Joining up government for public health

Realising Prevention: Practical Policies for Healthier Society

There is growing recognition that tackling complex social problems, like climate change and health inequalities, can only happen by building strong interconnections across policy jurisdictions and sectors. Over the decades, a slew of initiatives have sought to achieve more joined-up government in the UK, from Churchill’s abortive system of ‘overlords’ through to the short-lived levelling up agenda. Despite these and many similar attempts, Whitehall retains a structure of competing departmental fiefdoms.

Realising Prevention: Practical Policies for Healthier Society

The task of improving the nation’s health is currently split between the NHS and local government. These two vast and complex systems often struggle to work together effectively. The role of local government in England’s health policy should not be underestimated. It includes the £23.69bn social care budget and a £3.6bn public health grant, both of which come with statutory duties that local authorities must fulfil. While this is dwarfed by £181.7bn NHS budget, it is in the areas of social care and public health that we find the roots of the pressures on the NHS. And yet, preventative approaches are only a tiny fraction this vast NHS budget.

Realising Prevention: Practical Policies for Healthier Society

With 708,000 overcrowded households in England, it is clear why the government wants to build 1.5 million new homes over the course of the current parliament. In recent years, both parties have repeatedly insisted that reforming the planning system is the key to unlocking housebuilding. The Labour Government have laid out extensive reforms to the planning system in the Planning and Infrastructure Bill.

Realising Prevention: Practical Policies for Healthier Society

Since the landmark Marmot Review was published in 2010, every Labour and Conservative manifesto has promised to rebalance health from treatment to prevention. And yet, despite the ambitions of politicians, change has been far too slow in recent decades.

Tackling complex health problems requires joined up cross-sector working between stakeholders with diverse objectives. Evidence is one tool that can be used to bring stakeholders together and to influence decision-making processes. However, the challenge of using evidence to persuade policy actors to think more about health is enhanced when working in a complex system with multiple stakeholder groups with different priorities, preferences, values and skills.

Examining how value is considered and placed in the decision making process for urban development reveals who shapes the rationale. Where is the influence and how does this affect urban development? What does this mean for health in decision making processes?