As a public health program lecturer at my medical school, I was shocked by the news Sunday morning of the disbandment of Public Health England. Especially since it seems to be on the verge of cutting for nothing other than to allow our current government to save face from its many failures during the pandemic.
That public health can be so misinterpreted (intentionally or not) solely as the fight against infectious diseases highlights how poorly public health services are understood by those in power. In the nearly 100 years since public health has been on the medical radar, in Europe at least, it has done much more than prevent the spread of infection. Public health measures are responsible for increasing our average lifespan by decades and have improved the lives of millions of children and adults by preventing and mitigating disease through screening programs, health promotion, testing, vaccines and social care reforms.
Indeed, healing from illness, disease and ill health requires more than medication and surgery. Instead, how we keep Britons healthy long term is a complex collection of prevention programs, social support, inpatient and outpatient services, and public service initiatives, akin to playing chess on roller coaster: Every move affects the game as a whole, and the whole board can be disrupted at any time by national and global health emergencies. The fact that the government chose to shut down Public Health England right after announcing a national obesity initiative shows how little it understands the important role Public Health England plays in maintaining our health and well being. -be in general.
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Initiatives such as the anti-obesity program are what is called health promotion. Health promotion programs promote behavior changes that improve the overall health of the population – and we know a lot of them, like the five-day initiative, the 5 km couch, and the many quit smoking programs currently available for free. These action plans target changes in individual health that result in a healthier population as a whole, and as an added bonus, a less overworked NHS when not faced with the consequences of these diseases.
Screening programs are another essential, non-pandemic service supported by public health. Similar to health promotion, screening for disease at times when the disease is likely to be detected early and best managed (e.g. cancer) means that fewer people have advanced disease, more people survive than die from these diseases, and again the NHS is benefiting. increased ability to treat disease quickly, effectively, efficiently and, most importantly, at lower cost. To do this, Public Health England operates screening, testing and laboratory services across the country.
Finally, Public Health England has a wealth of information and research on maintaining the health and safety of people at home and at work, by promoting and contributing to safety initiatives across all sectors. These three examples are just the tip of the iceberg in public health.
In the UK we have a tradition of public health that has little to do with pandemics and everything to do with improving the health of the whole nation in the long term. I could go on at length on the important, non-pandemic role that Public Health England plays in our daily lives; however, it may be more effective to see what can be lost if we equate public health with the only pandemic response. Public Health England currently has nearly 60 targeted programs in place to improve the health and well-being of all people. Here are just the highlights. Are we ready to lose them so that our government can save the world from its poor response to the pandemic? For me, the cost of losing any of these services is far too high.
Dr Alexis Paton is Lecturer in Social Epidemiology and Sociology of Health at Aston University, Chairman of the Committee on Ethics in Medicine at the Royal College of Physicians and Director of the Institute of Medical Ethics.