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Deprived areas receive six times more cuts to public health budgets

The 10 most deprived areas in England have been hit with nearly 15% of all public health budget cuts over the past five years, according to new analysis. 

Local investment in public health budgets as a whole has fallen by almost £900m since 2014, however, the most deprived areas have had ‘disproportionate’ cuts. 

Analysis by think tank the Institute for Public Policy Research (IPPR) found that councils in England have had their public health budgets cut by £871.6m by the Government over the last five years. Almost £1 of every £7 cut has come from the most deprived areas in England, according to the research. 

The BMA said this showed ‘fundamental flaws’ in the way the Government allocates funding. 

In July, the King’s Fund reported that around £3.2bn was spent on total public health in England in the 2019/20 budget, a drop from the £3.3bn the previous year. 

The IPPR report estimated that between 2014/15 and 2019/20 public health services such as those offering health checks, drug and alcohol and stop smoking cessation support, received £871.6m less, with sexual health services alone losing £196.4m – the biggest cut. 

The report said: ‘This provides new evidence showing that those areas with the highest need have faced the highest cuts, suggesting that the approach to public health during the austerity era has been both unjust and inefficient. 

‘Comparing those cuts in the most and least deprived 10 local authorities, we see just how disproportionate. Almost £1 in every £7 cut from public health services has come from England’s ten most deprived communities – compared to just £1 in every £46 in the country’s ten least deprived places.’ 

It added: ‘The total, absolute cuts in the poorest places have thus been six times larger than in the least deprived. In relative terms, the poorest ten places have lost approximately 35p in every £1 of their budget, compared to approximately 20p in every £1 of their budget cut in the least deprived places.’

Previous research shows that sexual health services, for example, have a strong return on investment – £11 for every £1 invested in teenage pregnancy and £9 for every £1 spent on contraception – while cuts on these services have resulted in diagnoses of syphilis and gonorrhoea rising considerably.

Likewise, tobacco control targeting children can generate up to £15 of benefits for every £1 invested.

Responding to the report, BMA public health medicine committee chair Dr Peter English said: ‘We know that there is a clear link between cuts to public health and deprivation as some of the most vulnerable people in society are being hit the hardest by worsening access to services.

‘This IPPR report is further evidence that there are fundamental flaws in the way the Government allocates funds to local authorities for public health.’ 

He added: ‘This exacerbates the effects of already damaging cuts and widens health inequalities by hitting the poorest hardest. This must be rectified urgently before the additional resources promised to public health are allocated.

‘Sufficient and appropriately allocated public health funding is vital to the future sustainability of the NHS and to ensure that the Government actually delivers on its promises in the prevention green paper.’

Lead author and IPPR research fellow Chris Thomas said: ‘Austerity has meant substantial cuts to local government funding, including the public health budget. Today, we expose that these cuts have had the perverse effect of hitting the poorest, the hardest. This means the health and wellbeing of the most vulnerable people in our country has been put at risk – and puts unnecessary strain on the NHS.

‘Government must ensure our health and wellbeing by investing in a fairer deal for local government.’

A Pulse survey at the start of this year found four in 10 GPs have been asked to provide public health services without payment. 

In June a group of 14 major health charities called on the Government to reverse public health cuts and return £1bn of real-terms per head funding

A history of public health cuts:

In 2015, the Government cut £200m from the public health budget.

Public health services have seen cuts of over £550m since 2015/16, according to a BMA report.

Alcohol and obesity services have had their budget cut by over 10%.

In 2016, a Pulse investigation found that more than 20 local councils were scaling back their GP-run contraceptive and sexual health services.

Stop smoking services have been cut by over 20%, and one survey shows less than 10% of councils were commissioning smoking cessation as of April this year.

Some councils ended GP referrals to weight loss and exercise services as a result of the cuts in 2016.