Liverpool Director of Public Health Professor Matt Ashton says council public heath teams can play a significant role in supporting people with ill-health back into the workforce. But he warns budget cuts cannot continue if services are to remain viable.
If there is one thing Liverpool Director of Public Health Professor Matt Ashton has learned over the past decade, it is the importance of getting on the front-foot in public health.
‘Look at what has happened with smoking. As a result of bold policy decisions like the smoking ban, we have made real progress and seen the numbers smoking falling rapidly. One of our key tools in helping people to quit smoking in recent years has been e-cigarettes, but as we are now seeing there are both pros and cons of vaping.
“It is a useful tool to help you quit or at least reduce the harm from smoking. But if you are not smoking we absolutely do not want people taking vaping up. But we have seen industry move in and start marketing it and children have started taking it up. We should have foreseen this and been quicker to anticipate and respond to what was happening. We now have a problem.
“It is the same with junk food advertising and the 9pm watershed. We have been pushing for it to be introduced for years now, but the world has moved on and people are not watching television like that anymore. We need to be thinking about what we need to do to protect children from advertising. We need to be one step ahead of industry.’
The challenge of our times
In a similar vein, Professor Ashton believes public health needs to be proactive on the economy – and in particular the poor health that is driving many from the workforce. Latest Office for National Statistics figures show there are more than 2.5 million not working due to health problems – a record high and a 400,000 increase on the total seen before the start of the pandemic.
“This is such an important issue. We often think of things in economic and financial terms, particularly at the moment. But you cannot have a healthy economy without a healthy population. It is a symbiotic relationship - and at the moment we have too many people who are economically inactive because of ill-health. This is perhaps the challenge of our times.
“It is easier to help people from well-off education backgrounds remain healthy and in good employment. What is more challenging is supporting those from more disadvantaged backgrounds to enjoy this as well.
“The Association of Directors of Public Health has called for a new Public Health Act and a dedicated national health inequalities strategy. That’s because what we need is more joined up government – not one where individual departments are only concerned about their own budgets and priorities.
“But there are things we can do in local government. If you look at the health reasons for people not being able to work a large part of it is related to mental health. What people need at times is flexibility and support for employers and employers investing in their wellbeing.
“We worked with local employers during the pandemic – helping them with infection control, testing of their staff and the vaccination of their staff. We have built stronger relationships. There is no reason why we cannot work together to try to tackle this issue.
“But we will need to draw on the expertise we have across local government and the voluntary sector working together to support people back in to work.”
‘We’ve shown what we can do’
His belief is drawn from what has been achieved since public health returned to local government. “Local government is the right place to be because of all the levers – housing, education, neighbourhood services and economic regeneration.
“If you look at what determines health only around 20 per cent of it is actually as a result of the NHS, 40 per cent is the wider determinants, 30 per cent lifestyle and 10 per cent the environment. Local government has a huge role to play.
“We have had to cope with austerity and the cuts – you cannot get away from that. We have half the number of public health professionals we did and that, of course, damages your ability to achieve things.
“There are certain mandated services that are demand-led – sexual health and drug treatment – that have to be provided so what can get lost when budgets are tight is the preventative stuff across some really big areas such as addictions.
“The fact we have still been able to make real progress in areas such as smoking cessation, healthy homes and schools is testament to the way public health teams have worked and the influence we have been able to have across local government.”
Public health ‘cannot take anymore cuts’
He said what was achieved during the pandemic also highlighted the impact council public health teams are having. “Whether it was testing, vaccinations or – in the case of Liverpool – relaunching live events, it was local government that helped to find the solutions. The key has been the asset-based model, developing community-led approaches from the bottom up.”
But while Professor Ashton is urging public health to be proactive, he is concerned about its ability to meet the challenges. “When public health moved to local government we knew we were in a period of austerity, but I don’t think anyone ever imagined it would last so long.
“And now following the pandemic we are talking about another period of austerity. We have to ask ourselves whether we have reached a tipping point – where services simply cannot be cut any further. The pandemic showed how important public health is, but it is just as crucial during peacetime. The value of public health has never been more important.”