A renewed focus on and an increase in funding for public health services is badly needed if the current decline in the nation’s health and the widening of health inequalities are to be reversed, is the message from numerous organisations this September. 

Organisations, including the UK’s medical colleges, the Association of Directors of Public Health (ADPH), Action on Salt, Sustain, The Food Foundation, the British Heart Foundation and over 30 other health charities, are calling on the government to prioritise policies that improve the health of the nation.

Securing our Healthy Future: Prevention is better than cure, a report from the Royal College of Paediatrics and Child Health and the Faculty of Public Health, and supported by the 24 members of the Academy of Medical Royal Colleges, focuses on the importance of preventing ill-health in children

With the authors noting that, “the window for making the greatest — and most cost-effective — impact on health across the life course is in childhood, starting from pregnancy”.

The report contains recommendations to the government focusing on healthy weight, oral health, vaccinations, clean air, and mental health, all of which if not tackled in childhood may lead to long-term ill-health in adulthood.

Policy needed

The Association of Directors of Public Health (ADPH) in its Manifesto for a Healthier Nation: Delivering Change calls for government action on a number of issues, including a new Public Health Act for England to put public health at the centre of government policy-making.

At the same time the ADPH, along with over thirty well-known health organisations, Royal Colleges and charities, have launched the ‘Recipe for Change’ campaign, calling on the Government to introduce a new industry levy on salt and sugar to make food healthier and raise additional revenues for investment in children’s health.

Changes are needed badly as over 13 years of Conservative-led government the population of this country has become more unhealthy and health inequalities have widened. 

A 10 year follow-up report to the landmark study Fair Society, Healthy Lives (The Marmot Review) by the Institute of Health Equity and the Health Foundation found that people can expect to spend more of their lives in poor health, improvements to life expectancy have stalled, and declined for women in the most deprived 10% of areas, the health gap has grown between wealthy and deprived areas, and where you live can have a dramatic effect on life expectancy.

High death rates

A recent analysis by the IPPR found that the UK has a higher number of deaths that could have been avoided with timely healthcare or public health interventions than in all other comparable European nations. They estimate that if the UK had an avoidable mortality rate similar to those in comparable European countries, around 240,000 fewer people would have died in the decade from 2010. 

Millions of people are now unable to work due to sickness with the latest figures from the ONS (July 2023) estimating the number at over 2.5 million, a new record level. The data also showed that over a third of the working-age population – whether employed, unemployed or inactive – report a long-term health condition of some kind. 

Although the Covid-19 pandemic has increased long-term ill-health, the trend upwards began before the pandemic, with the IPPR analysis of ONS data showing that from 2000 to 2013 the number of people economically inactive due to sickness fell, but since then it has risen steadily and currently stands at the highest level on record.

Furthermore, from 2011 the trend to improving life expectancy slowed in England after decades of steady improvement.

This fall in the nation’s state of health coincides with 13 years of Conservative-led governments that have downgraded and underfunded public health services as well as taken a less interventionist approach to controlling what is in our food and the air we breathe. 

As an editorial in the BMJ in September 2022, highlighted, since 2010, successive Conservative governments have “dismantled and defunded public health rather than recognising the importance of a healthy population and a robust and effective public health function.”  

These governments have cut the amount of funding that is provided for public health services, with funding down by 26% from 2015/16 to 2023/24 on a real terms per person basis. And the cuts have fallen hardest in areas of deprivation, those areas that are most in need of and benefit the most from public health services.

For over a decade underfunding has meant a reduction in public education on smoking, alcohol, healthy eating, sexual health, plus a lack of investment in preventative dentistry, and mental health services.  

The health of the nation has also been made worse by the unwillingness of Conservative governments to put laws in place that would improve public health or enforce legislation already in place. For over a decade there has been little or no action on tackling the sales of unhealthy food and levels of air pollution.  ==

Warnings ignored

A prime example is the 2011 scrapping of the regulatory programme instigated in 2006 by the Food Standards Agency (FSA) under which food manufacturers had to reduce the salt content of scores of different types of processed and prepared foods. 

The government considered that the food manufacturers could be trusted to set their own salt levels under its  “public health responsibility deal”. This move was heavily criticised at the time by public health experts. And their fears that relying on voluntary efforts by firms to create healthier products rather than the FSA’s tougher regulatory tactics, would lead to higher salt levels have now been proved correct. A paper published this month in the Journal of Hypertension shows that the scrapping of the regulations has led to thousands of premature deaths and puts thousands more lives at risk. 

