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The welfare benefit system is a public health system

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This blog is based on a talk I gave at the recent Faculty of Public Health Conference  – reacting to the Ken Loach film I Daniel Blake.

In a recent blog I set out how public health has struggled to recognise the important contribution that the benefits system makes to wellbeing and tackling health inequalities. We need to think of the benefit system as a public health service.

Nonetheless, we are in a position where this crucially important Public Health Service is increasingly difficult to access and where it is even hard to have a discussion at a local level about how we can ensure that vulnerable populations make best use of it.

A reminder – the NHS budget is just over £100 billion a year and the social welfare spend is £126 billion – not including pensions.

In fact as the figure below from Simon Duffy (Centre for Welfare Reform) shows the actual cost of social welfare to the state is considerably less than this.

When it comes to public health strategies and practice at a national level we look to two agencies to scope the landscape – Public Heath England and NICE. Between them they would argue that they describe the strategic public health challenges and actions needed to improve population health and tackle health inequalities.

At the conference we heard that this is not the case. Both agencies work within the constraints of Government Policy – Public Heath England strategic focus has to be consistent with the government agenda – not only does it not publicly challenge DWP actions – the only time it mentions welfare payments in its strategies is with regard to actions that will reduce their take up! It also does not offer strategies and actions to ensure that the benefit system is used to its best effect.

NICE works to a shopping list of priorities signed off by Government – again this list does not include welfare benefits.

This means that we must not accept that the Public Health England Strategy includes all the issues we need to address and the actions we can take or that it even includes the most important ones! In fact the Public Health England strategy is based on a mixture of evidence and a government ideology.

Local Action

Luckily, local Public Health teams have a degree of autonomy from central government. However there are challenges here too. It is quite difficult to have a system level conversation about access to the welfare benefit system – I think that this is for three reasons:

Actions

Five actions for local Public Health.

What do you think?

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