Embedding public health in public policy
Two quick ideas at 1:40am from a bystander
I often hear people talk about silos, and how difficult it is to make positive change to improve the nations health when levers sit beyond those who explicitly work “in health”.
Below are two areas I’ve been thinking about recently where a little advocacy might reduce that difficulty.
Suggestion 1: Green Book and ministerial legal duties
The Green Book is guidance issued by HM Treasury for all public servants, on how to appraise policies, programmes and projects, to provide objective advice to decision makers (in central government, this means ministers).
(This is somewhat confusingly titled given the separate public health Green Book, which has the latest information on vaccination procedures for vaccine preventable infectious diseases in the UK).
Following work by those involved in greening government, from 1 November 2023, Ministers of the Crown have a legal duty to have due regard to the environmental principles policy statement (EPPS) when making policy. As a result, when writing ministerial policy advice in Whitehall, civil servants should include a specific section outlining the environmental impact of policies. This is reflected in the Green Book, there's a new supplementary guidance document all about it.
While there is supplementary guidance on health, it was last updated on 21 April 2013.
A campaign for a similar legal duty for Minister to consider health impacts when making policies, could be an effective way to deliver HIAP in the UK Civil Service. This would require every piece of ministerial advice include a section on health impacts of that policy. The precedent has been set by the work on EPPS.
At the very least, please can we have an updated health supplementary document?
Suggestion 2: the Spending Review
“Spending reviews” in the UK are a process by which government sets out public spending plans for government departments. They typically set departmental budgets for multiple years in the future. This process doesn’t happen that often (last completed in 2021).
The Government has committed to a multi-year Spending Review in Spring (June) 2025, which will set the overall envelope from 2026-27 to 2028-29. Departments are asked to submit spending proposals to the Treasury. Usually these will be assessed against the Governments priorities/missions.
As those in Public Health know, often the levers for health sit outside the Department for Health and Social Care. A lot of public health policy really sits within other departments (e.g. MHCLG, DfT, DCMS).
At the moment there's no incentive or easy ability for departments to work together to fund public health focused projects. Their interests don't always align, as savings or economic growth aren't necessarily 'delivered back' to whichever department spent their money on a programme.
Advocacy in ensuring that the Governments 'missions'/priorities include explicit references to public health, so that departmental spending review bids are made with consideration to that, and assessed with that in mind, could drive departments to prioritise public health in policy making for the whole spending review period.
Moreover, both these policies would increase the understanding of public health and prevention within the policy making community across Whitehall.