Public health funding essential for levelling-up

New analysis from the charity highlights that the public health grant has fallen by nearly a quarter in real terms per capita over the last six years – equivalent to a reduction of £1bn. It added that the cut was hitting the most deprived areas of England the hardest.

In Blackpool, the most deprived local authority in England, the per capita cut to funding was one of the largest at £43 per person per year. Girls born in Blackpool can expect to live 12.6 fewer years in good health (57.1 years) compared to the area with the highest healthy life expectancy (69.8 years in East Cheshire).

Local authorities include areas of high and low deprivation and the gap in healthy life expectancy is even greater at small area or neighbourhood level. ‘Even before the pandemic, a girl born in one of the poorest areas could expect to live nearly 20 fewer years in good health than a girl born in the one of the wealthiest,’ said Jo Bibby (pictured), the foundation’s director of health. ‘And Covid-19 is likely to have only further widened this gulf.’

She noted the government’s promise to ‘level-up’ society to spread opportunity more equally. ‘But ongoing cuts to the public health grant run counter to this agenda and will ultimately serve to further entrench health inequality,’ she said. The £1.4bn a year investment would restore the real-terms cut to the grant and enable services to keep pace with rising demand and costs.

The Association of Directors of Public Health (ADPH), backed by more than 50 charities and representative bodies, published an open letter citing the Health Foundation analysis and calling for urgent action on funding.

The association’s interim president Jim McManus, said that grant cuts had undermined the leadership and services that are essential to reducing inequalities. ‘Investing in local public health is critical to levelling up, preparing for the future threats and building a more prevention-focused health and care system,’ he said. ‘The costs of not doing so are clear – health and wellbeing will worsen further, health inequalities will grow and too much potential in our society and economy will remain untapped.’

The analysis increases the pressure on the government to boost public health funding in this year’s spending review, due to be announced later this month.

The Health Foundation said that cuts to public health are a false economy, with failure to invest in prevention of ill-health meaning greater NHS treatment costs over the longer term. It highlighted research showing that each additional year of good health achieved in the population by public health services costs £3,800 – three to four times lower than the cost of achieving the same result from NHS services.

Smoking cessation services and tobacco control have seen the greatest real-terms fall in funding with a 33% reduction. But there have also been big reductions for drug and alcohol services (17%), sexual health services (14%), drug and alcohol services for young people (11%) and children’s services (5%). One area has bucked this trend with spending on obesity services for children seeing a 9% increase.

NHS Providers chief executive Chris Hopson said that Covid-19 had thrust the importance of a ‘robust and well-resourced’ public health system firmly into the spotlight, as well as the need to address health inequalities.   

‘The public health activities which help prevent ill health, such as tackling obesity and improving mental health, are vital to the overall health of the nation and to reducing pressures on the NHS,’ he said. ‘It is more important than ever for the government to commit to long-term investment in public health services, recognising the vital role they play in supporting resilience to national emergencies and supporting overall health and wellbeing.’