Good public health, drawing imaginatively on all of local government’s functions, can make a real, large-scale difference to individual and population health.
It can promote the independence of people with long-term, chronic conditions; prevent ill health and therefore reduce pressures on social care and the NHS; improve people’s lives and wellbeing; and reduce health inequalities.
Public health teams, working across councils, are tackling persistent problems such as adult and childhood obesity, mental illness, alcohol and drug misuse, sexually transmitted infections and the health impact of isolation and loneliness in old age, as well as addressing some of the serious health inequalities that still exist within and between communities.
Despite these challenges, the changes to public health over the last six years should be seen as an exemplar of public sector reform. Good practice from individual councils shows what potential there is for public health, if properly resourced, to make inroads into improving health and wellbeing, and to
do it efficiently.
There is no magic wand for England’s main public health challenges, the immediate causes of which remain tobacco use, poor diet, mental health, physical inactivity and substance misuse. Each is driven by a complex web of socioeconomic circumstances that the NHS alone cannot address.
But with comprehensive strategies, we are making a difference, according to LGA analysis of official government and Public Health England data. Teenage conception rates have plummeted, and youth smoking and drinking rates are lower than they’ve been for decades. Other improved outcomes include reducing premature deaths, cutting new cases of sexually transmitted infections and a drop in adult smoking.
We have, in a number of areas, delivered better outcome at less cost since 2013 when councils took on responsibility for public health.
We know there is more work to be done to make sure improvements are consistent across all councils, and the data we have pulled together should not mask the areas where we have seen a worsening in health outcomes and in performance.
But it demonstrates that a number of key health outcomes have improved since responsibility for public health transferred to local authorities, despite the spend in several areas falling, primarily because of government reductions to local authority budgets.
The NHS alone cannot deliver improvements in population health. It needs what local authorities do to meet its objectives.
The reward of thriving early years for our children, improved incomes for the low paid, healthy and productive ageing, good quality work opportunities and high-quality places is at the core of the local government mission. Now, the challenge for local councils is to break the generational cycle of disadvantage that drives health inequalities.
The rationale for a local government lead in public health is unchanged: that the greatest impacts on health are the circumstances in which we live, employment, education, environment and the effects of the social gradient of health – that is, equality or the lack of it. Local government can certainly impact more on these factors than the NHS, and many in public health are responding positively to the opportunity to influence population health.
However, despite all the excellent work, there have been significant reductions in the resources available for public health work. Councils’ public health grant funding is being cut by £531 million in cash terms between 2015/16 and 2019/2020.
Councils and their public health teams have put a brave face on the compromises they have had to make, working with their local NHS and voluntary sector, sharing public health initiatives and sometimes even public health teams across councils, reorganising in an attempt to achieve more with less.
They have also taken some decisions that the NHS simply could not, or would not, make. Significant modernisation of sexual health services, for example, have coped with the substantial increase in demand for services despite a reduction in funding. The same can be said for health visiting: outcomes have held up while funding has reduced. Local government relationships with providers and partners have helped achieve this.
The recognition that the transfer of public health to local government was absolutely the right decision, and that our confidence in local leaders was well placed, was confirmed by the Commons’ Health Select Committee in its report, ‘Public health post-2013’.
It endorsed local government as the best home for the local leadership of the public’s health.
Of course, there remains an important role for national policy making but this cannot be a substitute for local leadership and local responsibility for improving the health of local people. It is right that those decisions are being made locally as this is where the action really happens.
A picture of public health
- The public health outcomes framework (PHOF) tracks 112 health indicators. In the past six years,
80 per cent of those have been level or improving.
- Rates of premature deaths from all causes in England have fallen steadily.
- Between 2012 and 2017, the prevalence of smoking among adults in England fell from 19.3 per cent to 14.9 per cent.
- Attendances at sexual health clinics are up and diagnoses of new sexually transmitted infections are down.
- The conception rate in teenagers has dropped by 23 per cent since 2013/14.
- Local authority-commissioned services measured more children than at any time in the past 10 years.
- Almost all (98 per cent) of adults in contact with drug and alcohol services were able to access drug treatment services within three weeks, and 100 per cent of children.
- Spend per resident on public health is more than three times higher in England’s most deprived upper tier local authorities than in the least deprived, reflecting the poorer health status of its population.
- Even in the area of greatest need in the country, spend per resident on public health in 2017 was less than a fifth of the combined spend per resident on children’s and adults’ social care.
- The percentage of children achieving a good level of development at the end of reception (school readiness) has increased from 51.7 to 70.7 per cent since 2012/13.