Shirley Cramer CBE, Chief Executive of RSPH, reflects on the last year and looks at the challenges facing public health in 2016.
Today is the winter solstice, the darkest day of the year and it is already living up to expectations here in London, being wet and almost dark and gloomy at 3:30pm. However, inside we are full of Xmas good cheer and getting ready for the new year. It has certainly been a busy 12 months at RSPH and IHM, and in our education programmes, partnerships and campaigning we have seen some progress in furthering our vision ‘to optimise health and wellbeing for all’.
But has it been a good year overall for the public’s health? The scales will probably show that it has been a mixed year and, as in all things, it depends through which lens you are looking or more particularly, whose lens. The Institute of Health Equity has continued to highlight our growing health inequalities and despite the evidence of the widening gap, we don’t seem to have a comprehensive plan to bridge this chasm.
In March, through our Health on the High Street campaign, we showed that keeping healthy isn’t just about individual choices but about our local environment. Unsurprisingly, we discovered that the majority of ‘unhealthy high streets’ were in the most deprived areas. We asked the question, why do the poorest communities have to put up with the worst environments? We called for local authorities to have the power over licensing and planning so that they can design health promoting communities.
So it was pleasing to learn that local authorities were to gain increased powers as a result of the Comprehensive Spending Review (CSR) in November. On the other side of the scale however there will be an increased reliance on business rates for funding, and we know that the most disadvantaged communities also have the fewest businesses. This has the potential to increase health inequalities. There is the suggestion that a formula will be found to equalise funding, but will this happen?
Communities across the UK have shown great ingenuity in developing new ways of supporting and protecting the health and wellbeing of their residents, often integrating programmes, supporting volunteers and training the wider workforce. Local authorities understand the social determinants of health and many have initiated inspiring programmes this year. Although this is still not consistent across the country, real progress has been made in many areas.
So what were we to make of the unexpected £200m in year cut to the public health local authority budget? A case of short-sighted and short-term thinking, and an assumption that local authorities know how to ‘do austerity’ and will manage somehow.
We now know that, as a result of the CSR, public health spending will fall by at least £600million in real terms by 2020/21, a cut of 3.9% each year. This in turn will affect the sustainability of health and social care in the future, but political windows are short and the long term needs of citizens are set aside in the race for a positive message now.
There has been comprehensive condemnation of the cuts to investment in prevention from the health community but perhaps we have to reach rock bottom before the often hailed ‘radical upgrade in public health and prevention’ will take place.
This weekend I was up in water-logged Cumbria to visit family and saw for myself the havoc that the recent floods have caused to many of the towns and villages across the region. I grew up in this beautiful north west corner of England and, although the rain was ever present, I do not recall flooding to any degree in my childhood.
The recent extraordinary flooding of Cockermouth in 2009 and yet again last week with Storm Desmond show our need to consider the impact of the environment on health. Oxford University scientists have concluded that climate change has made flooding 40% more likely and also showed that intense rainfall (13.4 inches on Honister in 24 hours) is now more likely to occur again.
For 2016, we will need to take forward the recent Paris Agreement on Climate Change which emphasised the importance of taking action to protect human health from the negative consequences of climate change, as part of the overall efforts to reduce greenhouse gas emissions.
Extreme weather is a global phenomenon and its effects reach all of us. The hardy and generous Cumbrians are focused on the clean up now, some for the third time this year, and I have no doubt they will maintain a positive attitude, at least for now.
Seasons greetings and here’s to a happy and healthy 2016.