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A Manifesto for Public Health

Position statements | November 22, 2019
The state of health in the UK
The health and wellbeing challenges we face today are clear. While people are living longer, the number of years that they do so in good health is deteriorating, and health inequalities are increasing. People in the wealthiest areas of the country can expect to live 19 more years in good health, compared to those in the poorest. Although the adage ‘prevention is better than cure’ is once again in ascendency amongst politicians and policy-makers, action and investment consistently fall short of what is needed. For too long, Government spending has focussed on treating illness, rather than keeping people healthy and preventing problems from arising in the first place.This short-term strategy does little for the health of our nation. The potential of too many people and places is unfulfilled, hindering our economic success and putting a huge strain on our communities and public services.Our health and wellbeing depends on many different factors.A small proportion – just 10-20% – is determined by access to traditional health services, like the NHS. The remainder is shaped by the economic, social and environmental conditions of our lives: such as our income, the education we receive, the housing we live in, the transport we use and the air we breathe.We need a long-term plan to address the root causes of ill health.


The health of the people is the highest good
Creating a society in which we can all be as healthy as possible, for as long as possible must be the fundamental mission of any Government. The Association of Directors of Public Health is calling for health and wellbeing to be the next Government’s top priority.Below we set out the contribution we will make, as well as our asks of the future UK Government.


The role of Directors of Public Health
Directors of Public Health are ambitious about protecting and improving public health locally and nationally. We believe in the power of a genuine ‘public health partnership’ between the UK Government, the devolved nations, the NHS, local government, charities, professional bodies, businesses and individuals to make this happen.
To achieve this vision, we will:


Provide local place leadership on wellbeing and inequalities.

As independent advocates for public health, with unique knowledge and expertise about our populations, Directors of Public Health will promote health and wellbeing in all policies across local public services, from councils to the NHS to the police.


Deliver efficient and effective services.

Directors of Public Health have reformed services and achieved good outcomes and will continue to do so, despite what is an increasingly unsustainable balancing act. For example, in England, The Public Health Outcomes Framework (PHOF) tracks 112 health indicators. In the last six years, 80 percent of those have been level or improving ; notable, particularly as they have been achieved in a context of year-on-year cuts to the Public Health Grant.


Work collaboratively on joining up services and promoting population health.

Directors of Public Health are committed to working with local and regional NHS and local authority colleagues to ensure integrated pathways between the public health services provided in hospital settings and those offered in the community (e.g. stop smoking and alcohol treatment services); and to ensure that all parts of the health and social care system are focussed on population health outcomes.


Support efforts for healthy public policy at a national level.

As the national voice for Directors of Public Health, the ADPH will play its part in developing and promoting good policies across key agendas like early years, violence prevention, sexual health, alcohol and drug treatment, obesity, smoking cessation, mental health, healthy economic growth and air quality. We will work constructively with Government departments and agencies, professional bodies, commissioners, charities and other partners to implement approaches that work for our communities.


The change we need nationally

Improving the nation’s health requires a bold vision, strong leadership and political will. We ask the next government to:


Make wellbeing a cross-government ambition.

Wellbeing should be built into the fabric of Government decision-making when it comes to both policy-making and funding allocation. Wales has already made a vital step towards realising this ambition, through the introduction of the Future Generations Wellbeing Act . Similarly, in Scotland, there is now a vision for national wellbeing in the form of the National Performance Framework . These efforts must be matched in England – the proposal to create a ‘health index’, alongside existing wellbeing data collected by the Office for National Statistics, could provide a framework to drive change and embed accountability across Whitehall.


Deliver a multi-year funding settlement for public health.

More investment is urgently needed in public health and prevention. In addition, further investment is needed across a wide range of policy areas including housing, transport and welfare to tackle the root causes of ill health. The ADPH supports the call from the Health Foundation and The King’s Fund for at least £1 billion more a year for the Public Health Grant in England.


Take a whole system and place-based approach to health inequality.

This includes wide-ranging action on the social determinants of health (including housing, the environment and skills), as well as acting on health inequalities caused by the commercial determinants of health such smoking, alcohol use and obesity, expanding the use of the ‘Polluter Pays’ principle.


Set binding national targets to reduce child poverty.

Poverty is the most significant determinant of children and young people’s health in the UK. Currently, 4.1 million children in the UK are living in poverty .


The Association of Directors of Public Health is excited about the opportunity to work with the next Government, other political parties and stakeholders to protect and improve public health in the years ahead.


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