A team of researchers led by Dr Jing Song from Queen Mary University of London (QMUL), found that after the FSA programme was initiated, the average amount of salt that people in England consumed fell by almost 20%, but after 2011, average intake rose again, from 7.58g a day in 2014 to 8.39g a day in 2018. The recommended daily intake is no more than 6g.

The researchers calculated that if the salt reduction drive had continued past 2011, average intake would have fallen by a further 1.45g a day between 2014 and 2018, which “would have prevented over 38,000 deaths from strokes and heart disease in just a four-year period, of which 24,000 would have been premature”.

The researchers also found that the abandonment of the regulations on salt levels has led to a levelling-off of both population-wide blood pressure levels and also the rate of deaths from heart attacks and strokes, both of which had fallen after foodstuffs became less salty.

The report Securing our Healthy Future: Prevention is better than cure, a report highlights the current shocking state of children’s health and the environment we are now exposing them to, including: 

  • obesity prevalence among children is increasing, with 23.4% of Year 6 children living with obesity in 2021/22 in England; 
  • in 2022, 29.3% of five year olds in England had tooth decay; 
  • vaccination coverage decreased in 13 out of 14 of the routine childhood vaccination programmes in the UK, and no vaccines met the 95% uptake target in 2021-2212; 
  • 86% of UK cities exceed recommended limits for particulate matter and the consequent effects on children and young people are irreversible leading to long-term respiratory problems. Long-term exposure to air pollution has been linked to cancer, cardiovascular disease, diabetes, obesity and dementia.
  • Rates of poor mental health for children and young people are rising: 5.5% of 2 to 4-year-olds have experienced a mental disorder, while 15% of 7-10s, 20% of 11 to 16s and 26% of 17-19 year olds now have a probable mental health disorder.

The report notes that: 

“failure to act to prevent childhood health issues such as obesity, tooth decay, respiratory problems, and poor mental health may lead to these issues continuing and compounding into adulthood. We understand that prevention is better than cure, but we must also recognise that prevention in childhood is better than prevention in adulthood.”

The reports from both the Medical colleges and the ADPH call for more investment for public health and for the government to put public health at the heart of government so that it is part of policy across departments. 

The report – Securing our Healthy Future: Prevention is better than cure asks for the appointment of a Cabinet-level Minister for Children and Young People to ensure the UK Government adopts a ‘child health in all policies’ approach to policy development. And the ADPH in its Manifesto for a Healthier Nation: Delivering Change calls for the government to introduce a new Public Health Act for England, pulling together many pieces of legislation so that public health is at the centre of government.

The ADPH calls for an additional £0.9 billion for public health teams to reverse years of funding cuts. Plus a shift of budgets away from a short-term model to a long-term model to enable public health teams to make decisions knowing funding is available.

The ADPH’s manifesto also calls for a dedicated health inequalities strategy with clearly defined targets and a new Child Poverty Act which commits to ending child poverty in all parts of the UK by 2030. 

High stakes

If this government and future governments do not invest in public health the outlook is bleak for millions of people, who will live shorter, more painful lives, with their ability to contribute to society severely curtailed. There will be massive costs in both social and economic terms for the UK.

A good example is preventable cancers, such as those caused by obesity, smoking, alcohol and sun exposure, all of which public health services are set up to educate the population about, could cost the UK £1.26 trillion by 2040, according to a study commissioned by the Guardian from Frontier Economics, which specialises in projecting the costs of major diseases using data published by government, official and medical bodies.

The study found that between now and 2040, 3.7 million people will be diagnosed with cancer who would have not developed the disease if it had not been for the four known main risk factors – smoking, drinking, obesity and UV (sun) exposure. Frontier found that on current trends the number of avoidable cancer diagnoses is due to rise from 184,000 to 226,000 a year by 2040 because of population changes. 

The government’s own Office of Budget Responsibility (OBR) has warned of the consequences of not tackling the rising tide of ill-health, noting that not tackling it will result in millions in reduced tax revenue, billions in higher welfare spending, and higher healthcare spending, with the OBR projecting additional NHS costs, when someone moves from being economically active to inactive, of £1,800 per person per year.

With the NHS under extreme pressure, over 7 million people on waiting lists, and 2.5 million working age people economically inactive due to ill-health, one would hope that the government now and future governments will look seriously at these recommendations made by experts and invest heavily in public health services and on policies to eradicate health inequalities. If they do not, then both a large proportion of the UK population and our economy face a bleak future.

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