The silence on public health in the election debate

As the election campaign has got into full swing, politicians have been seeking to outbid each other on funding for the NHS. And there has been extensive discussion – what do the bids mean; will they be enough; and, perhaps most importantly, when exactly will the cash be delivered?

However, there has been almost total silence on public health. Looking back, the contrast with the last election is stark. In 2010, the Conservatives were promising a Department of Public Health, the headquarters of health across government and public health – and public health even merited its own separate section in the coalition agreement. We have recently given our verdict on the coalition’s record on public health, so no more of that here.

So why is the debate so different this time round, and why does it matter? First, unlike in 2010, the polls are now showing the NHS at the top of voters’ concerns and Labour in particular have focused the debate on funding and ‘privatisation’. Second, there may be a view amongst the parties that the coalition’s public health reforms have handed over ‘the problem’ to local authorities, meaning there is less need to define a national position. Third, the coalition government’s focus on public health has not been accompanied by targets and therefore not subject to scrutiny in terms of accountability and debate. Finally, and more speculatively, parties may be concerned about appearing to take the position of a ‘nanny state’, something that can clearly be seen in Labour’s manifesto on public health, although they deserve credit for being the only party to write such a document.

This all really matters for our health of course – and for the NHS. As a colleague recently pointed out to me, the £30 billion that the NHS five year forward view says it needs to find per year by 2021 is the same amount that Derek Wanless argued in 2002 could be ‘saved’ on the annual NHS budget by 2022/23 if the NHS was more proactive and productive (particularly on disease prevention), and if people were much more engaged in their own health. Indeed, the Forward View starts with a call for a ‘radical upgrade in prevention’, but this only makes the contrast with the current radio silence even more noticeable. With £1 in every £5 of overall government spending set to be consumed by the NHS, there needs to be a greater focus on prevention and on the wider factors that shape our health.

If you look carefully, there is actually plenty in the parties’ manifestos that will impact on public health for good or ill, but lots of it is not in the health or NHS sections. This runs from the Liberal Democrats’ focus on air pollution to Conservative proposals for reviewing welfare benefits for claimants refusing obesity treatment and Labour’s promotion of the living wage. The thing you won’t find in Labour’s manifesto is arguably the most significant commitment from its public health manifesto – the stated commitment to ‘health in all policies’.

So it’s not as if there isn’t enough to debate. And belatedly some public health issues are managing to get into the press, including the Supreme Court’s ruling that the UK government needs to do more on air pollution and renewed criticisms of the Responsibility Deal. Whatever you think of the latter, I agree with Shirley Cramer, head of the Royal Society of Public Health, who said in response to the criticisms ’The time is ripe for a new Public Health White Paper...’.  Unfortunately, you wouldn’t know it from the silence of the politicians.

The first months after an election are the best time for politicians to engage with policies that are likely to deliver long-term benefits rather than short-term political capital. Let’s hope the silence on public health during the election campaign is not a signal of inaction once those in the new government take their seats.

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Comments

#543586 Chris Price
engineer
self-employed

You might also take on board the massive hit to Public Health's image caused by the general perception among a significant proportion of the public - and more importantly, their willingness to speak out about it at any opportunity - that the Public Health industry is a corrupt special-interest group working for its own benefit and for commercial funders.

Because the Public Health industry appears to be doing everything in its power to protect cigarettes sales and the highly profitable disease it causes by blocking tobacco harm reduction and specifically electronic vapourisers ('ecigs'), the knock-on effect is a major hit to its credibility. Many now feel that it is a special interest group, that it suffers from endemic corruption, that it works to the agenda of commercial funders, that it contains numerous half-mad zealots, and that it is nothing more than a front group for the smoking economy.

Some of us will do everything in our power to fight the corruption and zealotry you host: see for example the Ecigarette Politics website in the UK, and the NotBlowingSmoke website in the USA.

Until you get rid of the obvious corruption and the barking-mad zealots, you're going to have a public image problem. As far as many of us are concerned, the term 'public health' now means a bunch of toxic parasites causing immense harm to the health of the public. You probably need to fix that.

Chris Price

#543715 Loretta Sollars
Health and Wellbeing policy consultant
Wheeler Sollars Ltd

I too have bemoaned that lack of attention paid to public health issues throughout this election campaign. I think there are additional reasons why PH has not figured much in the election campaigns:
1. The media has not been asking questions about public health or raising the topics when interrogating politicians;
2. The focus on the future of the NHS stops with the funding black hole and the short term responses for dealing with it by integrating health and social care and addressing the future role of hospitals. The longer term PH solution doesn’t get a look in after these big discussion items;
3. In an election campaign, candidates are attempting to persuade electors to vote for them because of what they, the aspiring government, will do – telling the public that they have to change their behaviours, live more healthily and “be good” is not going to win many votes, especially those of the undecided.

Yes, David is right to suggest that Public Health should feature in the start of the policy making actions because it is a long term project. I propose three areas that they could focus on:
1. Legislation/regulation – despite the approach taken by the Coalition, all the evidence tells us that it is ultimately legislation that brings about mass behaviour change – seat belts in cars, smoking in public places, minimum hours for PE in school – all have contributed to improving the nation’s health. In the wake of the failure of the responsibility deal, we need some firm action on levels of sugar in food and drink.
2. Funding for positive interventions – the NHS and local authorities need a kick start to get the interventions in place that will ultimately decrease demand for primary health from peope with long term conditions. Channel it through Health and Wellbeing Boards and connect it to health and social care integration and set performance measures that will demonstrate its worth in reducing demand so that the projects provide the local evidence for maintaining it long term (because National Guidance obviously isn’t enough to make the business case locally or it would have been done already).
3. Take it personally – people in power must realise that they are citizens as well as role models. They can establish healthy practices in government and parliament and most crucially adopt healthier lifestyles themselves. If they can’t be bothered or don’t think behaviour change is important enough for themselves, then cultural change for the population as a whole is one step further out of reach.

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