Public health in England: an option for the way forward?

Abstract

It was clear as soon as it was announced that UK Health Secretary Andrew Lansley's unexpected decision to subject the National Health Service (NHS) in England to revolutionary change 1 The LancetThe end of our NHS. Lancet. 2011; 377: 353 Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar would have profound consequences for public health. 2 Department of HealthEquity and excellence: liberating the NHS. Department of Health, LondonJuly 20, 2010http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353 Google Scholar The White Paper, Healthy lives, healthy people, 3 Department of HealthHealthy lives, health people: our strategy for public health in England. Department of Health, LondonNov 30, 2010http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_121941 Google Scholar proposes that the public health function currently based in Primary Care Trusts be fragmented (figure). Some elements will move to the Department of Health, to a division called Public Health England, while others will move into local government. Health-care planning elements might move to proposed Commissioning Consortia and the NHS Commissioning Board, although this is not explicit. 4 UK ParliamentHealth and Social Care Bill. Parliament, London: UKJan 19, 2011http://www.publications.parliament.uk/pa/cm201011/cmbills/132/11132.i-v.html Google Scholar Blue arrows=funding flows; red arrows=cross-membership of boards. NHS=National Health Service. GPs=general practitioners. Public health: profession, health system, government controlPublic health efforts are essential for the health of populations. Individuals' lifestyles and their environment pose various health threats, including obesity, infectious diseases, chronic diseases, and injuries. Prevention at a population level is often a more effective strategy than relying solely on individual treatment and cure. The impact of public health programmes on the decline of premature mortality is of a magnitude similar to the effect of individual health-care services, at far less cost. Full-Text PDF The benefits of recessionHealth professionals around the world are rightly asking difficult questions of their governments as cuts to health services are implemented within national austerity packages. The global financial recession has led to an international health recession, with the exception of a small number of high-growth economies, such as China. The fear that governments will use their economic predicaments to cut back state funding for health is not imaginary. The UK is a prime example of a country in which politicians have exploited an emergency to open up new markets for any willing private provider. Full-Text PDF