Among the many weaknesses in the wider care and health system brought starkly to the light of day by coronavirus, the state of public health ranks close behind that of social care.
Those with lifestyle-related conditions such as obesity, diabetes or heart and lung issues caused by smoking were most prone to the virus whose impact was even unequal geographically.
Improving public health was unfinished business before the virus and no amount of moving deck chairs and retreading Public Health England – as the National Institute for Health Protection – will suddenly transform the statistics. Even the vaccine, should it ever be rolled out, only accentuates the public health hierarchy of need with care home occupants at the top of the priority list followed by the elderly down to those with health problems like diabetes and obesity and finally the under-50s.
Handing public health to local government in 2013 and then cutting the ringfenced grant by 12.7% in real terms between 2016/17 and 2019/20 to £3.1bn, a drop in the ocean compared to the NHS budget of £140bn, hardly helped.
Even the Conservative-leaning think-tank, Policy Exchange believes the grant is a paltry amount and in a new report this week recommends it should be increased. In fact, it even suggests it should be pegged to rises in the NHS budget – imagine!
The report gets over-enthused about structures, proposing yet another body, the National Institute for Health Improvement based at the Department of Health and Social Care. But the think-tank is clear that public health must remain within local government and calls for a cross-Whitehall approach. Inevitably, public health is linked to socio-economic conditions and hence to politics.
Reducing health inequalities is part of the ‘levelling up' agenda and just as the chancellor promises his Northern MP colleagues to invest in infrastructure in the region so should he invest in public health. As the Policy Exchange report concludes: ‘We should no longer quote the differences in life expectancy between Blackpool and Beaconsfield, we should have a proper plan to close them.'
