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There is something missing from health policy.
Not an apostle. There are plenty of them and disciples, evangelists even. No, not an apostle.
An apostrophe.
We talk endlessly about public health, we should spend more time talking about the public’s health.
It is only a punctuation mark, but it changes everything.
Public health is a profession, a discipline and a specialist workforce.
The public’s health is whether people are warm, properly fed, securely housed, breathing clean air, doing safe work and able to get help before a manageable problem becomes a life's struggle or a medical emergency.
That is not a calumny on the profession of public-health people. They are the specialist core; the conductors of the orchestra and the conscience of a system too often focused on treating illness.
Without them, the public’s health would become nobody’s business, but…
… they cannot do it alone.
The government says it wants to move the NHS from sickness to prevention.
Good, but…
…there’s a danger the promised ‘left shift’ becomes little more than moving the same patients, with the same illnesses, somewhere else.
Treating illness somewhere else is still treating illness.
The public’s health is created much further upstream, long before anyone reaches the GP’s front door. Neglect it and the consequences eventually arrive under blue lights and a wailing siren.
Health is created in the home people return to, the food they can afford, the security of their job, the air they breathe and the neighbourhood in which they grow old.
A hospital can mend a fractured hip. It cannot remove the loose carpet or loneliness that contributed to the fall.
A GP can prescribe an inhaler. They cannot remove the mould from a child’s bedroom.
The NHS can advise someone to eat better. It cannot make healthy food affordable.
Public health has a specialist home. The public’s health is made everywhere…
…in schools, housing departments, workplaces, supermarkets, transport policy, town planning and household budgets.
It’s everybody’s business, and, alas...
... when something belongs to everyone, it can quickly become the responsibility of no one.
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The NHS treats the consequences.
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Councils manage some causes.
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Employers shape others.
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The Treasury controls much of the money.
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Whitehall departments pursue separate targets.
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Individuals are blamed for the outcome.
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Everyone owns a piece of the problem…
… no one owns the whole result.
That’s why the public-health profession matters, but...
... its job is not to carry the entire burden. It provides the expertise, evidence and persistence that hold the parts together...
...asks awkward questions, exposes the consequences of other people’s decisions and keeps prevention on the agenda when short-term pressures threaten to push it off.
Public health must find a way to seize the authority to nail the apostrophe onto the door of every government department, and hammer it into every policy and law.
A council may spend money improving homes or reducing falls, but much of the financial benefit appears later in an NHS budget.
The organisation paying for prevention is rarely the one that banks the saving.
When money is tight, prevention becomes tomorrow’s good idea and today’s easy cut.
We count health checks, referrals, vaccinations and smoking-cessation appointments. They matter, but activity is not achievement.
The real test is whether people became healthier.
Did fewer children develop asthma?
Did fewer older people fall?
Did healthy life expectancy improve?
Did the gap between rich and poor communities narrow?
Those questions take longer than an electoral cycle…
…which is why they are so easily avoided.
Public health helped give us the sugar levy, smoke-free public places, motorcycle helmets and seatbelts.
Parts of the public and powerful commercial interests, railed against them as infringements of freedom.
Public health provides the fulcrum point for change.
The public’s health tells us whether we have reached the inflection point.
The apostrophe connects the expertise to the outcome.
Bring back the apostrophe.
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