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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee


Are we making progress in Public Health?

Feb 27. till Feb 27.

Invitation Only Event

Hosted by: Charlotte Leslie MP

With guest speaker: Duncan Selbie, Chief Executive, Public Health England

Respondent: Professor David Walker, Deputy Chief Medical Officer, Department for Health

February 27, 20142014-02-27T03:30:25 - February 27, 2014 2014-02-27T05:00:01
3:30 PM 2014-02-27T03:30:25 - 5:00 PM 2014-02-27T05:00:01
Portcullis House, Westminster


Public Health policy has received sustained attention over the last 15 years. The last government introduced ambitious targets in 2001 to reduce health inequalities by 2010, ran a ‘Programme for Action’ and set up the Health inequalities National Support Team (HINST). The current government has retained this focus on health inequalities. 2013 has seen the implementation of the Coalition Government’s significant changes to the structure of Public Health. These changes have seen Public Health move from PCTs to Local Authorities. The creation of local Health and Wellbeing Boards which will bring together local stakeholders from the NHS, the new Clinical Commissioning Groups and Local Authorities as well as academics and those working in the Third Sector.

Yet what have these sustained efforts and reforms achieved? Since the mid 1990s the number of smokers in the UK has been falling slowly. In 2010 21% of the population were smokers, compared to 27% in 1994. Yet there has been a slower decline in smoking among those working in manual jobs, resulting in smoking becoming increasingly concentrated in this population. In 2011 31% of those working in ‘routine’ jobs smoked compared to 10% of those working in higher professional jobs or large employers and higher managerial roles. In the last 8 years there has been a marked increase in obesity rates. In 1993 13% of men and 16% of women were obese. In 2011 24% of men and 26% of women were obese.

What’s more, the current economic climate isn’t helping health inequalities. The increasing rate of long term unemployment will bring about short and long term mental and physical health implications. We have already seen a recent increase in mental health problems and suicide rates, often linked to debt and financial stress.

Last year’s restructuring of Public Health presented a historic opportunity to tackle these glaring health problems and inequalities in England. Public Health England has talked about tackling the structural and economic determinants of health and they should now be able to work alongside professionals in local authorities who are responsible for housing, transport, education and the environment. Policy areas which can have a direct and significant impact on people’s health. Through Health and Wellbeing Boards, those working in public health are now also able to work closely with primary care – a key component in promoting preventative care and in encouraging patients to take more responsibility for their own health.

However, people on the ground have expressed concerns about a loss of expertise and resources due to reforms and the financial constraints on the NHS. Others have voiced the opinion that health inequalities will become even more piecemeal in the new arrangements, as the commissioning of public health will be dependent on the interest and agency of particular individuals within the new commissioning groups.

Finally, to what extent is progress in public health today outside the control of England based health professionals? The lasting effects of the recession have left us with a larger group of long term unemployed and shrinking workforces may mean that progress does not match professional’s ambitions in this area. Multinational food and drink companies make impactful and persuasive adverts which often sell an attractive life style, contribute to our idea of what makes a normal diet and which food and snacks are healthy. Unfortunately, these adverts can be misleading.

Key questions:
• Do local councils have enough autonomy to decide what public health policies are best suited for their area?
• In general, are we seeing strong relationships developing between Public Health England and CCGs?
• Have the reforms helped improved health education in England? Whether through campaigns or work in primary care? Have we seen an improvement in GPs’ promotion of public health?
• How are different areas of policy in Local Authority working together to tackle public health issues?
• As public health in Western Countries is increasingly about managing non-communicable diseases, how much control do public health professionals have over improving public health?
• How is public health changing in the devolved nations compared to in England?