Restructuring Public Health England: public health is about more than being prepared for future pandemics

Paul C Coleman, Joht Singh Chandan, and Fatai Ogunlayi consider the effect this restructure will have on the future health and wellbeing of England

We have serious concerns about the future of public health in England after the announcement earlier this week that Public Health England (PHE) will be disbanded. Few organisations can claim not to have made any mistakes in the management of the covid-19 pandemic. Yet media reports on the role of PHE have often been misinformed and one sided, with PHE receiving criticism for mistakes outside of its remit, including a lack of mass testing and problems with the supply of personal protective equipment. PHE has also received criticism for halting contact tracing on 12 March—a decision that was in fact part of the government’s move into the delay” phase of its coronavirus strategy

While there are lessons that must be learnt, it would be prudent for the government to delay any restructure until we can better understand the mistakes that have been made, especially since the prime minister announced in July that there would be “an independent inquiry into what happened.” 

We are particularly concerned about the crippling effect this restructure will have on the future health and wellbeing of this nation, and the ability of our public health system to respond to the interrelated challenges posed by communicable and non-communicable diseases. While it is too early to ascertain why the UK experienced one of the highest levels of covid-19 mortality in Europe, there is evidence to suggest that this could be partly due to the UK’s high prevalence of morbidities, such as obesity and diabetes, which are recognised risk factors for severe covid-19 outcomes. Furthermore, the UK’s ethnic and regional variation in deaths from covid-19 shows that it is incredibly difficult to disentangle the effects of the virus from the wider impacts of health inequalities in our society.

Since its inception in 2013, in the wake of another disruptive top-down restructure, a core function of PHE has been to address the socioeconomic determinants of ill health. However, the spending review of 2015 saw PHE’s budget cut drastically and during this time we have seen widening inequalities between the richest and poorest parts of England, a stall in improvements to life expectancy, and rising levels of morbidity and mortality from a range of non-communicable diseases. These failings are due to a decade of austerity, cuts to local authority public health budgets, and the government continually prioritising cure over prevention—as demonstrated by the disparity in funding for the NHS and public health. 

Unfortunately, it seems that yet again the socioeconomic causes of ill health are being ignored. The announcement of PHE’s disbanding by Matt Hancock, the secretary of state for health and social care, outlined no plans for the future of health improvement and PHE workstreams focusing on the non-communicable causes of disease. 

While covid-19 may be the greatest public health challenge currently facing the country, mortality from the impacts of air pollution alone is predicted to outweigh covid-19 related deaths over the next decade. What we need from the government is a cohesive strategy that recognises the complexities of addressing the interconnected challenges posed by communicable and non-communicable causes of diseases—as highlighted by the inequalities in covid-19 morbidity and mortality.

We urge the government to consider the vital role of public health in reducing inequalities and improving the health of the whole nation. In particular, we need to see greater investment in local public health services, especially in areas with the highest levels of deprivation and worst health outcomes. Critically, we also demand immediate clarity on the government’s future plans for the vital health improvement work undertaken by PHE, and how as a country we will address both the communicable and non-communicable causes of disease.

Paul Coleman is a public health specialty registrar at the University of Warwick.

Joht Singh Chandan is an academic clinical fellow in public health at the Universities of Birmingham and Warwick. Twitter @JohtChandan

Fatai Ogunlayi is a public health specialty registrar at the University of Warwick. Twitter @O_LaFatai

Competing interests: PC, JSC, and FO have worked as members of the West Midlands Public Health England (PHE) health protection team during the covid-19 outbreak. PC, JSC, and FO all currently hold honorary contracts with PHE and are members of the out of hours health protection rota.