ADPH Manifesto for a Healthier Nation: Delivering Change
Policies behind our Manifesto pledges
This briefing has been developed to outline how ADPH’s Manifesto for a Healthier Nation could be delivered by the next Government.
Develop and pass a new Public Health Act
What?
A new Public Health Act should be developed to consolidate existing legislation and ensure health and wellbeing is at the heart of policy and funding allocation.
Why?
A new Public Health Act would demonstrate a commitment by the new Government to improve and protect public health. Currently there are many disparate pieces of legislation, in an already fragmented public health system, that cover a variety of topics from prevention and treatment of disease to sanitation in England. Due to the vast nature of public health, consolidating the large number of Acts that currently exist into a single all-encompassing Act would be a considerable undertaking. However, doing so would reduce fragmentation and ensure that public health policy is fit for the 21st century. A new Act would also ensure the UK has a clear and up-to-date approach to health protection and pandemic preparedness.
How?
We recommend amalgamating the numerous Acts of Parliament concerning public health that have been developed over the past 175 years into a new Public Health Act. Governments across the UK should take a coherent approach to public health, with every department playing its part in achieving a healthier society. England should use the revised all-encompassing Act to then develop a wellbeing strategy, similar to those that exist in Wales, Scotland and Northern Ireland.
Reduce health inequalities
What?
A dedicated health inequalities strategy with clearly defined targets.
Why?
Improvements in health are being experienced disproportionately, with the gap between the most and least deprived areas widening, with a gap of over ten years between men and women’s healthy life expectancy in the least healthy LAs, compared to the most healthy. The Government currently have ambitious targets to achieve an increase in healthy life expectancy by 5 years by 2035 and to narrow the gap between the areas with the best and worst health (as outlined in Levelling Up the United Kingdom in 2022). Creating good health requires ambition on the social determinants of health – income levels, housing standards and security, education and employment opportunities, and the environment. Both a cross-government strategy and sustained structural national policy action are needed to tackle the variety of interconnected factors that cause health inequalities. Commercial determinants of health are a huge driver of health inequalities, through driving unhealthy product consumption, such as alcohol, tobacco, unhealthy foods, and gambling, and thereby exacerbating existing inequalities. As part of addressing health inequalities more generally, the Government must address inter-related issues such as the commercial determinants of health in order to improve the health of the nation.
How?
Cross-governmental approach: Governments across the four nations should introduce a dedicated health inequalities strategy and take a whole system, Health in All Policies approach overseen by a cross-government ministerial-level committee in order to achieve health equity.
A place-based approach to inequalities: Local public health authorities should consider using Health Impact Assessments and Health Equity Assessments across all policies. Community engagement should be sought when local public health authorities are developing policy to ensure communities are empowered to influence their own environments.
Commercial determinants of health: Governments across the four nations should implement policies to act on the harm caused by products and services from the tobacco, alcohol and fast food industries that further exacerbate health inequalities. This could include policies such as extending smoke-free legislation, introducing Minimum Unit Pricing, and acting to curb junk food marketing.
End Child Poverty
What?
A new Child Poverty Act should be developed which commits to ending child poverty in all parts of the UK by 2030. Putting this into legislation should be an early priority for the next Government.
Why?
The physical, emotional, and mental wellbeing of children and young people are significantly shaped by the social determinants of health into which they are born, live, learn, and grow. A child can be vulnerable to the impact of action or inaction by other people and their physical and social environment, especially poverty. A shift towards poverty prevention and early intervention is needed to support children and young people to lead healthy and fulfilling lives and prevent ill health in later life.
How?
Prevention: Governments across the four nations must prioritise prevention and early intervention, and should reintroduce binding national targets to reduce child poverty and tackle the root causes of poverty, not just the symptoms.
Whole family approach: A whole family approach should be taken to prevent and reduce the impact of poverty and adverse childhood experiences. It should be proportionate to need with a focus on positive parenting.
Invest in public health
What?
Government should invest at least an additional £900 million in local public health budgets in England. Equivalent investment should be made in public health in the devolved nations.
Why?
Public health interventions provide excellent value for money, with the costs being three to four times lower than the cost resulting from NHS interventions.[i] Additional funding is required for a variety of elements within public health, such as investment in the specialist workforce (including the voluntary and community sector) and practice improvement. In England, the public health grant is paid to Local Authorities to provide vital services that support health, such as smoking cessation and sexual health services. Despite its critical purpose, it has been cut by over a quarter on a real-terms per person basis since 2015/16. Similar reductions in public health spending and budgets have been seen across the devolved nations. Investment in public health is key to improving the health of the UK and its increase should be high on the agenda of the next Government.
How?
Investment in Local Public Health Teams: Investment in public health must be increased across the four nations. In England, the public health grant needs £0.9 billion more a year to reverse years of funding cuts. Public health teams across the UK receive their budgets annually, and in England, the public health grant allocations are received with only a matter of weeks for Directors of Public Health to make decisions on how to spend the money in their local area. Budgets should be shifted away from a short-term model for public health teams to be able to make decisions with the knowledge that there will be sufficient long-term funding available.
Public health within the NHS: The NHS should spend a larger proportion of its budget on achieving good public health outcomes. Investment in prevention within the NHS should be increased as this will reduce the investment required for treatment. In England, increased investment in prevention should extend beyond the NHS to ICSs as well. Prevention not only represents better value for money, but better health outcomes for local populations.
Public health funding across Government: Whilst specific funding streams, such as the public health grant are vital, increases in public health funding should be broad-based and make use of opportunities and mechanisms to boost investment through all available routes including Department for Transport, Department for Levelling Up, Housing and Communities, Home Office and other Government departments. This will ensure a health in all policies approach and establish health and wellbeing as key priorities across the whole of Whitehall.
[i] The Health Foundation, Public Health Grant. 2023. https://www.health.org.uk/news-and-comment/charts-and-infographics/public-health-grant-what-it-is-and-why-greater-investment-is-needed [Accessed May 2023].