How do we tackle the looming health time bomb? Lancashire’s public health boss tells Fiona Finch why cuts in public health funding must stop now and why the prevention of ill health is everyone’s business.
Lancashire’s Public Health boss likes to practise what he preaches.
Cue applause for his weight loss.
Dr Sakthi Karunanithi, Director of Public Health at Lancashire County Council, is delighted to relay the news that an increase in swimming and cycling with the family over the summer (aided by the many weeks of good weather when the sun shone down upon the county) has resulted in a slimmed-down doctor.
He said: “I’ve lost 25 kilogrammes over the course of the last seven or eight months. Basically I’ve not gone on a magic diet.”
Noting the saying It’s 90 per cent attitude and 10 per cent action”, he said: “I’ve become more conscious of what goes in and, with the children, I have started reading labels more.
Certainly the weather helped - we got ourselves on to cycle paths and in swimming pool and certainly I was reducing portion size and carbohydrates.”
So it is clearly a case of not just do as I say, but do as I do for Dr Sakthi, whom it should be made clear, was not boasting, but responding to my query - had he taken any of his own health advice on board?
His task is to meet the council’s public health commitments within a reduced budget and to assist the county’s population to live more healthily.
For the last few years he has repeatedly warned that too many people live the last decades of their lives in Lancashire plagued by infirmity or illness.
He also knows there are pockets of deprivation in the county - including wards in Preston, where life expectancy is reduced compared to more affluent wards.
Statistically 40 per cent of deaths and illnesses are deemed premature or avoidable.
While there is no instant sticking plaster to remedy these health inequalities he is an advocate of a holistic and shared approach to health and wellbeing which he believes will pay dividends in the future by preventing many health problems developing.
This month the Government published a new document entitled “Prevention Is Better Than Cure”. Unveiling the 41 page report, health minister Matt Hancock said: “In the UK we are spending £97 billion of public money on treating disease and only £8 billion preventing it across the UK. You don’t have to be an economist to see those numbers don’t stack up.”
He continued: “A focus on prevention and predictive medicine isn’t just the difference between life and death, it’s the difference between spending the last 20 years of your life fit and active, or in constant pain from a chronic condition. So our focus must shift from treating single acute illnesses to promoting the health of the whole individual. That requires more resources for prevention.”
Duncan Selbie, Chief Executive of Public Health England stressed at its launch: “Investing in prevention is the smartest thing we can do. We need to move from a system that detects and treats illnesses to one that also predicts and prevents poor health through promoting health in all policies and puts people back in charge of their own health.”
Dr Sakthi wholeheartedly agrees and he knows his service will have a major role to play. But there is one sticking point.
After its allocations increased public health funding saw a nearly £2m cut between 2016/17 and 2017/18. He is concerned about the declining resources for public health in the county and reckons nationally £3.9 billion is needed.
He warned: “What’s happening is this year on year reduction in resources for prevention and public health, there is no more room for efficiency and all we will be left with is a service reduction if this trend continues ... I think I’m most concerned about the health of the future generation and the more we get squeezed I’m worried about the future health of the babies that are born today.”
“We need to ask the question - are we spending enough on prevention? ... It’s a big question for local and national politicians.”
Preventative services can, for example,range from smoking cessation advice and eye tests in schools, to encouraging breastfeeding. Cutbacks are, he says, not immediately obvious.
Good progress is being made in some areas - in the past 18 months there has been a 30 per cent reduction in the use of sugar, salt and fat in school meals. Digital improvements have benefited the Family and Children’s Wellbeing service and he hopes the new NHS Orb will provide much useful healthy living information readily accessible online.
Changes must, says Dr Sakthi, involve a range of other sectors and other “agendas” and the individual.
As an example he cites the arts and culture offer in the county as one that can contribute much to public health and wellbeing.
Preston’s Harris Museum and Art Gallery is, he argues, a case in point: “The Harris has got a lot to offer- whether it’s the history and the heritage or all the culture on offer.”
Wellbeing is, not only the domain of public service he stresses, citing the link between housing conditions and health. Friendships and a sense of community count enormously too in preventing illness .
He said: “80 per cent is about the economy, about jobs, about education. I welcome the Secretary of State’s vision for prevention. The reality is we are having to reimagine health and wellbeing and how we improve that in the county and how we prevent illness....I am calling for an honest dialogue nationally and locally about how we value prevention and how much we are prepared to invest.”