" After April 2013, public health budgets will be protected for the first time, with local authorities taking the lead for improving the health of their local communities. This will help drive local efforts to improve health and wellbeing by tackling the wider determinants of poor health."
(GOV UK website)
This shift of responsibility in the NHS reforms has created a turmoil of different feelings for me, and I am hoping this blog post will allow me (and you) understand why!
This government quote suggests that public health campaigns tackle 'wider determinants of health'. Nature vs nurture? As we all know, although our genes may create a rough blueprint of how we suffer from ill health, it is the increasing number of unhealthy lifestyle choices that can kick us down in the future.
Public health is therefore a preventative technique that tries to tackle the cause of ill health. If it works, it should reduce the demand on GP's and hospitals and other forms of care.
This is what bothers me about this responsibility shift - preventative measures are SO important, and the responsibility has been shifted to local authorities that do not have the medical expertise that the NHS has at its finger tips.
This isn't to say that I like the idea...bottom up governance systems are usually more sustainable, local empowerment and all that, but have they not got enough on their plate?
A great example of preventive medicine at work is in Cuba. During the US embargo, access to medicines was extremely limited so the government relied on preventative measures. It seemed to work, with an increase in life expectancy, but it cannot be ignored that a reduction in food and the need for a agricultural sustainability base greatly improved the populations lifestyles. There present day health system is very interesting, and I plan to dedicate its own blog post to it. The local authorities have not been left with the public health budget without plenty of guidance. NICE (National Institute for Health and Care Excellence) have produced briefings on the main subjects such as smoking, alcohol, obesity... check the website out for some rather worrying stats! There is also close cooperation with local GP surgeries and research using the life course approach (a multidisciplinary paradigm).
Looking at all this information I think I still believe that the NHS may be best placed to tackle public health, but the local authorities have enough information and access to health care professionals that I am sure they can shoulder this great responsibility, and hopefully promote and create healthier living for all British people.
