There is a growing mismatch between spending on public health and the significance attached to prevention in the NHS 5 Year Forward View, a committee of MPs has concluded.
The Health Select Committee calls on the government to recognise that tackling health inequalities and improving public health does not happen in hospitals, rather it requires a whole life course approach, tackling the wider determinants of health in local communities, effective action on prevention and early intervention, and through joined-up policy making at a national level.
To support this agenda, the committee wants to see a Cabinet Office minister given specific responsibility for embedding health across all areas of Government policy at national level.
The report concludes that while there is evidence of progress locally, there is less evidence of such an approach becoming embedded across Government departments. It calls for the Government to take bold and brave action through its life chances and childhood obesity strategies in order to improve public health and reduce health inequalities.
After taking on responsibility for public health, local authorities were dealt an in-year cut of £200 million last year and now face further real terms cuts to public health budgets. Cuts to public health and the front line 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, says the report.
In her first speech as Prime Minister, Theresa May put reducing health inequalities at the top of her list for action, highlighting the ‘burning injustice’ that if you are poor you will die on average nine years earlier than if you are rich.
Health Committee Chair, Dr Sarah Wollaston, said: “The disappointing watering down of the childhood obesity strategy, published in August, demonstrates the gap in joined-up evidence-based policy to improve health and wellbeing. Government must match the rhetoric on reducing health inequality with a resolve to take on big industry interests and will need to be prepared to go further if it is serious about achieving its stated aims.”
The report calls on the government to make good on its commitment to health in all policies by enshrining health as a material consideration in planning and licensing law
In some local authorities good progress has been made, the report says, but in others less. The Committee is 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.