Andy Bell, Deputy Chief Executive, Centre for Mental Health
Last month the Government announced its plans for the future of national public health activity, breaking up Public Health England into a new health protection organisation (the UK Health Security Agency) and an Office for Health Promotion which will be based within the Department of Health and Social Care under the leadership of the Chief Medical Officer.
While the vital role of public health in responding to the pandemic has gained a lot of attention this year, its many other essential functions have, perhaps inevitably, been overshadowed. Yet it is the day-in, day-out work of public health services, alongside their partners in the NHS and other agencies, that we all need to protect and improve our health and that fight on the frontline against health inequalities.
Few health inequalities are as stark and steep as those facing people with a mental illness. Life expectancy for someone living with a long-term mental illness was already two decades too short before Covid-19. And there is clear emerging evidence that mortality from Covid-19 has been greater for people living with schizophrenia in particular.
Public Health England has taken some important steps to address these inequalities. Working with Equally Well UK and other partners, PHE has published national data that highlights just how serious the health gap is for people living with a mental illness, from a young age onwards. It has provided guidance on cancer screening to try to stop people with a mental illness missing out on vital preventive health care. And it has worked with us to improve smoking cessation and weight management services for people with a mental illness.
It is vital that this work is sustained and expanded by the Office for Health Promotion. We have a long way to go to achieve physical health equality for people with a mental illness. We need to see much more progress in offering effective smoking cessation support to people with a mental illness. We need to ensure that future vaccination programmes (against Covid and flu) are appropriately targeted towards people who face the biggest risks from infectious disease. And we must ensure that screening programmes are better able to reach people with experiences of trauma.
The new national infrastructure will need to get up to speed quickly. And it must avoid the temptation so often faced by public health agencies to fixate on people’s ‘behaviours’ and ‘lifestyles’. Instead, it must take the opportunity of its place within government to exert a real influence on the determinants of health, and the way they too often cause harm to people living with a mental illness.
The Government’s election manifesto spoke of its determination to address health inequalities. It must now act on those words. And to do that it must ensure that public health services are funded adequately to enable them to tackle health inequalities. This year’s Public Health Grant once again fell far below what is needed to enable local authorities to promote and protect health in their communities. Future settlements will have to begin to put this right.
We have seen all too clearly the cost of health inequality during the pandemic. Now that we know the shape of the public health system over the next few years, it’s time to get to work and make a difference.