The silence on public health in the election debate As the election campaign has got into full swing, politicians have been seeking to outbid each other on funding for the NHS. And there has been extensive discussion – what do the bids mean; will they be enough; and, perhaps most importantly, when exactly will the cash be delivered?
However, there has been almost total silence on public health. Looking back, the contrast with the last election is stark. In 2010, the Conservatives were promising a Department of Public Health, the headquarters of health across government and public health – and public health even merited its own separate section in the coalition agreement. We have recently given our verdict on the coalition’s record on public health, so no more of that here.
So why is the debate so different this time round, and why does it matter?
First, unlike in 2010, the polls are now showing the NHS at the top of voters’ concerns and Labour in particular have focused the debate on funding and ‘privatisation’. Second, there may be a view amongst the parties that the coalition’s public health reforms have handed over ‘the problem’ to local authorities, meaning there is less need to define a national position. Third, the coalition government’s focus on public health has not been accompanied by targets and therefore not subject to scrutiny in terms of accountability and debate. Finally, and more speculatively, parties may be concerned about appearing to take the position of a ‘nanny state’, something that can clearly be seen in Labour’s manifesto on public health, although they deserve credit for being the only party to write such a document.
This all really matters for our health of course – and for the NHS. As a colleague recently pointed out to me, the £30 billion that the NHS five year forward view says it needs to find per year by 2021 is the same amount that Derek Wanless argued in 2002 could be ‘saved’ on the annual NHS budget by 2022/23 if the NHS was more proactive and productive (particularly on disease prevention), and if people were much more engaged in their own health. Indeed, the Forward View starts with a call for a ‘radical upgrade in prevention’, but this only makes the contrast with the current radio silence even more noticeable. With £1 in every £5 of overall government spending set to be consumed by the NHS, there needs to be a greater focus on prevention and on the wider factors that shape our health.
If you look carefully, there is actually plenty in the parties’ manifestos that will impact on public health for good or ill, but lots of it is not in the health or NHS sections. This runs from the Liberal Democrats’ focus on air pollution to Conservative proposals for reviewing welfare benefits for claimants refusing obesity treatment and Labour’s promotion of the living wage. The thing you won’t find in Labour’s manifesto is arguably the most significant commitment from its public health manifesto – the stated commitment to ‘health in all policies’.
So it’s not as if there isn’t enough to debate. And belatedly some public health issues are managing to get into the press, including the Supreme Court’s ruling that the UK government needs to do more on air pollution and renewed criticisms of the Responsibility Deal. Whatever you think of the latter, I agree with Shirley Cramer, head of the Royal Society of Public Health, who said in response to the criticisms ’The time is ripe for a new Public Health White Paper...’. Unfortunately, you wouldn’t know it from the silence of the politicians.
The first months after an election are the best time for politicians to engage with policies that are likely to deliver long-term benefits rather than short-term political capital. Let’s hope the silence on public health during the election campaign is not a signal of inaction once those in the new government take their seats. The King's Fund
However, there has been almost total silence on public health. Looking back, the contrast with the last election is stark. In 2010, the Conservatives were promising a Department of Public Health, the headquarters of health across government and public health – and public health even merited its own separate section in the coalition agreement. We have recently given our verdict on the coalition’s record on public health, so no more of that here.
So why is the debate so different this time round, and why does it matter?
First, unlike in 2010, the polls are now showing the NHS at the top of voters’ concerns and Labour in particular have focused the debate on funding and ‘privatisation’. Second, there may be a view amongst the parties that the coalition’s public health reforms have handed over ‘the problem’ to local authorities, meaning there is less need to define a national position. Third, the coalition government’s focus on public health has not been accompanied by targets and therefore not subject to scrutiny in terms of accountability and debate. Finally, and more speculatively, parties may be concerned about appearing to take the position of a ‘nanny state’, something that can clearly be seen in Labour’s manifesto on public health, although they deserve credit for being the only party to write such a document.
This all really matters for our health of course – and for the NHS. As a colleague recently pointed out to me, the £30 billion that the NHS five year forward view says it needs to find per year by 2021 is the same amount that Derek Wanless argued in 2002 could be ‘saved’ on the annual NHS budget by 2022/23 if the NHS was more proactive and productive (particularly on disease prevention), and if people were much more engaged in their own health. Indeed, the Forward View starts with a call for a ‘radical upgrade in prevention’, but this only makes the contrast with the current radio silence even more noticeable. With £1 in every £5 of overall government spending set to be consumed by the NHS, there needs to be a greater focus on prevention and on the wider factors that shape our health.
If you look carefully, there is actually plenty in the parties’ manifestos that will impact on public health for good or ill, but lots of it is not in the health or NHS sections. This runs from the Liberal Democrats’ focus on air pollution to Conservative proposals for reviewing welfare benefits for claimants refusing obesity treatment and Labour’s promotion of the living wage. The thing you won’t find in Labour’s manifesto is arguably the most significant commitment from its public health manifesto – the stated commitment to ‘health in all policies’.
So it’s not as if there isn’t enough to debate. And belatedly some public health issues are managing to get into the press, including the Supreme Court’s ruling that the UK government needs to do more on air pollution and renewed criticisms of the Responsibility Deal. Whatever you think of the latter, I agree with Shirley Cramer, head of the Royal Society of Public Health, who said in response to the criticisms ’The time is ripe for a new Public Health White Paper...’. Unfortunately, you wouldn’t know it from the silence of the politicians.
The first months after an election are the best time for politicians to engage with policies that are likely to deliver long-term benefits rather than short-term political capital. Let’s hope the silence on public health during the election campaign is not a signal of inaction once those in the new government take their seats. The King's Fund
- See our work on public health
- Catch up with our commentary and analysis ahead of the 2015 election
- Explore the manifestos in our animated infographic
- Download our round-up of the main five parties' pledges
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