Public health post-2013 inquiry

In her first speech as Prime Minister, Theresa May put reducing health inequalities first on her list of ‘burning injustices’ that need to be tackled. We agree. Action should go beyond tackling the difference in life expectancy to include the inequality in the years lived in good health between the most and the least advantaged in our society.

We welcome the focus on public health but recognise that reducing health inequality will also need to address the wider determinants of health, such as education, employment, housing, and the environment. This will require cross-Government working. We recommend that a Cabinet Office minister be given specific responsibility for embedding health across all areas of Government policy at national level.

We welcome the move of public health to local authorities in 2013. They are well placed to deliver these same objectives across their communities and in doing so can harness a far wider network of individuals who can help to improve public health.

Local authorities face a number of challenges and have had to cope rapidly with major system change. In addition they face real terms cuts to public health budgets, including last year’s in-year cut of £200 million. As a result, they are trying to deliver more with less. Whilst we have seen examples of innovative practice, local authorities are now at the limit of the savings they can achieve without a detrimental impact on services and outcomes. There is a growing mismatch between spending on public health and the significance attached to prevention in the NHS 5 Year Forward View.

Cuts to public health and the services they deliver are a false economy as they not only add to the future costs of health and social care but risk widening health inequalities.

The new public health system is designed to be locally driven, and therefore a degree of variation between areas is to be expected. However, we are concerned that robust systems to address unacceptable variation are not yet in place. The current system of sector-led improvement needs to be more clearly linked to comparable, comprehensible and transparent information on local priorities and performance on public health.

Changes to local government funding, especially the removal of ring-fencing of the public health grant, must be managed so as not to further disadvantage areas with high deprivation and poor health outcomes.

While strong local political leadership can bring enormous benefits for public health, there is also the potential for tension between political priorities and evidence-based decision making. Clearer standards should be introduced and monitored transparently to improve accountability and to make sure that services to underrepresented or politically unpopular groups are maintained at an appropriate level.

We also recommend that local authorities be given greater powers to directly improve the health of their local communities and reduce health inequalities by including health as a material consideration in planning and licensing. We commend the proposals for a tax on the manufacturers of sugary soft drinks and call for further bold and brave cross-Government action to be included in the childhood obesity strategy and life chances strategy.