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ADPH Consultation Response Summary: Prevention Green Paper

Consultations | November 4, 2019

The Government’s leadership in shifting the conversation, including through this Green Paper, towards a more preventative approach to health and wellbeing is a positive step forward. Directors of Public Health are committed to playing their part.

Prevention is now a widely used term, but different organisations often use, and interpret it, in different ways. There are three levels of prevention (primary, secondary and tertiary) – and all have a role to play. The ADPH response largely focusses on promoting primary prevention that seeks to implement population wide measures to support the health and wellbeing for everyone in society.

The ADPH’s view is making the mantra of ‘prevention is better than cure’ a reality for individuals and communities requires significant progress across four areas.

Taking a social determinants approach
Our health and wellbeing is overwhelmingly shaped by social, economic and environmental factors and this evidence should be fully reflected in the Government’s prevention agenda. This means going beyond a conversation about health which is focussed on hospitals, services and treatment. It is essential that the Government focusses on population level policies which address the root causes of poor health as these will make the biggest difference for the largest number of people.

Embedding wellbeing across Whitehall
Bearing in mind the impact the social determinants of health have, wellbeing should be built into the fabric of Government decision making – both when it comes to policy development and funding allocation. Too often health is a second order priority when it should be the foundation without which individual flourishing and economic prosperity cannot be realised.

Investing in sustainable, long-term funding for public health
Investment is needed across all the determinants of health. In respect of public health services specifically, at least £1 billion extra per year is required. The Government will need to work with the public health community to properly cost new commitments arising from the Prevention Green Paper. Considering spending through the social determinants lens should lead to significant new money for education, housing, transport and much more besides.

Strengthening collaboration and partnerships
It is only through strong partnerships that integrated service pathways and good outcomes can be achieved – the delivery of the NHS Long Term plan and proposals in the Green Paper depends on collaboration between the NHS, local government and the Voluntary and Community Sector. The NHS cannot do it alone. Links must be reinforced at every level.

Key recommendations

  • The Spending Review next year must deliver a sustainable package for public health in local government. The Public Health Grant needs at least £1bn more a year to reverse years of cuts to public health funding.
  • The Government should tackle the social determinants of health and building wellbeing into policy decision making and funding allocation a cross-government priority, supported by a new ‘health index’ and better utilisation of existing ONS wellbeing statistics.
  • The Government should adopt a whole system approach to health inequality and promote place-based approaches.
  • The Government should reintroduce binding national targets to reduce child poverty
  • The Government should address the fundamental role of planning, housing and place policies in the promotion of wellbeing and prevention of ill health across the life course.
  • NHS England needs to ensure that prevention forms a key, mandatory and funded part of all Sustainability and Transformation Partnership and Integrated Care System plans to ensure good health across the life-course
  • Directors of Public Health should have a place at both local and national decision-making tables in relation to discussions about designing and delivering prevention services – particularly in relation to the NHS Long Term Plan – and the implementation of system change, such as Integrated Care System.

We are also a signatory to the joint submission led by Cancer Research UK, urging the next Government to prioritise public health.

Read the full consultation response to the Green paper.

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