The Chancellor’s Spring budget is imminent and the message from the public health and health sectors is that poverty is a public health crisis, which he would be wise to target if the economy is to improve.

A letter signed by 60 organisations and individuals, including the Association of Public Health Directors (APHD), leaders of medical colleges and charities has been sent to the Chancellor Jeremy Hunt urging him to put tackling obesity and other public health issues at the heart of his budget for the sake of the economy.

The letter says that poor health is “one of the greatest threats” facing Britain today and warns of it damaging the economy “from the size and strength of our labour market, to productivity, to growth and GDP”.

However, what needs to be tackled, according to director of the Faculty of Public Health Professor Kevin Fenton and Professor Paul Roderick FFP Chair, FPH Poverty Special Interest Group in a recent blog, is the root cause of the public health crisis – poverty.

“Poverty detrimentally affects health across the lifespan, particularly impacting children, and diminishes life expectancy and healthy life years. These health ramifications reverberate across the NHS, public services, the labour market, the economy, and society as a whole.

To safeguard the well-being of our communities and combat widening health disparities, prioritising the prevention and alleviation of poverty and its health impacts is imperative.”

Levels of poverty according to a recent Joseph Rowntree Foundation (JRF) report have deepened in recent years, with 3.8 million people experiencing destitution in 2022, a figure almost two and a half times higher than in 2017.  

Government data for 2021/22 revealed that 14.4 million people, including 4.2 million (1 in 3)  children, lived in poverty. A report from UNICEF reported a 20% increase in child poverty in the UK between 2012 and 2021, surpassing all other EU/OECD countries. The Resolution Foundation forecasts an additional 300,000 people falling into absolute poverty in 2024/5.

The effect of poverty on a person’s health is overwhelming, affecting acute and chronic conditions, and ultimately leading to reduced healthy life expectancy, and premature death. The recent study released by the Institute of Health Equity (IHE) at University College London led by Sir Michael Marmot – Health Inequalities, Lives Cut Short – showed that more than 1 million people in England died prematurely in the decade following 2011 due to a combination of poverty, austerity policies and Covid.

Poverty is associated with a poor diet that leads to many chronic conditions, including obesity, diabetes, heart disease and a number of cancer types. There are also now rising rates of those diseases linked to the poor of the early 20th century and Victorian era – rickets and scurvy – both caused by inadequate diets.

Recent Food Foundation tracker data shows that 15% of UK households, that’s about eight million adults and three million children, have gone hungry or skipped meals in recent weeks because they could not regularly afford to buy groceries. 

Experts warn that the persistence of high levels of food insecurity among low-income families was a “health emergency”, according to the Guardian, that would drive the prevalence of conditions linked to poor nutrition, such as malnutrition and rickets.

The constant worry about having enough money that those in poverty have takes its toll, leading to chronic stress, anxiety, and depression. Added to this is that in today’s society, poverty restricts the part you can play in society and your social interactions, leading to isolation and loneliness. 

Then there is the effect of poverty on a person’s living environment; poverty means the massively increased likelihood of living in inadequate and squalid conditions, with poor ventilation, much less personal space, mould and inadequate heating, all of which lead to poor health and health outcomes.

Recent headlines have highlighted how the levels of unhealthy people are affecting the economy;  the number of people inactive due to long-term sickness is now at 2.8 million, and there is a significant increase in mental health issues in young people in their early 20s, those just starting out in work, up 24% on the 2000 figure.

Public health services can play a vital role in mitigating some of the health effects of poverty, as Fenton and Roderick note in their blog.

“Public health teams have played a pivotal role in mitigating the cost-of-living crisis locally, collaborating across sectors to provide essential support and resources to households in need.” 

But, public health services have received repeated cuts to funding which has led to cuts across services.A recent analysis by the Guardian found that people are being hospitalised for sexual health conditions that are easily treatable in local clinics, but cuts to local council public health funding over the last 10 years, by up to two-thirds in some cases, means the clinics are no longer available.

Now despite all the evidence on the importance of public health services, in early February the government once again announced a Public Health Grant that is “nowhere near enough”, according to the Directors of Public Health (DsPH).

Although billed as an increase by the Government, the ADPH noted that high inflation and pay increases mean that the grant settlement will be the ninth consecutive year of real-term cuts to local public health funding.

Public health teams will once again have to try and deliver services amidst increasing demand with less money.

Greg Fell, President of the Association of Directors of Public Health (ADPH), said:

“For nearly a decade now, the amount of money we have to spend on our local populations’ health has been repeatedly cut. In spite of our best efforts, this inevitably means that some services have had to be scaled down or, even worse, stopped, despite overwhelming evidence of their impact and effectiveness.”

Fell  added:

“There is currently a lot of talk from all the political parties about the need for prevention. If they are serious, and genuinely want to help people avoid getting entirely preventable diseases, then the next Government needs to make a dramatic change to how our local public health services are funded.”

It is not just the funding that needs to be addressed, as Professors Fenton and Roderick note there needs to be a comprehensive, national system wide strategy to address poverty and improve health, a policy that should:

“encompass bold policies on ensuring secure employment with the real living wage, an adequate safety net for all through the benefit system, and housing reform to ensure affordable quality homes for rent. 

It will also need to address food and energy security, access to affordable childcare and public transport, and ensure high quality education and skills training for all ages. Furthermore, a fairer distribution of wealth through taxation reforms and innovative solutions like universal basic services must be seriously considered to ensure economic prosperity and improved health outcomes for all.”

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