Mission possible, but only if…

Along with Labour’s victory in this month’s General Election came the promise of building a “fairer Britain, where everyone lives well for longer” by delivering a “prevention first revolution” and, on the face of it, there is nothing not to like in the Government’s health mission.

They have rightly recognised that instead of being able to concentrate on treating patients, our health and social care services are under unsustainable pressure providing care for people with chronic – and often multiple – long-term conditions. They have also recognised that to reduce this pressure, we need to create a society where “health is promoted and protected” and that this will only be achieved by “cross-Whitehall joined-up Government and a proper partnership with local communities.”

There has of course already been a commitment to phase out smoking, tighten restrictions on junk food advertising and restrict the sale of energy drinks in the King’s Speech and Labour’s manifesto promised to tackle gambling harm and workplace health – all contributory factors to the alarming rise in people suffering from largely preventable disease and ill-health.

All music to the ears of those of us working in public health who have long since advocated for a health in all policies approach to support creating good health and wellbeing outcomes for all. I am incredibly excited to see this shift towards prevention and it is crucial that the new Government follow through with their promise to learn from what works well at the moment, and from past mistakes, and even more importantly, provide the mechanisms and resources to the right places to implement change.

For that to happen, there must be a clearer understanding that health is not just created by the NHS. In fact, much of what the Government’s health mission promises – from the broader goals like “making the healthy choice, the easy choice” to more specific aims like providing 5,000 new health visitors – will actually be delivered by local authorities.

Although this is reflected in the recognition that all Government departments with an influence over the determinants of health need to be involved, and that this needs to flow through to local government, that this cross-working is also needed at the delivery stage is not as clear.

This may seem like semantics, but the reality is that creating an environment where everyone can be healthy is done by a huge range of people, most of who don’t have ‘health’ in their job titles and, even with those that do, who don’t work for the NHS. Instead, our health and wellbeing is reliant on town planners, builders, teachers, transport officers, retailers, chefs, leisure providers, and many many more.

It is also reliant on public health teams and while they are part of the NHS in Scotland, Wales and Northern Ireland, in England, these teams, who are led by Directors of Public Health like me, sit in local authorities.

As well as providing a range of services, including for sexual health, tobacco, drug and alcohol treatment, weight management, and early years provision, public health teams bring together partners across their local area to create healthier places for people to live, learn, work and relax in. The way we do this differs from place to place, depending on the needs of our communities.

For example, what is needed and what works in Sheffield, where I am Director of Public Health, may not be the same as in Shrewsbury, so throughout the UK’s four countries (and its dependant territories) there are teams of public health professionals who analyse data and work with community organisations and local businesses to get to know their populations. With this knowledge, and by working with colleagues across all sectors, we are able to develop programmes and initiatives that support our local residents to live healthier lives.

However, public health budgets have been subject to consistent real-term cuts in funding for the last nine years. As a result, not only have services had to be scaled down, despite overwhelming evidence of their effectiveness, but our ability to introduce initiatives that help build healthier environments has also been diminished.

The Government’s health mission has tremendous potential to improve our nation’s health. Their ambition of improving healthy life expectancy (HLE) for all and halving the gap in HLE between different regions of England is very welcome, and one we wholeheartedly support. Similarly, their goal to give every child a healthy start and tackle child poverty is definitely needed. Their commitment to achieving this through not just treating the immediate problem, but by simultaneously bringing in measures to cut the cycle from continuing is equally welcome, and again, we are keen to support them to make it work.

The public health community must be considered an integral part of the solution and ADPH are ready to work constructively with all departments, and the proposed health mission delivery board, to ensure that the Government’s ambitions are realised equitably, effectively and efficiently.