Health body in need of serious reform
Christopher Snowdon
HAS ANYBODY heard from Public Health England recently?
When the agency was set up in 2013, its ‘primary duty’ was ‘to protect the public from infectious diseases and other environmental hazards’ and yet the fight against coronavirus has been led by the Department of Health and the NHS.
While the Chief Medical Officer and his deputy have become household names, the head of PHE (can you name him?) has been nowhere to be seen.
The quango’s main contributions to date have been hindering the roll out of testing with its overly centralised bureaucracy and assuring the public that it is ‘very unlikely that people receiving care in a care home or the community will become infected’.
Public Health England gets £4bn from the taxpayer each year. Of this, more than three-quarters goes to local authorities in ring-fenced grants.
Each local authority has Director of Public Health on a six-figure salary. With PHE gone AWOL, the Directors of Public Health have spent the crisis complaining about being left out of the loop.
If there was ever a time for the public health establishment to shine it is now. PHE’s budget for ‘protection from infectious diseases’ has risen from £52m to £86.9m in the last few years.
The latter is, admittedly, only two per cent of the public health budget, but how the money is divvied up is a political choice. If a fraction of the £4bn available had been spent stockpiling personal protective equipment, we would be in a much stronger position than we are now.
With hindsight, spending £220m a year on doomed attempts to reduce obesity doesn’t look like the smartest move, but these kind of sums show that ‘under-funding’ per se is not the issue. There always seems to be buckets of cash available when it comes to hectoring people about what they eat, drink and smoke.
If we have learned anything from Britain’s sub-standard response to the pandemic, it is that our public health system needs a shake up.
On the face of it, Public Health England’s primary objective is to prevent and tackle infectious disease outbreaks, but the list of priorities it published last September has ‘effective responses to major incidents’ sixth on the list behind a ‘smoke-free society’ and ‘healthier diets’. Noble ambitions, perhaps, but how trivial they now seem as we start another week under house arrest.
When you look at how taxpayers’ money is squandered on nanny state projects, the idea of public health being under-funded is laughable. Public Health England has spent millions trying to take sugar out of biscuits and calories out of sweets.
Public health academics were recently given £400,000 to study the drinking habits of football fans; £795,463 has been spent training Imams in Bangladesh to preach about secondhand smoke in mosques. You can buy a lot of face masks with that kind of money.
Even local councils, which have seen real cuts to their budgets, still find money to fund pressure groups to lobby for higher alcohol taxes and protest about fizzy drinks.
People can decide for themselves whether they have a sugary drink or a sugar-free drink. They have less control over whether they get infected with Covid-19 on the bus to work.
The distinction between public health issues and private health issues has been deliberately blurred over the years, with the word ‘epidemic’ being applied to binge-drinking, obesity and even gambling because it implies that tough government action is required when it isn’t. Only now have affluent Westerners been reminded what a real epidemic and a real public health issue looks like.
Yet this focus on lifestyle regulation is reprehensible in the case of the World Health Organisation. Infectious disease continues to kill millions of people every year in developing countries and yet the WHO has been preoccupied with alcohol and vaping (it disapproves of both). Like Public Health England, it needs serious reform.
Both organisations have to get back to basics. We need public health agencies that are wholly focused on genuine public health issues, which is to say contagious diseases and environmental hazards that require collective action.
When the next epidemic arrives, Public Health England should be in a position to take full control and full responsibility. We should be able to say, truthfully: ‘You had one job.’