As the lecturer in charge of the public health curriculum at my medical school, I was shocked by the news on Sunday morning that Public Health England will be disbanded. Especially as it appears to be on the chopping block for no other reason than as a way for our current government to save face in their many failures during the pandemic.
That public health can be so badly interpreted (willingly or not) only as infectious disease control highlights how poorly understood public health services are by those in power. In the 100-odd years since public health has been on the medical radar, in Europe at least, it has done much more than prevent the spread of infection. Public health measures are responsible for an increase in our average lifespan by decades and have improved the lives of millions of children and adults by preventing and mitigating illness using screening programmes, health promotion, testing, vaccines and social care reforms.
This is because recovering from disease, illness, and ill health takes more than drugs and surgery. Instead, how we keep Britons healthy in the long term is a complicated grouping of prevention programmes, social care support, in- and out-patient services and public service initiatives, akin to playing chess on a rollercoaster: every move affects the overall game, and the whole board can be disrupted at any time by national and global health emergencies. That the government has chosen to axe Public Health England just after announcing a national initiative to fight obesity shows how little it understands the important role that Public Health England plays in maintaining our overall health and wellbeing.
Initiatives such as the anti-obesity programme are what are called health promotion. Health promotion programmes promote behavioural changes that improve the overall health of the population – and we are familiar with many, such as the five-a-day initiative, couch to 5K, and the many smoking-cessation programmes currently available for free. These action plans target changes to individual health that result in a healthier population overall, and as a bonus, a less over-stretched NHS when it does not have to deal with the consequences of these diseases.
Screening programmes are another essential, non-pandemic service supported by public health. Like health promotion, screening for disease at points when the disease is likely to be caught early and best managed (cancer, for example) means fewer people suffer from advanced disease, more people survive than die from these diseases, and again, the NHS benefits from an increased ability to treat disease quickly, effectively, efficiently, and more importantly, cheaply. To do this, Public Health England runs screening services, testing and laboratories across the country.
Finally, Public Health England holds a wealth of information and research on keeping people healthy and safe in their home and work environments, promoting and contributing to safety initiatives in all sectors. These three examples are only the tip of the public health iceberg.
In the UK, we have had a tradition of public health that has almost nothing to do with pandemics and everything to do with improving the health of the whole nation for the long term. I could continue at length about the important, non-pandemic role that Public Health England plays in our daily lives; however, perhaps it is most effective to see what can be lost if we equate public health with pandemic response alone. Public Health England currently has close to 60 targeted programmes in place to improve health and wellbeing across the whole population. Here are just the highlights. Are we willing to lose them so our government can save global face on their poor response to the pandemic? For me, the loss of any of these services is much too high a cost.
Dr Alexis Paton is a lecturer in social epidemiology and the sociology of health at Aston University, chair of the Committee on Ethical Issues in Medicine at the Royal College of Physicians, and a trustee of the Institute of Medical Ethics
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