Intended for healthcare professionals


Investing in public health is essential for the UK’s economic recovery

BMJ 2022; 379 doi: (Published 16 November 2022) Cite this as: BMJ 2022;379:o2756
  1. Kevin Fenton, president
  1. Faculty of Public Health, London

Budget cuts and a failure to invest are a false economy, writes Kevin Fenton

As the UK’s new government sets its priorities, it does so in the middle of overlapping challenges including another difficult winter season, with demand for NHS and care services reaching an all time high,1 a crisis in the cost of living,2 and widening health inequalities. Improving the nation’s health must be at the heart of the government’s work to deliver economic growth and increase productivity. Investing in our public health system, and in the public’s health, should be seen as an essential part of our economic recovery—not a distraction from it.

The costs of ill health can be seen throughout society and the economy. Avoidable illness and death are major factors in the relentless pressure on the NHS, particularly in deprived areas,2 while a record 2.5 million people are economically inactive because of long term illness.3 Excess mortality, which is largely preventable, remains stubbornly higher than average as we emerge from the latest phase of the covid-19 pandemic,4 reflecting the increasing pressure on our health and social care systems, growing unmet health needs, and worsening workforce shortages. As Andy Haldane, former chief economist of the Bank of England, recently commented, “Having been an accelerator of wellbeing for the last 200 years, health is now serving as a brake in the rise of growth and wellbeing of our citizens.”5

The nature and scale of these challenges make it clear that we can’t simply “treat” our way out of this situation. A focus on creating and protecting health, reducing health inequalities, and improving population health will be essential if we’re to ease demand on services and tackle the growing burden of multimorbidity. Improving the health of our most deprived communities is in lockstep with these aims and with the government’s central objectives of economic growth and levelling up. Key to achieving all these outcomes is prevention.

When delivered at scale, evidence based prevention programmes—whether by the NHS or by local authorities—improve health outcomes, saving lives and money.6 Yet there have been worrying signals in recent weeks that the government is wavering in its commitment to build on hard won gains in public health issues, such as childhood obesity,7 alcohol and substance misuse,8 sexual and reproductive health, and smoking cessation.9

Drivers of ill health

Smoking is still a major cause of illness and death in the UK and is one of the biggest causes of health inequalities in England.10 The gains made by the UK in reducing smoking rates over the past four decades provide a strong foundation to accelerate renewed progress, but this will require sustained investment. The government must focus on reducing variation in smoking rates while prioritising the most effective interventions to meet its goal for England to be “smokefree” by 2030. We await the new tobacco control plan to see clear actions on this.11

In England 67% of men and 60% of women were overweight as of 2020, including 26% of men and 29% of women who were obese.12 Obesity was found to be a factor in more than a million NHS hospital admissions from April 2019 to December 2020—an increase of 17% on the previous year.13 There are some signs that we’re beginning to turn the tide on obesity: its prevalence among schoolchildren in year 6 fell from 25.5% in 2020-21 to 23.5% in 2021-2214—still shockingly high, but at least moving in the right direction.

The need to improve the public’s health is made even more urgent by the cost of living, which is likely to place even further strain on primary, emergency, and social care, as well as mental health services. Sharply rising energy and food prices will substantially increase deprivation, at a time when 11 million people are already estimated to be in absolute poverty.15

The government must step in to mitigate the negative health and economic ramifications of this situation with measures that are known to work. Providing nutritious free school meals, for example, reduces child hunger and obesity and alleviates pressure on household finances, but many children living in poverty don’t currently meet the threshold for accessing this scheme in England.16

Similarly, providing affordable, well insulated social housing will cushion people from higher energy bills and extortionate rent, while also helping to keep people fit for work and out of poverty.17 Yet social housing is in short supply, and research has found that UK homes are among the least energy efficient in Europe.1819

A missed return on investment

Failing to invest in public health is a false economy. When compared with other wealthy nations, a strikingly high proportion of our health spending goes on hospitals, while comparatively little is spent on prevention activities that offer a huge return on investment. In 2020-21, £190bn (€217bn; $226bn) went to the NHS, while the public health grant was £3.3bn.20

The budget cuts of recent years have doubled down on this false economy. In the six years to 2019-20, public health spending was slashed by 13% in real terms. Cuts were made to almost every major service area, including around a fifth of funding for health protection and a quarter of funding for smoking cessation and the NHS Health Check programme from 2016-17 to 2020-21. Spending on health at work almost halved.21

The health of the population is one of any nation’s greatest assets. Good health improves people’s wellbeing, productivity, and ability to participate in society. In his first speech as UK prime minister, Rishi Sunak reaffirmed his government’s commitment to strengthening healthcare and levelling up, as well as the Conservative Party’s 2019 manifesto commitments on healthcare,22 which included extending healthy life expectancy by five years by 2035.23 At the Faculty of Public Health we look forward to working with the new secretary of state for health and social care, Steve Barclay, to deliver better health for our nation, and we’re pleased to note his support for smoking bans when he was a backbench MP24 and for the sugar tax as health minister.25

One of the biggest lessons from the covid-19 pandemic is that a robust public health system, supported by a skilled and engaged workforce, increases our local and national resilience, the sustainability of the NHS, and our ability to respond to known and emerging health threats, ranging from infectious diseases to climate change. Every day, public health teams working locally, regionally, and nationally play a critical part in keeping our communities safe, improving health, and delivering an extraordinary range of services—for mental health, sexual health, substance misuse, vaccinations, infectious disease outbreaks, health checks, and health at work.

As we face a crisis in the cost of living and a difficult winter for millions of families, we hope that the government will support critical public health programmes as well as the specialist workforce tasked with ensuring their prioritisation, delivery, and quality. These efforts are essential to protect lives and livelihoods, save money, and keep communities safe through these most challenging of times.


  • Competing interests: None declared.

  • Provenance and peer review: Not commissioned; not externally peer reviewed.