Blog post from Councillor David Fothergill on the importance of preventative strategies for public health.
It is estimated by the World Health Organization (WHO) that almost one third of the disease burden in industrialised countries can be attributed to four main behaviours: smoking, alcohol intake, poor diet, and lack of physical activity. But when considering the cost of that illness it is not just the bill for the treatment and care that should be taken into account. The economic consequences of premature death and preventable illness are considerable too. These can include loss of productivity in the workplace, lead to poor mental health and the cost of crime and antisocial behaviour.
The LGA has consistently argued that the current social care and health system is unsustainable and will buckle under the weight of demand unless we re-engineer our planning and service provision to protect health, prevent sickness and intervene early to minimise the need for costly hospital treatment and care.
Trying to fix this by focusing on treatment alone is not the answer. We need preventative strategies that mitigate or defer the need for costly interventions and at the same time deliver better outcomes for individuals.
Prevention works. Research clearly shows how effective some of these services are. Sexual health services have strong Returns of Investment – £11 for every £1 invested in teenage pregnancy and £9 for every £1 spent on contraception, for example. Tobacco control aimed at children can generate £15 of benefits for every £1 invested. Analysis by the University of York suggests that the expenditure through the public health ring-fenced grant is three to four times as cost-effective in improving health outcomes than if the same money had been spent in the NHS baseline.
A radical change of course is needed. As the industrialist Henry Ford said: 'If you always do what you’ve always done, you’ll always get what you’ve always got.' It is just plain common sense (and fiscal sense) that investing in prevention is necessary to help reduce the long-term cost of treatment and to maintain a sustainable health and social care service. But why is this so challenging in reality?
When local authorities are under pressure to make savings within reduced budgets, making the case for investment of any kind can be difficult. Making the case for investment in activity that can’t always guarantee immediate cost savings and may not reap a return for a number of years might seem impossible. But that doesn’t mean it isn’t the right thing to do.
It is also difficult for local authorities to build a business case to invest their scarce resources in initiatives where the financial benefits accrue to other agencies such as the NHS or the benefits system. We need to find a better way. It can only be tackled by adopting a system-wide approach, rather than budgets for treatment and budgets for prevention operating in silos.
We do not actually know what the whole health and social care system currently spends on prevention. A recent World Health Organisation report stated that on average around 3 per cent of national health sector budgets are currently spent on public health and prevention.
The degree of effectiveness of population wide interventions, for example the introduction of seat belts, oral contraception, raising the smoking age, food labelling etc which require a high level of political commitment can be highly effective compared to interventions which require low political commitment but considerable individual effort, these can be less effective.
The health needs of the future – especially people with long-term conditions – and the challenge of closing a growing funding gap means that we cannot go on with business as usual. As Archbishop Desmond Tutu once said. ‘There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in’.
Councillor David Fothergill, Chair, LGA Community Wellbeing Board