Cuts to public health run counter to levelling up

The Health Foundation and the Association of Directors of Public Health are calling on the government to increase funding for public health following years of underinvestment.

New analysis shows that the public health grant has been cut by 24 per cent in real terms per capita since 2015/16 (equivalent to a reduction of £1 billion). The cut is falling most heavily on those living in the most deprived areas of the country who have seen greater reductions in funding even though they tend to have poorer health.

The ADPH has also published an open letter which calls for urgent action on public health funding. The Health Foundation has calculated that additional investment of £1.4 billion a year by 2024/25 is now needed to restore the real terms cut to the grant and keep pace with rising demand and costs. The additional funding is also vital to ensure that services can meet increased need arising from both historic trends of worsening health and increased risks to health due to people’s experiences of the pandemic. 

The two organisations say that, while they welcome the Health and Social Care Secretary’s promise to ‘level up health’, continued cuts to public health funding threaten to undermine the levelling up agenda and further widen already stark health inequalities, which have been compounded by the coronavirus pandemic. While the government’s focus in the wake of the pandemic has understandably been on providing much-needed financial support to the NHS, there have been no clear signs of similar intent to invest in public health, despite urgent need.

The analysis reveals how the reduction in overall funding for the public health grant has impacted different services. Stop smoking services and tobacco control have seen the greatest real terms fall in funding with a 33 per cent reduction. But there have also been significant real terms reductions for drug and alcohol services (17 per cent), sexual health services (14 per cent), drug, and alcohol services for young people (11 per cent), and children’s services (five per cent). The one area in which spend increased has been in obesity services for children which has seen a nine per cent increase. 

Jo Bibby, director of Health at the Health Foundation, said: “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. And Covid-19 is likely to have only further widened this gulf. The Health and Social Care Secretary has promised to finally address this injustice and has rightly acknowledged that levelling up health is fundamental to levelling up economically - a healthy and productive population will be essential to the country’s future prosperity. But ongoing cuts to the public health grant run counter to this agenda and will ultimately serve to further entrench health inequality.

“As the country emerges from the biggest health crisis it has ever faced, the role of public health is as important as it’s ever been. The upcoming spending review presents an opportunity for the government to finally put an end to the short-sightedness of underinvesting in services which keep people healthy and prevent them from becoming ill in the first place. While there is a clear need for further investment in the NHS, to aid recovery from the pandemic and tackle the backlog in care, this must not be at the expense of funding for public health. The evidence shows that this would be a false economy - a failure to properly fund public health now will mean that the costs of dealing with poor health will be felt across the economy and our society for years to come.”