Relocation of public health raises questions about where and how to invest

The relocation of public health to local authorities has raised questions about where and how investment should be prioritised, concludes the first stage of a study led by Fuse.

Should more be spent funding lifestyle interventions like stop smoking services, or broader actions on social determinants such as poor housing and unemployment, and to what extent should evidence influence these decisions?

The findings come from the ‘Shifting the Gravity of Spending’ project,  funded by the National Institute for Health Research (NIHR) School for Public Health Research (SPHR), which explores public health decision making and priority setting in the context of local government in England.

The research team is led by Fuse Deputy Director Professor David Hunter from Durham University and includes collaborators  from  the School of Health and Related Research (ScHARR), Sheffield University, and the University of Kent.

The study found that there were four main influences on priorities for public health investment in the case study sites:

  • an organisational context where health was less likely to be associated with health care and where accountability was to a local electorate;
  • a commissioning and priority-setting context located within broader local authority priority-setting and decision making processes;
  • different views of what counts as evidence and, in particular, the importance of local knowledge; and
  • debates over what constitutes a public health intervention, triggered by the transfer of the public health budget from the NHS to local authorities in England.

The  ‘Shifting the Gravity of Spending’ project looks at decision-making for investment in prevention at a time when local authorities in England have, since April 2013, become commissioners for public health services. The project took a developmental and evaluative approach based on the premise that if decision-support methods are to be used they should be developed in conjunction with local commissioners, reflecting local priorities and context. It has involved close engagement with commissioners, practitioners and other stakeholders through targeted activities. Working closely with them to identify the tools and techniques they might find most useful, the research team has adopted a co-production model of knowledge generation and exchange.

A one-year follow on study is selecting a number of local authorities which have adopted priority-setting tools and approaches to identify what helps and hinders their uptake and impact.

Project summary

Publication: The return of public health to local government in England: changing the parameters of the public health prioritization debate? (Public Health)

More about the project

Last modified: Tue, 31 Jul 2018 09:13:48 BST