From the West Midlands Socialist Health Association, June 2011
The implications for Public Health of the Government’s legislation have attracted little attention compared with the upheavals to primary care and commissioning. On 21 May WMSHA held a discussion of this neglected issue, led by Dr John Middleton, Director of Public Health at Sandwell MBC and PCT, and Dr Ros Hamburger, Consultant in Dental Health at Heart of Birmingham PCT. This Brief distils key points relevant to local action as well as to the Healthcare Bill.
Public Health matters
We all know of the huge improvement in life-expectancy brought by improved sanitation and housing since 1900. Less well-known is that even since the NHS was founded only 30% of the continuing improvement is down to medical interventions. Health Improvement Plans were an important part of Labour’s agenda in 1997, but lost ground to the more headline-grabbing aspects of acute care. Labour’s 2010 Public Health White Paper planned a better balance between safeguarding health and curing sickness. This remains a worthwhile mission, and an unintended side-effect of the 2011 Health Bill is that ‘localisation’ may give Councils the chance to do something about it.
Future challenges
Issues ‘coming over the hill’, identified by speakers and SHA members included:
- The link between life-expectancy and income means that increasing inequalities will lead to worse health outcomes, concentrated in the poorest communities;
- Global disruptions from climate change, rising food and energy prices and increasing insecurity will feed through into UK, concentrating health hazards in particular areas;
- A weaker social fabric will continue to drive the rise in addictive behaviours;
- Government plans pass public health responsibilities to Councils without the capacity to deliver as national agencies cream off cash and the role of DPH is not defined;
- Narrow, single-issue campaigns (eg anti-flouridation) increasingly hi-jack public policy, and distract attention from lifestyle issues (eg obesity) affecting whole populations.
Campaigning issues
We recognised that while localisation may make for more joined-up local action, it also risks parochialism where a more collective response is needed. Counteractions suggested included:
- There should be strong Council representation on Health & Wellbeing Boards and GP Consortia, with the Director of Public Health (DPH) having a statutory role to serve both;
- The DPH should have a high level role in all local programmes influencing health, butressed by independent reporting to disseminate evidence and raise public awareness of dangers;
- The duty of partnership between the NHS and Councils should ensure collaboration on public health issues below national level but still larger than local (eg Council spending on housing or traffic calming that saves the NHS money; NHS spending on preventing teenage pregnancy that saves Councils money; or spending on flouridation over a wider area).