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05 December 2019

What do the manifestos offer on public health?

Charles Wolfe

CHARLES WOLFE: Health is a barometer of the economic and social health of the country but the manifestos lack comprehensive coverage of the agenda for prevention


The Policy Institute is producing a series of comment pieces analysing election manifesto pledges from the different parties across a range of policy areas. Read the full series here

Health is central to the future success of the country. A population of healthy people can fulfil their potential, shape and make use of opportunities for meaningful work, and contribute positively to their communities, the economy and society more generally. As such, health is a barometer of the economic and social health of the country. The party manifestos outline health priorities and all have pledges that can be interpreted as contributing to public health, however healthcare policy focuses on the NHS and overall, without comprehensively covering the agenda for prevention and care across health and social care.

Determinants of health and inequalities

Key policy areas that affect health and that drive the deepening social inequalities in this country include education, housing, employment and transport. Labour will introduce a "Future Generations Wellbeing Act", enshrining health aims in all policies and a new duty for NHS agencies to collaborate with directors of public health. Tackling inequalities in health is the holy grail, yet inequalities persist and are worsening.

The Liberal Democrats state that poor housing, unsafe streets, poor air quality, unhealthy diets and financial uncertainty can create the conditions for people to become both physically and mentally unwell and plan to publish a National Wellbeing Strategy, which puts better health and wellbeing for all at the heart of government policy. Specific innovative pledges to actually tackle inequalities are not articulated in the manifestos, only new strategies which may not see population benefit for many years.

Delivery of public health

The health and social care systems are fragmented and operate in a myriad of structures with lack of overall governance and service integration. There are no pledges that really tackle this although in various cities, strategies have been developed to overcome some of the current issues. The Lib Dems plan to keep public health within local government and reinstate the funding that was cut from public health budgets by the Conservatives and join up services across public health and the NHS, which can only be a logical step bringing us back to where we were a few years ago.

Funding for refurbishment of hospitals is obviously important and the focus on buildings and secondary care is clearly a priority in the manifestos. However there is a need to radically rethink the balance between prevention and cure, hospital and integrated community services and primary care.

NHS England’s Long Term Plan emphasises the need to develop integrated services between hospitals, the community and networks of professionals, yet these issues are not highlighted in the manifestos. Labour will invest more than £1 billion in public health and recruit 4,500 more health visitors and school nurses, although the details of where the money will be spent or how health visitors will be recruited is to be determined. How primary and secondary care staff can be harnessed to deliver the public health agenda is a missed opportunity. Presumably there is a need for a workforce plan across sectors and a capacity-building and recruitment strategy that tackles the peaks and troughs of staff available in key areas of public health and the NHS.

There is a need to radically rethink the balance between prevention and cure, hospital and integrated community services and primary care...yet these issues are not highlighted in the manifestos

Charles Wolfe


Prevention of disease is at the heart of public health and a priority, given the epidemics we are seeing in such areas as childhood obesity, air quality-related illnesses, and multiple long-term conditions in an ageing population. The Conservatives will overhaul NHS screening and use new technology and mobile screening services to prevent ill health. The Liberal Democrats will develop a strategy to tackle childhood obesity, including restricting the marketing of junk food to children, closing loopholes in the soft drinks industry levy and extending it to include juice and milk-based drinks high in added sugar. They will also guarantee that every child who is eligible for free school meals has access to at least an hour a day of free activities to improve their health and wellbeing, with local authorities  funded through the public health grant to deliver the “Wellbeing Hour” according to local needs. Labour also pledges to increase the public health grants.

The Lib Dems will reduce smoking rates by introducing a new levy on tobacco companies to contribute to the costs of healthcare and smoking cessation services. The Conservatives similarly pledge to tackle the underlying causes of increases in NHS demand, for example via a long-term strategy for empowering people with lifestyle-related conditions such as obesity to live healthier lives, as well as tackling childhood obesity, heart disease and diabetes.

Transport policies directly impinge on health through the risks associated with poor air quality, poor road safety and issues of accessibility to transport in an ageing population. The Liberal Democrats will legislate for the right to unpolluted air and take urgent action to reduce pollution especially from traffic, but none of the parties address the effect of roads and transport on the health of the public, such as lighting.

Promoting health

Living with health conditions was always considered to be associated with ageing yet we are now observing epidemics of long-term conditions such as diabetes in young adults. Multiple long-term conditions are a national research and clinical priority, which consume much resource, but services are not well developed, and outcomes are often suboptimal. Included in this arena are mental health conditions such as dementia, depression, anxiety and substance use. Mental health is a public health priority for Labour and public health approaches to tackling it are mentioned by Labour and the Liberal Democrats.

There are also a range of pledges from the Lib Dems to address drug-related deaths, alcohol-related health problems and adverse impacts of gambling as matters of public health, treated accordingly in expanded addiction support services. They also single out cannabis, including addressing the law on, research into and services to manage its use. Labour will establish a Royal Commission to develop a public health approach to substance misuse, focusing on harm reduction rather than criminalisation.

Despite the many pledges outlined above and the policies to improve NHS services. A major area that is not explicitly tackled by any of the parties, is the use of personalised data from electronic health records for research and designing care pathways, diagnosing conditions and managing care. This is exercising services, staff and citizens, but there is no new thinking on how to land this big agenda. The NHS spends a relatively low amount of 1 per cent of its budget on research, but ultimately it is research that drives innovation in healthcare. How we improve our efforts in public health and in the NHS will require sustained and increased research funding.

Charles Wolfe OBE is a Professor of Public Health and Head of the School of Population Health & Environmental Sciences, King's College London.