The efficacy of council public health spending


Across the UK, local authorities and NHS boards are responsible for delivering changes to people’s behaviour for areas associated with purportedly poor lifestyle choices. The Health and Social Care Act 2012 in particular lead to the decentralisation of public health spending, campaigns and interventions to local authorities in England. Public health professionals in the UK are increasingly vocal in their criticism of individuals’ lifestyles. A more intrusive approach by them has been witnessed, with Public Health England pontificating on individuals’ apparent vices and hiring M&C Saatchi for their latest advertising campaign.

This research note examines the spending, access and cost effectiveness of four areas of public health spending across the UK: smoking, physical health, obesity and alcohol. Respectively, it entailed asking about interventions and programmes for adults across the UK which sought to reduce or stop their smoking, take up sport, reduce their weight and diminish their alcohol intake. In England, these are non-statutory areas of spending.

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This is especially important to debates around the rationale for government interventions, since such measures are often assumed to save taxpayers’ money in the longer term, and reduce the ‘societal cost’ of such apparent behavioural ills. Yet societal costs of alcohol, smoking and obesity can be defined very broadly, and the calculations of the public health lobby are invariably misleading. Savings to taxpayers are often lazily lumped together with more intangible externalities, such as being a nuisance drunk. A 2017 study published in the British Medical Journal suggested that the total economic cost of smoking globally was $1.4 trillion.

This was subsequently defined as treatment costs in media coverage, which was far removed from the authors’ position.1 Whilst premature mortality is sub-optimal, the buttressing of public health’s responsibilities to alter individuals’ behaviour is disturbing. It is an abasement of the original function of public health practitioners, that of health protection.

This entailed emergency preparedness, stopping the spread of infectious diseases and preventing the dangers of environmental hazards.

Finally, the escalation of indirect taxes on alcohol, tobacco and, from next year, sugar, is emblematic of the wider malaise in how public health has moved away from its original functions. Altering one’s behaviour is achievable, without recourse to using taxpayers’ funds in local authorities which have seen drastic changes in revenue and spending in recent years.

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