Abstract
BackgroundAmid local government budget cuts, there is concern that the ring-fenced public health grant is being appropriated, and Directors of Public Health (DsPH) find it difficult to make the case for investment in public health activity. This paper describes what DsPH are making the case for, the components of their case and how they present the case for public health.MethodsThirteen semi-structured telephone interviews and a group discussion were carried out with DsPH (November 2013 to May 2014) in the Southern region of England.ResultsDsPH make the case for control of the public health grant and investing in action on wider determinants of health. The cases they present incorporate arguments about need, solutions and their effectiveness, health outcomes, cost and economic impact but also normative, political arguments. Many types of evidence were used to substantiate the cases; evidence was carefully framed to be accessible and persuasive.ConclusionsDsPH are responding to a new environment; economic arguments and evidence of impact are key components of the case for public health, although multiple factors influence local government (LG) decisions around health improvement. Further evidence of economic impact would be helpful in making the case for public health in LG.
Highlights
Amid local government budget cuts, there is concern that the ring-fenced public health grant is being appropriated, and Directors of Public Health (DsPH) find it difficult to make the case for investment in public health activity
There is ongoing debate about the merits of this move. It may facilitate work on socioeconomic and environmental determinants of health,[1,2] but there are concerns about capacity and technical support for Directors of Public Health (DsPH) and that public health funds may be diverted to other local government (LG) activity due to severe budget cuts imposed by national government.[3]
Another DPH felt that LG officials presumed public health grant money would be used for services that could no longer be funded through the LG budget
Summary
Amid local government budget cuts, there is concern that the ring-fenced public health grant is being appropriated, and Directors of Public Health (DsPH) find it difficult to make the case for investment in public health activity. Results DsPH make the case for control of the public health grant and investing in action on wider determinants of health. The cases they present incorporate arguments about need, solutions and their effectiveness, health outcomes, cost and economic impact and normative, political arguments. Conclusions DsPH are responding to a new environment; economic arguments and evidence of impact are key components of the case for public health, multiple factors influence local government (LG) decisions around health improvement. There is extensive literature on decision-making and evidence use in public policy,[6,7,8] including in public health[9,10,11,12] which suggests that many factors influence public health decision-making, and evidence is used differently in different
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