Spending on public health cut as councils look to save moneyBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3401 (Published 13 July 2017) Cite this as: BMJ 2017;358:j3401
All rapid responses
For many years we have consistently argued for an increase in public health funding.(1-5) This we think is needed primarily to cope with our current and future public health concerns. The case for funding can also be supported by the fact that there are effective interventions available and there has been considerable public health success in the past.
Our calls to prioritise the prevention of ill health and health promotion are co-terminus with many knowledgeable individuals, groups and organisations, including: Wanless; Marmot; House of Commons Health Committee; NHS England; the Richmond Group; and the BMA.(6-12) For example it was stated in the Five Year Forward View 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.”(8)
Doctors and nurses have key roles to play in protecting and promoting the health of individuals and communities that they serve. However they will only be able to make a success of this if they are supported. Having the time to undertake health promotion is critical and linked to this is the issue of adequate staffing levels. For too long areas with the greatest health needs have faced shortages of vital staff such as GPs.(13)
Professionals in other settings also have roles to play. Health promoting settings need to be established so that it is easier for members of the public to choose the healthier options.(14,15) For example, with adequate resources, health promoting schools and health promoting hospitals could be created.(15,16)
A healthy school promotes and develops health literacy in the young and also protects and promotes the health of its entire staff.(17) A healthy workforce is more likely to be effective in the delivery of high quality teaching. Teachers, school nurses and catering staff all have parts to play in creating health promoting schools, however if they are to be effective they will need support.
Directors of Public health should be the new masters and champions of public health for their communities.(1,18) They have significant roles including: health improvement; health protection together with emergency response; health and care service planning and commissioning; and reduction of heath inequalities. They should have the stature, power and resources to act as independent advocates for the health of their population. With a robust multidisciplinary team they would be able to support key professionals in different sectors as well as galvanising them into action.
In conclusion we think the cuts to public health budgets will be a short term false economy and be devastating for the health of the nation. The country as a whole, needs a well-funded long term public health strategy. This would protect and promote the health of the population; have economic benefits; and take some pressure off our overloaded NHS.(8)
1) Watson MC and Lloyd J. Re: BMJ briefing: meet the new masters of public health. British Medical Journal Rapid Response 8th July 2013 http://www.bmj.com/content/346/bmj.f4242/rr/652995.
2) Watson M C and Lloyd J. Raiding the public health budget. Action is needed to tackle current public health threats BMJ 2014;348:g2721
3) Watson M C and Lloyd J, 2016. Need for increased investment in public health BMJ 2016;352:i761.
4) 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. http://www.bmj.com/content/355/bmj.i6319/rr
5) 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. http://www.bmj.com/content/355/bmj.i6853/rr-1
6) Wanless D. Securing our future health: taking a long-term view. Final report. 2002. http: //si.easp.es/derechosciudadania/wp-content/uploads/2009/10/4.Informe-Wanless.pdf.
7) Marmot M. Fair society, healthy lives: strategic review of health inequalities in England post-2010. 2010. www.instituteofhealthequity.org/projects/fair-society-healthy-lives-them....
8) NHS England, Public Health England, Monitor, Care Quality Commission, Health Education England. Five year forward view. October 2014. www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf.
9) House of Commons Health Committee Public health post-2013: second report of session 2016-17. House of Commons Paper No 140, 2016-17.
10) Richmond Group of Charities. What is preventing progress? Time to move from talk to action on reducing preventable illness. 6 Nov 2014. www.richmondgroupofcharities.org.uk
11) BMA. Public health and healthcare delivery task and finish group: final report. Jan 2015. http://bit.ly/2cpiHIp.
12) BMA. Funding for ill-health prevention and public health in the UK. May 2017. http://bit.ly/2quLN3K.
13) Watson M C and Forshaw M, 2016. Tackling the crisis in general practice. Prioritising prevention and health promotion BMJ 2016;352:i1333.
14) Poland B, Green L and Rootman I (eds). Settings for Health Promotion. London: Sage Publications, 2000.
15) Watson, M., Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.
16) Lloyd J. Compassion through development of physical and mental health and well-being. In, Towards the Compassionate School. Ed. Maurice Irfan Coles. London: Trentham Books/IOE Press. 2015.
17) Lloyd, J. Improving health outcomes and health literacy for children and young people through Personal, Social and Health Education in schools. Paper presented at the 17th EUSUHM Congress. 27th June 2013. London: Royal College of General Practitioners, 2013.
18) Watson M and Tilford S, 2016. Directors of public health are pivotal in tackling health inequalities. BMJ 2016;354:i5013.
Competing interests: No competing interests
"If you pay peanuts, you get monkeys" is an old saying, and most of UK public health expenditure is on staff. On the same day as the BMJ reported the King's Fund data on cuts to local authority public health spending, Public Health England produced online a Health Profile for England (Gateway number 2017051 HTML). For deaths across the age range 15 - 49 years, alcohol and drug use is the behavioural risk factor associated with the highest proportion of deaths. But today's report on expenditure found a cut of 5.5% in spending on such substance misuse.
By the beginning of the 21st Century, we were beginning to understand what made services for drug and alcohol problems effective. In 2002 I could write confidently that "the most obvious change in many types of UK service over the last few years has been the growth of inter-professional teamwork to address the varied needs of clients, combined with multi-professional, inter-agency co-operation in developing the quality of practice". Human capital is decisive, to engage with the hydra of substance use disorders. Be sure, that if we cut back on skilled staff, that poisonous hydra will grow more and more heads!
 Caan W. The nature of heroin and cocaine dependence. In (Caan W, De Belleroche J, Ed.s) Drink, Drugs and Dependence. London: Routledge, 2002, 171-195.
Competing interests: About 40 years' research on problems related to alcohol