Clear leadership from the government is needed on public health

By Dr Jeanelle de Gruchy | 08 January 2020

A new year, a new me! Ah, the opportunity the new year brings to set new health goals. And so much easier today, with all the inspiring social public health movements, such as Dry January and Parkrun. Social movements, social media, digital technology. The level of public engagement demonstrates the huge appetite that exists for wellbeing. This is cause for celebration.

While apps and initiatives are fantastic tools, they cannot be the whole story. It is what is happening on our streets, rather than our screens, that is overwhelmingly responsible for shaping our health and wellbeing – transport, housing, income, education and skills (often collectively referred to as the ‘social determinants of health’).

Context matters. Let’s take some common aims most of us will recognise. Reducing alcohol consumption or eating healthier is made harder when we are bombarded with adverts and cheap supermarket deals. Taking part in volunteer-run physical activities in your community is challenging without well-maintained parks and open spaces. Walking and cycling to school and work is unappealing when confronted with congested roads and poor air quality. Keeping warm in the depths of winter is impossible in a cold, damp house.

We need to create the conditions that enable us all to be as healthy as possible. This should be the nation’s new year’s resolution.

Before the General Election, the Association of Directors of Public Health published a Manifesto for Public Health setting out what we thought the Government’s priorities should be. This is an agenda for 2020 and the decade ahead.

Firstly, 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 Wellbeing of Future Generations Act. Similarly, in Scotland, there is a vision for national wellbeing in the form of the National Performance Framework. England must follow with its own Wellbeing Act.

Secondly, lets address the worrying level of inequalities across the country. This means understanding and acting on the social determinants of health – income and employment, school readiness and attainment, housing – and of course that green space near you big enough for a Parkrun. It also means addressing the commercial drivers of smoking, alcohol use and poor diet, expanding the use of the ‘Polluter Pays’ principle.

Thirdly, it is time for a multi-year funding settlement for public health. More investment is urgently needed in public health and prevention. Increasing spending on the NHS is essential but it must be matched with a long-term settlement for the home of prevention: local government. We are committed to working alongside the other representative bodies for local government directors - the Association of Directors of Environment, Economy, Planning and Transport (ADEPT), the Association of Directors of Adult Social Services (ADASS) and the Association of Directors of Children’s  Services (ADCS) - to make the collective case for more funding to meet service pressures alongside the wellbeing and prevention initiatives that help create healthy, resilient and thriving places. In addition, further investment is needed across a wide range of policy areas at a national level including housing, transport and welfare to tackle the root causes of ill health.

The Government should act immediately to confirm the Public Health Grant allocations for 2020/21. The delay is hampering the ability of councils to plan the best possible services and support to improve public health in their communities.

Finally, binding national targets to reduce child poverty are fundamental. 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. 2020 was meant to be the year we ended it for good.

There are glimpses of light. The Department of Health and Social Care has recommitted to making prevention a priority and we look forward to the progression of the Prevention Green Paper. The page has been turned on a decade of severe cuts to public services, although repair and recovery - let alone reform - will take time and significant resources. There is also talk of regenerating some of our most deprived towns and investing in infrastructure, bringing with it the opportunity to foster healthy growth.

Public health is a team sport. In 2020 we all need to play our part – clear leadership from the Government will be essential. Directors of Public Health are fit and ready to go. If we work together, we can all win.

Dr Jeanelle de Gruchy, President, Association of Directors of Public Health

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Public health ADASS ADCS ADEPT Funding inequality well-being ADPH