Shortage of public health independence and advocacy in the UK

Abstract

As public health registrars we believe it is the duty of UK public health institutions to advocate strongly for evidence-based measures to improve the health of society. However, several public health reports have made us concerned about the independence of our institutions. One example is the latest Chief Medical Officer’s report on child health. We were struck by the mismatch between the problems identified and the actions recommended. The report excellently highlights the social determinants of poor child health. However, its recommendations focus on healthcare services (such as giving out more vitamins) with no recommendations to tackle the social determinants of health (such as tackling child poverty). When the report cites the work of the WHO Commission on Social Determinants of Health, individual-level targets, such as parental education, are singled out, rather than wider recommendations such as social inclusion of caregivers, childcare, flexible working hours, or full and fair employment. A second example is the exclusion of climate change from the analysis of the health impacts of fracking by Public Health England. Such limited analyses give out harmful messages that can be easily misinterpreted. Our criticism is not aimed at any individuals, but at the institutional restrictions preventing bolder analysis of public health issues. We agree with Marmot and Kickbusch that a “health in all policies” approach is central to a healthy society. Public health must be free to draw attention to any potential eff ect on health of any government policies. So what is to be done? First, Public Health England and the Chief Medical Officer should be independent expert advisers, with no political interference in the scope or focus of their work. Only this will maintain their public credibility. Second, public health professionals must champion the “health in all policies” approach at every opportunity. Third, public health professionals should actively engage with policy makers, civil society, and the media to facilitate this. The increasing influence of tobacco, alcohol, and food industries on government policy show the increasing inability of the public health profession to work eff ectively. Shying away from advocacy is comparable to medical negligence. The changes taking place in UK public health present a unique opportunity for strong, independent public health institutions, and determined public health advocacy. This could bring tremendous gains to the health of our populations.