The demise of Public Health England
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3263 (Published 19 August 2020) Cite this as: BMJ 2020;370:m3263Linked Opinion
Public health is about more than being prepared for future pandemics
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Dear Editor
Over 70 organisations and alliances committed to improving health and reducing inequalities have endorsed a joint statement which we have sent to the Prime Minister, the Secretary of State for Health and the interim leadership of Public Health England (PHE). This sets out the principles we all agree must underpin the reorganisation of the health improvement and wider functions of PHE. [1]
We are deeply concerned that the Government’s plans for the reorganisation of health protection in the UK currently pay insufficient attention to the vital health improvement and other wider functions of Public Health England (PHE).
Chronic non-communicable diseases are still, and will remain, responsible for the overwhelming burden of preventable death and disease in this country. The communities hit hardest by COVID-19 are those suffering most from inequalities in health and wellbeing. It is a false choice to neglect vital health improvement measures, such as those that target smoking, obesity, alcohol and mental health, in order to fight COVID-19.
Reorganisation is difficult at the best of times and these are not the best of times. Avoiding fragmentation and ensuring seamless transition from the current to any new system is essential.
At this time of global pandemic and recession, health improvement is not a ‘nice to have’ but an essential component of a successful response to the challenges we face.
Yours sincerely
Dr Nicholas S Hopkinson
Respiratory Specialist, Imperial College London, Chair of Action on Smoking and Health, on behalf of the Smokefree Action Coalition
Imperial College, London SW7
Professor Maggie Rae
President of the Faculty of Public Health
Professor Linda Bauld
Chair of Public Health at the University of Edinburgh and Director of public health research consortium SPECTRUM
Nicola Close
Chief Executive, the Association of Directors of Public Health, on behalf of the Public Health Network
Neil Tester
Director, The Richmond Group of Health and Care Charities
Sir Ian Gilmore
Director, Liverpool Centre for Alcohol Research, and Chairman, Alcohol Health Alliance UK
Caroline Cerny
Obesity Health Alliance Lead
Dr Peter English
BMA public health medicine committee chair
[1] Joint statement to the Government on Public Health Reorganisation with list of signatories https://smokefreeaction.org.uk/phehealthimprov/
Competing interests: No competing interests
Dear Editor
We have serious concerns about Health Promotion after the recent announcement that Public Health England (PHE) will be disbanded.(1,2) Over the last 25 years there have been successive reorganisations and at the same time dramatic reductions in budgets at national, regional and local levels.(3-6) At each upheaval skilled and experienced staff are lost.(1,7,8)
We are in the middle of a pandemic and there are other important non-communicable causes of disease that need urgent and significant action including: alcohol; mental health; smoking; sexual health; obesity; and the ubiquitous issue of inequalities.(9) The Institute of Health Promotion and Education was therefore surprised by the Health Secretary’s announcement, particularly as there were no concrete plans for the future of health improvement and PHE workstreams focusing on the non-communicable causes of disease.
Health promotion is at a crossroads: the choice is between a continued decline or a paradigm shift in thinking and a movement forward to a thriving country with a positive view of health. We strongly believe that there should be an increased investment in health promotion action at two levels: at a local level led by directors of public health and their multidisciplinary teams, and at a national level led by an organisation that has a well-resourced workforce who are at the cutting edge. The new body to take over the non-health protection areas of PHE should include health promotion in its title.
Strong national leadership is required because of the immediate threats to public health. However, the history of public health in the UK indicates that individuals have been put into senior roles with no qualification in public health.(10) The Institute of Health Promotion and Education firmly believes that senior positions should be filled with elite professionals who are qualified and skilled and have extensive experience of public health.
Our academic institutions currently run some excellent public health courses. Typically, they cover the three domains of public health activity:
1) Health improvement
2) Health protection; and
3) Improving health services.
It is important to highlight that these domains overlap. For example, qualified practitioners focusing on disease prevention may be using the same skills and similar types of resources as those focusing on promoting health. Providing data, analysis, evidence, advice, surveillance and support to local, regional and central government, the NHS and other organisations is needed both for health protection and health promotion.
