Public Health England is an Executive Agency of the Department of Health this means that while it is treated as being managerially separate from the Department it does carry out some of the executive functions of Government.
So, when Public Health England announces something we should see this as being as a Government Position.
So the announcement on Tuesday the 11th of “Shocking” local variation in early death rates across the country appears to be official recognition that health inequalities is still an issue of real concern to Government…..except that health inequalities is not mentioned at all.
What I want to focus on is how the data is presented and what the underlying message is – because this information sets the tone for government discussions with local authorities and will be the information that Directors of Public Health in particular will be taking into Health and Wellbeing Boards.
The Big Killers
Despite Government commitment to give equal weighting to mental health (see foreword of No Heath without Mental Health) the Longer Lives website ignores this and instead focusses on the old medical public heath favourites of Cancer, Heart Disease and Stroke, Lung Disease and Liver Disease. These are all presented with regard their impact on early death.
So, in this the first significant product from Public Health England for local authorities and Health and Wellbeing Boards the early messages are:
- Its early death not long term illness
- Its physical health not mental health
Blame the Poor
As well as the focus being on “the big killers” the proposed interventions are weighted heavily towards lifestyle three quarters of the interventions focus on behaviour change. In other words teaching and persuading people to accept their circumstances and improve their behaviour. The graph below shows that of the proposed interventions approximately 3/4 focus on lifestyle change. (My workings out are here – PHE Blog)
Collectively they give a very dubious message to Health and Wellbeing Boards which is:
- Prioritise telling people to live more healthily
- Don’t worry about how they feel
- Don’t worry too much about their socio economic circumstances
Comparing apples with pears
I think that the way the data is presented replicates a mistake made bythe last government which grouped those local authorities with the greatest health inequalities compared to the national average into ‘spearheads’. This meant that local authorities with a large middle class population and a large deprived population appeared to be less challenged than those with where the majority of people were deprived – even though they might have more people who were experiencing inequality.
The way the data is presented feels inaccurate because it is comparing average premature mortality at local authority level. This means that very deprived communities within local areas can be masked by more affluent ones.
What happens next
Local Authorities and Health and Wellbeing boards are working on much broader approaches to improving health and wellbeing that recognise the importance of mental health and the impact of the social determinants of health. It will be important that the governments narrow view of priorities and how to tackle them does not divert them from this agenda.
What do you think?