Healthy prevention beats expensive cure

Last week's BMJ article, which accused local authorities of 'raiding' public health budgets to prop up other services, shows a surprising lack of insight into the reasons why councils actually took on the public health role in the first place. It also fails to grasp well-evidenced connections between health and wider social factors that are dependent upon public services such as housing, sport and leisure, greenspace or school meals.

The transfer of responsibility for public health to local government last April marked a welcome shift in emphasis from treatment to a preventive agenda, which recognises the complexity of public health issues. It also recognises that councils are best placed to understand the specific needs of their communities and operate in a joined-up way to meet those needs. In its response to the medical journal's report, Public Health England rightly pointed out that councils' decisions will be judged according to the outcomes they bring.

At APSE, we see clear links between public health and a host of front-line council services and are embarking upon research to quantify that relationship. There is already strong evidence to support the principle that billions of pounds of public money could be saved by looking at human beings and their health in more rounded terms and investing relatively small amounts.

For example, the King's Fund has estimated that poor housing costs health services some £600m a year. The Marmot Review made a strong case for reducing fuel poverty to prevent health problems, including cardio-vascular and respiratory diseases and poor mental health. The Chief Medical Officer has suggested every £1 invested in keeping homes warm can save 42p in health costs. It is not surprising then that Leeds City Council and the London Borough of Harrow are among the authorities that view tackling fuel poverty as a public health issue.

The London School of Economics has calculated that motivating obese people to exercise could save £360m health spending. An increasing number of GPs are prescribing exercise at council leisure centres as a way of tackling depression, obesity and related conditions. Walsall Council specifically aligned its sport and leisure service with health outcomes and has seen a fourfold increase in activity by 'hard to reach' members of the local community.

While official figures show physical inactivity costs the NHS up to £1.8bn a year, Natural England has demonstrated that better access to greenspace would make people 24% more active. Invest to save examples include the Natural Choices project by Mersey Forest. Primary care funding of £380k for community greenspace has helped reduce mental and physical health inequalities and improve air quality and evaluation by the University of Essex found 18% improvements in well-being.

A quarter of children leave school obese and obesity related illness will cost £60bn pa nationally by 2050. The University of Northumbria's evaluation of investment in free breakfasts for primary children in Blackpool identified strong potential to reduce nutritional inequalities along with improved performance in class.

No one doubts that vital public health functions, such as substance misuse, sexual health and smoking cessation work, require adequate funding. But interpreting public health in a wider sense, which recognises the contribution of other local government functions, can be an effective way of managing demand and achieving better public value overall. Teenage pregnancy might be a big problem in one authority, for example, while obesity is a higher priory elsewhere. And professionals in yet another area might recognise that residents whose mental health is affected by poor housing might not be in a position to focus on giving up smoking.

Councils  showing foresight in using resources in ways that will save money by reducing risks to health and helping their residents make healthier choices should be applauded - not judged according to inflexible and regressive criteria.