During the current pandemic further research has been undertaken that shows the significant links between disease prevention and the health promotion agendas. For example, obesity and linked conditions are now associated with worse covid-19 outcomes.(11-13) It is crucial that we address the poverty issue and enable families to be as healthy as possible if we want them to be resilient to future infectious disease epidemics.
It is very positive that the health secretary, Matt Hancock, did commit to embed health improvement and inequality reduction across government.(2) This is in line with the Ottawa Charter for Health Promotion – a seminal public health document.(14,15) Actions will be needed in different departments including: Education; Health; Transport; Environment, Food and Rural Affairs; Ministry of Housing, Communities and Local Government; and HM Treasury. However, it is vital that there is a national body to provide expertise, coordinate, and drive things forward and appointed without delay.
The current epidemic of noncommunicable diseases has devastating health consequences for individuals, families and communities. In addition, they have major costs for our health and social care system. It is imperative that as a country we have a refocus on these diseases. Health promotion now needs to take centre stage at local and national levels as part of a new body. We urge the government to revitalise its efforts and as a first step appoint an appropriate senior person to drive this agenda forward.
References
1) Scally G. The demise of Public Health England. BMJ 2020;370:m3263
http://dx.doi.org/10.1136/bmj.m3263
2) Hancock M. Speech. The future of public health. Health and Social Care Secretary Matt Hancock spoke at Policy Exchange about the future of public health. Published 18 August 2020.
https://www.gov.uk/government/speeches/the-future-of-public-health
[Accessed 22/08/2020]
3) Watson M C and Lloyd J. Need for increased investment in public health BMJ 2016;352:i761.
https://www.bmj.com/content/352/bmj.i761
4) BMA. Funding for ill-health prevention and public health in the UK. May 2017. http://bit.ly/2quLN3K
5) House of Commons Health Committee. Public health post-2013: second report of session 2016-17. House of Commons Paper No 140, 2016-17.
6) Watson M C and Thompson S. Government must get serious about prevention. BMJ 2018;360:k1279.
https://www.bmj.com/content/360/bmj.k1279
7) Devakumar D, Mandeville KL, Hall J, Sutaria S, Wolfe I. Government changes are jeopardising public health. BMJ 2016;352:i1662. 10.1136/bmj.i1662 27026052
8) Middleton J. Public health in England in 2016—the health of the public and the public health system: a review. British Medical Bulletin, 2017, 121:31–46
https://academic.oup.com/bmb/article/121/1/31/2871226
9) IHPE. BMJ Letters and Rapid Responses. https://ihpe.org.uk/bmj-rapid-responses/ [Accessed 22/08/2020]
10) Scally G, Jacobson B and Abbasi K. The UK’s public health response to covid-19. BMJ 2020;369:m1932
https://www.bmj.com/content/369/bmj.m1932
11) Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ2020;369:m1985
https://www.bmj.com/content/369/bmj.m1985
12) Syed A, Soran H, Adam S. Obesity and covid-19: the unseen risks. BMJ 2020;370:m2823
https://www.bmj.com/content/370/bmj.m2823
13) Tan M, He FJ, MacGregor GA. Obesity and covid-19: the role of the food industry. BMJ 2020;369:m2237.
https://www.bmj.com/content/369/bmj.m2237
14) World Health Organization. Ottawa Charter for Health Promotion. Copenhagen: World Health Organization, 1986.
https://www.who.int/healthpromotion/conferences/previous/ottawa/en/
15) Thompson S R, Watson M C, and Tilford S. The Ottawa Charter 30 years on: still an important standard for health promotion. International Journal of Health Promotion and Education. 2018,56(2), 73-84.
https://www.tandfonline.com/doi/abs/10.1080/14635240.2017.1415765
Competing interests: No competing interests
Dear Editor,
This article, and the views of an expert like this is of public interest at this critical time and should be visible without paying for access.
Competing interests: No competing interests
Re: The demise of Public Health England
Dear Editor
I am glad of the views of Prof Scally.
I do not recall ever seeing such comments, indeed ANY comments from other eminent public health specialists. Not surprising that successive governments have destroyed public health. The successive Chief Medical Officers seem to have have colluded - in the past forty years.
I worked in public health from the 1960s. We were then accountable to the Public - the councillors.
We did not act as poodles of the Central Government.
Competing interests: No competing interests