Robust, united system essential for improved health of the public

Government must act now to invest in and unite our fragmented public health system, to protect the health of the public, build resilience against future crises and tackle inequalities, according to a policy statement published today by the Academy of Medical Sciences.

The policy statement, informed by academic researchers, funders, representatives from public health bodies and public health practitioners, says there has never been a more important time to invest in building a robust, coordinated public health system. This can only be achieved by working across departments and alongside the bodies delivering public health services.

Public health research has led to significant improvements in the health of the population, from identifying smoking as a major cause of cancer and cardiovascular disease to adding fluoride to drinking water to improve dental health.

The new statement follows a 2016 Academy report, ‘Improving the health of the public by 2040’, that called for a radical upgrade to health of the public research. While some progress has been made, including allocated funding for public health research and some improvements in the use of data for public health, there is still a long way to go.

Since then, complex health challenges have emerged, including a cost-of-living crisis, threats to food and energy security, as well as a global pandemic. Now, a report has found that the number of people living with major illness is projected to increase by 37% by 2040.

Professor Catherine Law CBE FMedSci, Emeritus Professor of Public Health and Epidemiology at UCL, who contributed to the statement, said:

“Since 2016, we have seen the detrimental impacts of an underfunded and fragmented public health system in England. Public health research and evidence can underpin effective action to improve lives, but this will only be achieved if it is integrated into a public health system which is resourced for sustained action across the whole population. We urge the Government to work with partners across the public health landscape, and seize the opportunity presented by the recent restructures of public health systems in England, by transforming them in a way that will achieve our health of the public aspirations.

“By working and communicating with each other and with national, regional and local bodies, these new structures have a huge opportunity to reverse the decline in the physical and mental health of the population and to promote the economic prosperity of the UK.”

In the past three years, the public health systems in England and Scotland have undergone vast restructures.

Public Health England has been split into two separate entities: the Office for Health Improvement and Disparities, which focuses on health promotion, and the UK Health Security Agency, which focuses on health protection. The Health and Care Act of 2022 formalised the establishment of Integrated Care Systems across England, bringing together organisations to deliver joined up health and care services for people in their area.

In Scotland, several different public health functions have been brought together under one umbrella in Public Health Scotland.

To realise the UK’s ambitions for a healthier population, four key actions are needed:

  1. Invest in health of the public research and practice through cross-government and cross-agency working to build an effective, evidence based and integrated public health system.

Investment in research has been successfully directed through the UK Strategic Coordination of Health of the Public Research, led by Academy President, Professor Dame Anne Johnson PMedSci. However, the ability to turn research into public health benefits is held back by a lack of resource. Recent analysis indicates that the funding given to local authorities in England for public health decreased by 26% in real terms per person since 2015.

  1. Harness data and novel methods and technologies for health of the public research and practice.

The regulations introduced during Covid-19 to allow health data to be collected and shared have now expired, and the UK risks losing the lessons learnt in how to better use data to inform public health activities. We must build on the advancements made in data linkage and governance to improve public health research and interventions. 

  1. Facilitate the use of health evidence for all policies across government departments.

Our health is not just determined by genetics, it is also shaped by the food we eat, air we breathe, and where we learn and live. Improving the health of the population therefore requires policy changes in areas outside of healthcare, such as transport and education.

  1. Develop the next generation of public health researchers and practitioners to enable work beyond the traditional boundaries.

While collaboration between disciplines and research areas has increased, connections need to be stronger between health of the public researchers and policymakers to ensure research is translated into outcomes that improve health.

Professor Vittal Katikireddi, Clinical Senior Research Fellow at the University of Glasgow, who contributed to the statement, said:

“Through the pandemic, we have witnessed first-hand the importance of an effective, resilient public health system. Research and evidence have to be at the heart of policymaking, and we need to be better at involving the public in a meaningful way so that we deliver health benefits for all, including the most underserved communities. The UK must also take the opportunity to learn from and work with international colleagues to improve the health of the public in the UK and globally.

“Only with ongoing commitment and resource from consecutive Government administrations, and coordination across public health researchers, practitioners and policymakers, and the inclusion of patients and the public, will we be able to build a healthier, more inclusive, more resilient and more prosperous society.”

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