A pragmatic approach to public health

The research from the British Medical Journal released today, a year after public health came back to local government, is a lesson from the coalition government in how not to do localism.

The BMJ claims ‘local authorities across England are diverting ringfenced funds for public health to wider council services to plug gaps caused by government budget cuts’. The report identifies ‘examples of councils reducing funding for a wide range of public health services, including those for substance misuse, sexual health, smoking cessation, obesity, and school nursing’.

A number of councils have found efficiencies to fund free school meals, or subsidised sports activity. Unsurprisingly, with the scale of cuts local government is facing, some councils are using the funding to cross fund services including those that have an impact on the wider determinants of health – trading standards, domestic abuse services, housing, parks and leisure centres.

The funding and services were transferred as a side part of a botched top-down NHS reorganisation, with no attempt to build a consensus on what objectives for use of the funding might look like. Public health expertise is among the most powerful tools we have to deal with the root causes of poverty, and to invest in the preventative measures that will save money for the NHS and social care in the long term.

It is a lot to ask of councils to invest in prevention when funding is short term, and huge cuts are still to come. The BMJ should not demonise local authorities for their pragmatism in the face of enormous pressure. They should campaign with us for medium-term budget settlements for local government, so we can plan; and for up front investment in the public health prevention work that is so badly needed to deal with the ill health that is a cause and effect of poverty.

If they really wanted to be helpful, they could work with us to lobby for greater planning powers to tackle the chicken shops that crowd around schools in Tower Hamlets, a major cause of obesity, for free schools to be bound into nutritional standards for school meals, or for more doctors to do ‘social prescribing’, prescribing exercise or community activity to improve wellbeing.

You do not need doctors and nurses to have an impact on health. In Tower Hamlets, trading standards and licensing officers have persuaded fast food outlets to change the fat and salt content of their food – this will have an impact on the wellbeing of many people who might not listen to a medical professional.

Let’s hope this report opens up a real debate on how public health can drive change, rather than demonising councils for this government’s cuts.

Photo: Ewan Munro