In the first sickness to prevention column for Healthcare Leader, Alice Wiseman, Vice President of the Association of Directors of Public Health, explores how the Government might realise this ambition
When the Government announced its ambition to move from sickness to prevention, the public health community gave a collective cheer after decades of making the case.
Treatment can act as a sticking plaster, but as Sir Michael Marmot, Professor of epidemiology and public health at University College London, famously said, ‘why treat people and send them back to the conditions that made them sick’. It’s only by preventing people from getting ill in the first place by improving the quality of the multitude of factors that determine how healthy we are, including our houses, our education, our jobs, our diet, our community and our access to clean air, will we ever make a meaningful improvement to the nation’s health and wellbeing.
The ambition represents a bold and welcome shift in national policy and gives long-awaited recognition from the centre to the power of prevention at a local level.
We know illness not only takes a toll on individuals’ health and wellbeing, but also significantly affects the economy through a combination of lost days at work and the cost of health and social care.
Currently, there is an average gap in healthy life expectancy of 22 years between different areas of the country and three times more people die by the age of 60 in the most deprived areas than in the least deprived. Most worryingly, 89% of deaths in England are caused by non-communicable diseases which are often preventable.
To realise the Government’s ambition then, access to – and quality of – the basic building blocks of health, alongside protection from the things that we know harm health, must be improved. So, what has been done so far to get us to the end goal?
There have been a flurry of announcements and initiatives since the 10 Year Health Plan was introduced.
There is a new plan to improve the quality, affordability and accessibility of early years education and the child poverty taskforce is making good on the promise to work across Government departments to improve outcomes.
The introduction of Awaab’s law promises to improve living conditions for thousands and elsewhere, the new PrEP injection has been given the go-ahead which will protect more people from HIV while the introduction of vaccines for gonorrhoea promise to help reduce its spread.
As well as starting to tackle the increasingly understood social determinants of our health, the Government has also recognised the danger of industry influence on our health. The commitment to deliver the Tobacco and Vapes Bill and stop the advertising and sponsorship of vapes and other nicotine products is very welcome, as is the upcoming ban on junk food advertising and promise to ban the sale of high-caffeine energy drinks to children.
However, taking a strong stance against all the industries behind harmful products, including alcohol and gambling, is needed to really turn the tide on the huge numbers of people suffering – and ultimately dying – from consumption of harmful products. That means applying the same types of hard-hitting and wide-reaching restrictions we know have reduced deaths from tobacco, to other industries.
For example, although improved labelling on alcohol is definitely needed, much more needs to be done to reduce the availability, affordability and attractiveness of alcohol if we are going to significantly reduce alcohol harm, which currently causes almost one in every 25 new cancer cases and contributes to crime and over a million hospital admissions every year.
Meanwhile the system is undergoing a huge change with the abolition of NHS England, devolution and local government reform all at varying stages across the country.
The driver to make these changes is to return decision making to local areas and that we are all for. Directors of Public Health have overall responsibility for the health and wellbeing of residents in each local authority area in England and what each community needs differs vastly between areas.
However, it remains unclear how the new NHS operating model will work alongside local authority public health teams. There are plenty of examples up and down the country of how this crucial partnership can provide effective initiatives to improve health outcomes, and it will be important in the coming weeks and months to learn from these successful models to ensure that the NHS does indeed become the “best possible partner” and that the reforms don’t duplicate the work already happening on the ground.
Whether then the plans will deliver on the Government’s promise to halve the gap in healthy life expectancy between the richest and poorest regions remains to be seen.
However, Directors of Public Health are ready and willing to do that work and are actively engaged in driving forward the changes needed to help the Government realise their ambition of helping everyone, regardless of where they live or how much money they have, to live a healthier life for longer.
Alice Wiseman is the Vice President of the Association of Directors of Public Health.
