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Jeanelle de Gruchy: Prevention paper must take poverty seriously

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Matt Hancock’s vision that prevention is key to longer, healthier lives is welcome. Councils have been saying this for years. 

Jeanelle de Gruchy, director of public health, Tameside MBC, and president, Association of Directors of Public Health

Jeanelle de Gruchy: Prevention paper must take poverty seriously

We know full well that the circumstances we grow up in: where we live, learn, work and grow shape our health. Homelessness, bad housing or air quality can drive poor physical and mental health.

So I agree with the premise, and therefore a green paper.

Creating a healthier population - and preventing ill-health - means tackling the root causes, acting on a wide range of determinants, across many sectors. Health and social care services aren’t nearly enough.

We know that poverty and structural inequalities drive health inequalities. So we need to talk money, for people and services.

One in every two children in Britain is now poor, yet giving every child the best start in life is the best prevention investment.

Women, children and those most vulnerable have been disproportionately impacted by recent fiscal policy. A study in Gateshead led their director of public health Alice Wiseman to comment that “universal credit, in the context of wider austerity, [is] a threat to the public’s health”.

The green paper needs to take reducing poverty seriously.

Creating a healthier population means tackling the root causes, acting on a wide range of determinants

Austerity means many are poorer, able to access vital services only when in crisis. It’s no surprise that A&E and police services are busier as a result.

While most people get that we need a shift from treatment to cost-effective prevention, the funding cuts mean they have delivered the opposite - arguably austerity costs more than it saves.

Health creation and wealth creation are integrally connected: poor health means poor productivity. A recent Northern Health Science Alliance report concluded that tackling health inequalities between the north and the south would boost the economy by £13.2bn.

While welcoming the NHS’s extra £20bn and an encouraging new emphasis on prevention, no amount of healthcare will end the burgeoning epidemic of non-communicable diseases.

Investing in prevention is essential across the system. We need to reverse local government’s 40% budget reduction and £700m public health grant cut and invest in our efforts to improve peoples’ health.

Mr Hancock’s vision rightly highlights local government achievements in health improvement and the important leadership role of the directors of public health. As local system leaders directors of public health are ambitious for their population’s health; they know that focusing primarily on individual responsibility just doesn’t work. Just think what more we could achieve if our role was strengthened and fully resourced.

Instead, we need cross-sectoral national policy to enable healthier environments such as upscaling active travel, improving air quality, increasing access to decent homes and tackling harmful commercial determinants through alcohol minimum unit pricing and a tax escalator for tobacco.

Finally, we could learn a lesson from Scotland and Wales. Adopting their policy obligation to think about future generations – the long-term impact of decisions, working better with communities and each other – would give us a solid foundation for preventing the deadly impact of poverty, health inequalities and climate change.

Jeanelle de Gruchy, director of public health, Tameside MBC, and president, Association of Directors of Public Health

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