This explainer highlights the importance of public health services in tackling deep-seated health inequalities in the UK. It outlines the level of spending and pressures public health services have been under and how councils can manage and promote public health initiatives. In addition, it explores the importance of partnership working with services like the NHS along with integrating public health into primary care.
What is public health?
According to the definition given by the Faculty of Public Health:
“Public health is essential to all aspects of health and wellbeing and is crucial to reducing health inequalities and influencing the wider determinants of health. Public health’s historic endeavours have led to enormous advances in the control of communicable disease, through immunisation, clean water and sanitation.”
Public health funded activities cover areas like:
- Health protection
- Physical activities
- Health at work.
- Public health advice to NHS Commissioners
- NHS Health checks
- National child measures
- Children’s services
- Obesity
- Substance misuse
- Sexual health
- Smoking and tobacco
How are public health services funded?
Most public spending is done by local authorities. However, there is some centralised funding via NHS England, as outlined here by the King’s Fund:
“The vast majority of public NHS funding comes from general taxation and National Insurance contributions (NICs). A small proportion of funding (1.0 per cent of the total Department of Health and Social Care budget in 2021/22) comes from patient charges for services such as prescriptions and dental treatment.”
“Public funding for health services in England comes from the Department of Health and Social Care’s budget. The Department’s spending in 2022/23 was £181.7 billion. The vast majority of this spending (94.6 per cent, or £171.8 billion) was on day-to-day items such as staff salaries and medicines. The remainder was largely capital expenditure on long-term fixed assets such as new buildings or equipment.”
How has public health spending changed over time?
Research from the King’s Fund shows that in 2023/24, the value of the public health grant will mean that planned spending on public health services by local authorities will be £3.5 billion (in real terms 2021/22 prices).
“On a like-for-like basis, this is 10% less than 10 years ago in 2013/14, and per person, this spending cut is even greater. Net revenue expenditure on public health services in England has decreased by 13 per cent on a like-for-like basis since 2013/14. Adjusted for inflation to 2020/21 prices.”
What do councils spend public health money on?
As highlighted above, public health services provided by local councils must focus on a range of areas. However, there are five mandatory services:
- Access to sexual health.
- Measures to protect the health of the population, including immunisation and screening measures.
- Advice to NHS commissioners.
- Deliver the National Childhood Measurement Programme.
- Encourage NHS National Health Check Assessments.
What impact would the integration of public health and primary care have?
Research from the European Observatory on Health Systems and Policies outlines that improved integration of public health and primary care is believed to yield substantial benefits to patients and wider populations – citing various example approaches in Europe and elsewhere. The reported benefits of collaborations between primary care and public health include “improved chronic disease management, communicable disease control, and improved maternal and child health.”
In addition, public health services have a central role to play in tackling health inequalities. There is a strong case for the new Integrated Care systems that cover England to work closely with public health to shift resources and activity to preventative measures and stop poor health from emerging.
“Health inequalities are avoidable, unfair and systematic differences in health between different groups of people. There are many kinds of health inequality, and many ways in which the term is used. This means that when we talk about ‘health inequality’, it is useful to be clear on which measure is unequally distributed, and between which people.”
Check out LGIU’s research into local health systems for more insights
Summary
Public health services are funded primarily by the government, and the services sit within the local authority structures. As a result, there is a close relationship with NHS and wider health services. The case for developing local services and strategies to tackle health inequalities is strong. The case to shift resources from secondary care (hospitals) to primary community-based services that focus on the prevention of ill health is also strong.
The public health budgets from central government have been cut, which many view as short-sighted in a landscape of growing public health needs. Arguably, the need to shift services to focus on prevention is paramount, and hopefully, the growing positive relationship between public health, Integrated Care Services and council services can help improve the health of the poorest communities across England.
About the author
Nigel Long runs Action Disability Training and Consulting. He writes and advises on disabled issues, housing, health and social care for a wide range of organisations. He provides training and consultancy on a range of housing, disability, NHS and social care areas. Nigel also chairs a Health and Adult Social Care Scrutiny Committee in local government and is a member of a scrutiny committee that oversees an Integrated Care Systems partnership covering 4 council areas. He is a Board member of a disability charity.
