson M C and Thompson S. Re: Government must not shy away from bold action on public health, says MP. British Medical Journal Rapid Response, 25th November 2016.

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

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

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

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

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

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

15) Watson MC and Lloyd J. Re: BMJ briefing: meet the new masters of public health British Medical Journal Rapid Response 8th July 2013

16) Watson M and Tilford S. Re: Government’s response to inquiry on public health raises fears of more cuts. There should be investment – not cuts. British Medical Journal Rapid Response 10th January 2017.

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

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

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

20) Watson M C and Errington G. Preventing unintentional injuries in children: successful approaches. Paediatrics and Child Health. 2016; 26(5), 194-199

Competing interests: No competing interests

15 May 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