October 2021 saw the formation of a new government body: the Office for Health Improvement and Disparities (OHID). OHID is being promoted as ushering in a new era of public health to tackle inequalities, putting prevention at the heart of all it does with the intention of helping people live longer, healthier and happier lives.
We are told that OHID will improve health and tackle disparities in health outcomes countrywide, working with the NHS and local government, the wider public health system and industry to deliver on its mandate. The biggest preventable killers—including tobacco, obesity and alcohol—cost taxpayers billions of pounds to provide treatment and long-term care, as well as adding to bed capacity pressure in hospitals. Reducing health inequalities and keeping people in better health for longer is in all of our interests, hence the new approach to public health with a focus on stopping debilitating health conditions before they can develop.
Healthier communities are more prosperous communities and our health is strongly determined by the social and economic conditions in which we live (Health Foundation, 2021). As highlighted at the launch of OHID, men living in the most deprived areas in England are expected to die around 10 years earlier than men living in the least deprived areas. For women in the same areas the difference is 7 years. In more deprived areas smoking is more prevalent and it is one of the leading causes of inequalities in life expectancy; although obesity is widespread it is also more common in the most deprived areas (Department of Health and Social Care (DHSC) and OHID, 2021).
OHID has been set the aim of changing these inequalities as it coordinates ‘an ambitious programme’ that traverses central and local government, the NHS and wider society (DHSC and OHID, 2021).
It has long been known that preventing illness before it can develop has the real potential to help reduce pressures on services, resulting in significant savings of money and resources and ensuring that investment in the health and social care system goes as far as possible. It has also been long recognised that, in order to promote health and to prevent illness, significant investment in the system is absolutely essential. Failure to invest in appropriate human and material resources will see OHID flounder, throwing good money after bad.
The pandemic has indeed ‘laid bare the health disparities' that individuals, communities and the country face but this has ever been thus—ask any public health nurse, they have been advocating for a robust public health system for years. It is not only COVID-19 that brings us to this pitiful state of affairs, it is the continual lack of resourcing and investment. Effective preventive health initiatives, managed by the most appropriate people, cannot be expected to succeed if they are funded on a shoestring—it simply cannot and will not happen, as cynical as this may sound. Over a decade of cuts to public health need to be reversed if these aspirations are to materialise.
OHID, if it is to be the driving force across government, as the health and social care secretary envisages, must engage communities, health and care professionals, academics and industry as it strives to address inequality (in its many perverse forms). Acknowledgment is needed and action taken on the wider factors influencing health: employment, housing and education. A cross-government endeavour will fail if the prevention of ill health is not prioritised along with the urgent restoration of funding for key public health services and an investment in public health nursing, something nurses have been repeatedly calling for.