{"id":48370,"date":"2020-08-19T17:57:09","date_gmt":"2020-08-19T16:57:09","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48370"},"modified":"2020-08-24T17:03:53","modified_gmt":"2020-08-24T16:03:53","slug":"restructuring-public-health-england-public-health-is-about-more-than-being-prepared-for-future-pandemics","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/08\/19\/restructuring-public-health-england-public-health-is-about-more-than-being-prepared-for-future-pandemics\/","title":{"rendered":"Restructuring Public Health England: public health is about more than being prepared for future pandemics"},"content":{"rendered":"<p class=\"standfirst\"><span style=\"font-weight: 400\">Paul C Coleman, Joht Singh Chandan, and Fatai Ogunlayi consider the effect this restructure will have on the future health and wellbeing of England<\/span><\/p>\n<p><!--more--><span style=\"font-weight: 400\">We have serious concerns about the future of public health in England after the <\/span><a href=\"https:\/\/www.gov.uk\/government\/speeches\/the-future-of-public-health\"><span style=\"font-weight: 400\">announcement earlier this week<\/span><\/a><span style=\"font-weight: 400\"> 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\u2014<\/span><span style=\"font-weight: 400\">a decision that was in fact part of the government\u2019s move into the <\/span><a href=\"https:\/\/www.gov.uk\/government\/news\/covid-19-government-announces-moving-out-of-contain-phase-and-into-delay\"><span style=\"font-weight: 400\">\u201c<\/span><span style=\"font-weight: 400\">delay\u201d phase of its coronavirus strategy<\/span><\/a><span style=\"font-weight: 400\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">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 <a href=\"https:\/\/www.bbc.co.uk\/news\/uk-politics-53419544\">announced in July<\/a> that there would be \u201can independent inquiry into what happened.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">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 <\/span><a href=\"https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/articles\/comparisonsofallcausemortalitybetweeneuropeancountriesandregions\/januarytojune2020\"><span style=\"font-weight: 400\">UK experienced one of the highest levels of covid-19 mortality in Europe<\/span><\/a><span style=\"font-weight: 400\">, there is evidence to suggest that this could be partly due to the UK\u2019s high prevalence of morbidities, such as obesity and diabetes, which are <\/span><a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1002\/jmv.26220\"><span style=\"font-weight: 400\">recognised risk factors for severe covid-19 outcomes<\/span><\/a><span style=\"font-weight: 400\">.<\/span> <span style=\"font-weight: 400\">Furthermore, the UK\u2019s <\/span><a href=\"https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/908434\/Disparities_in_the_risk_and_outcomes_of_COVID_August_2020_update.pdf\"><span style=\"font-weight: 400\">ethnic and regional variation in deaths from covid-19<\/span><\/a><span style=\"font-weight: 400\"> shows that it is incredibly difficult to disentangle the effects of the virus from the wider impacts of health inequalities in our society.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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 <\/span><a href=\"https:\/\/www.hsj.co.uk\/finance-and-efficiency\/marketing-and-job-posts-take-hit-from-latest-phe-cuts\/7024942.article\"><span style=\"font-weight: 400\">PHE\u2019s budget cut drastically<\/span><\/a><span style=\"font-weight: 400\"> and during this time we have seen <\/span><a href=\"https:\/\/www.health.org.uk\/publications\/reports\/the-marmot-review-10-years-on\"><span style=\"font-weight: 400\">widening inequalities between the richest and poorest parts of England<\/span><\/a><span style=\"font-weight: 400\">, <\/span><a href=\"https:\/\/www.bmj.com\/content\/364\/bmj.l1123\"><span style=\"font-weight: 400\">a stall in improvements to life expectancy<\/span><\/a><span style=\"font-weight: 400\">,<\/span> <span style=\"font-weight: 400\">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\u2014as demonstrated by the disparity in funding for the NHS and public health.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Unfortunately, it seems that yet again the socioeconomic causes of ill health are being ignored. The announcement of PHE\u2019s 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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">While covid-19 may be the greatest public health challenge currently facing the country, <\/span><a href=\"https:\/\/www.bhf.org.uk\/what-we-do\/news-from-the-bhf\/news-archive\/2020\/january\/heart-and-circulatory-deaths-related-to-air-pollution-could-exceed-160000-over-next-decade\"><span style=\"font-weight: 400\">mortality from the impacts of air pollution<\/span><\/a><span style=\"font-weight: 400\"> 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\u2014as highlighted by the inequalities in covid-19 morbidity and mortality.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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\u2019s 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.<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Paul Coleman<\/strong> is a public health specialty registrar at the University of Warwick.<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Joht Singh Chandan<\/strong> is an academic clinical fellow in public health at the Universities of Birmingham and Warwick. <\/span><span style=\"font-weight: 400\">Twitter <\/span><a href=\"https:\/\/twitter.com\/JohtChandan\"><span class=\"css-901oao css-16my406 r-1qd0xha r-ad9z0x r-bcqeeo r-qvutc0\">@JohtChandan<\/span><\/a><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Fatai Ogunlayi<\/strong> is a public health specialty registrar at the University of Warwick. Twitter <a href=\"https:\/\/twitter.com\/O_LaFatai\">@O_LaFatai<\/a><\/span><\/em><\/p>\n<p><span style=\"font-weight: 400\"><strong>Competing interests:<\/strong> 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.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Paul C Coleman, Joht Singh Chandan, and Fatai Ogunlayi consider the effect this restructure will have on the future health and wellbeing of England [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/08\/19\/restructuring-public-health-england-public-health-is-about-more-than-being-prepared-for-future-pandemics\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":48372,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-48370","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Restructuring Public Health England: public health is about more than being prepared for future pandemics - 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Today has been the first Saturday of high street shopping since non-essential retail stores across England were allowed to reopen last week, having been closed under the coronavirus lockdown for nearly three months. Yesterday, monthly retail sales data from the UK's Office for National Statistics (ONS) revealed the beginnings of a rebound during May, with a 12 percent recovery from record falls in April, but sales nonetheless remained 13 percent below February's pre-pandemic total. Retail sales figures for June, taking into account this month's reopening of the sector, will be published by the ONS on July 24. 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