The search for a post-pandemic public health story

2022 will be a complex one for public health policy - three defining themes standout.

First, COVID-19 remains a significant public health threat. We are in a transition period, edging tentatively towards a settled ‘business as usual’ approach. It is wise to ignore the loudest voices, those seeking to frame ‘living with COVID’ in terms of either strict lockdowns or letting the virus rip. There is a third path which politicians, public health professionals and the public can support. What this looks like – in terms of measures and messages - has yet to be adequately defined (perhaps a small unit in the Cabinet Office is currently ruminating over the next roadmap ‘Beyond Plan B’ or ‘Living with COVID…still’).  

The public inquiry offers the chance to take a step back and consider how policy-making can improve in the future. For me, some key areas are a must for scrutiny and deliberation – the government’s approach to and implementation of stakeholder relations, the process of rapid evidence gathering and policy development and public communications. On a separate but related note, those of us who work for professional bodies and charities should reflect deeply on how we influence; what has been effective and what has not.

Second, the public health policy space is in flux. The list of things at various stages of creation or implementation is going to push the capacity of policy wonks to breaking point – white papers on levelling up and health disparities are being drafted and there are strategies or plans for strategies on drugs, early years, obesity, mental health and much more besides. This policy backlog, inevitable after the last two years, raises difficult questions about coherence, delivery and resources (funding and workforce). Does, for example, the government view public health as an essential foundation to levelling up? Does it see obesity and mental health as medical issues to be treated or signals that the way our society and economy function is more likely to create ill health than good health? Has the pandemic fundamentally altered government thinking about the scale and depth of policy change needed?

For a while now, as waves of infections have come and gone, the policy discourse has veered from short-term survival (e.g. hospital capacity) to long-term societal transformation (e.g. levelling up). My starting point for policy thinking this year is fairly simple: society was unfair before the pandemic, and it is even more unfair now – our solutions will therefore need to be bigger and better. In formulating a policy agenda, there are significant fault lines to navigate about the relationship between individuals, businesses, public services and government (both local and national). The forces of individualism and collectivism are much more explicit in policy and political discussions than before the pandemic.

Personal responsibility can be a feature of a public health approach or strategy, it should not the be sole feature. Raising levels of understanding about the drivers of poor health (the social determinants) is critical. Just as our social and economic circumstances have impacted upon our level of exposure to COVID-19 and likelihood of hospitalisation or death, these same factors (work, housing, environment etc) shape our health and wellbeing more broadly. Good health and health equity is in everyone’s interests.

Third, structures and systems are shifting. One of the most absurd episodes of the pandemic was the abolition of Public Health England – regardless of the merits of this decision to undertake such an upheaval was a demoralising and costly distraction. The Office for Health Improvement and Disparities (OHID) and the UK Health Security Agency (UKHSA) are now staffed by exceptional individuals who will do exceptional work in the months and years ahead. They will take time to settle and develop proactive agendas. And that’s the problem with structural reform – at best it is a necessary means to deliver change, at worse it is an expensive and time-consuming exercise which achieves limited impact or savings. No doubt everyone involved will make the best of it. OHID in particular provides a home in government to make the case for health being at the heart of policy-making and funding allocation across Whitehall departments. If it gives more prominence to the social determinants of health amongst policy-makers and politicians that would represent seismic progress.

The Health and Social Care Bill also has some cracks of light, with a greater emphasis being put on the role of place in preventing ill health and reducing health inequalities. The central obstacles are the understandable prioritisation of service backlogs and the fact that many of the levers for creating healthier places sit beyond hospital walls (as they should). Integrated Care Systems will have to value and respect local government, charities and other partners, recognise existing roles and responsibilities and develop a strong culture of collaboration.

The government is also committed to reforms in respect of social care and integration. In addition, the levelling up agenda may propose local government reform. There is a risk 2022 is heavy on moving deckchairs and light on allowing changes to bed in and delivery. Where there are opportunities to give a tired public health - and wider health - community time and space to breathe the government would be well advised to do so.

The search for a post-pandemic public health story will take place in turbulent political waters – speculation about the leadership of the Conservative Party, a more competitive Labour Party, a cost-of-living crisis, and the likelihood of a general election within 18 months. 2022 promises to be a pivotal one for public health policy.