This week the Government announced extra funding of £50 million to 13 local authorities. (The lucky winners are Tower Hamlets, Newcastle, Doncaster, Aberdeen, Bradford, Plymouth, Gateshead, Blackpool, Coventry, Middlesbrough, Lambeth, Medway, and Islington.) The catch is that they are prohibited from spending the money on anything practical. This funding is “ring fenced.” It must all go on “research into health inequalities affecting their local area.”
It is a relatively small sum given the total funding to local authorities for Public Health. This financial year, according to the Department of Health and Social Care, “the total public health grant to local authorities will be £3.417 billion. The grant will be ringfenced for use on public health functions.” It’s up from £3.2 billion last year.
It is entirely possible to envisage public health spending that could provide value for money. I have suggested providing vaccination against shingles which could avoid the need for social care or even a stay in hospital. Or providing specialist accommodation for the homeless suffering from mental illness or drug and alcohol addiction. Or providing Vitamin D pills during the pandemic.
Doubtless, we could all think of other ways that public health funds could be spent effectively to avoid a lot of unpleasant illnesses and thus ease the pressure on the NHS, social care, and other public services. The difficulty is the reality that public health spending is being overwhelmingly wasted. In my borough of Hammersmith and Fulham there was spending of £1.19 million to help people stop smoking. 21 people did for at least 12 weeks. A cost of £55,000 each – for people who might have given up anyway. Meanwhile, the Council maintained a vaping ban in its buildings – even though lifting the ban would have cost nothing and surely have achieved far more in helping people quit.
At least, that anti-smoking effort was an attempt to do something practical. Much more usual is that the public health budget goes on inputting data, stakeholder engagement, cross-departmental coordination, projects, strategies, advisory assessments, cessation co-ordinators, units, task forces, working parties, commissions, panels, and champions.
So many well-meaning, intelligent and highly paid officials waste their lives holding meetings with each other – as The Beatles put it, “making all their nowhere plans for nobody.”
Assessing inequality levels is a favourite pursuit. The filing cabinets and computer hard drives in the Department of Health must already been groaning under the weight of assessments into the matter. Did the Department check if any of them had come up with any practical ideas that could be pursued before blowing another £50 million on more research? By the way, the real cost will be higher than £50 million due to all the staff time councils would have devoted to the bids which (anything is possible) might have been alternatively spent in some productive endeavour.
We already know, for example, that tower blocks are bad for your health. The people in Tower Hamlets and Lambeth living in them don’t need £3 million of research to discover this. We can note that the life expectancy in Tower Hamlets is 79.9 years compared to 82.2 years in Richmond-upon-Thames (where you will struggle to find a tower block).
There is an abundance of evidence that, on average, the richer you are the longer you live. That was one reason why justifying the lockdown on the basis that saving lives was more important than the economy was flawed. It is the poor who are the greatest victims of the anti growth coalition. If we all became twice as rich, the improvement in life expectancy for someone whose income went from £20,000 to £40,000 a year would be significant – for someone who went from earning a million a year to two million a year it wouldn’t make much odds.
But for all this expensive research to focus on the gap is to miss the point. If people in Tower Hamlets died at 79 and in Richmond-upon-Thames at 80 then health equality would have increased – but so would the number of corpses in both boroughs.
A significant source of inequality comes from children in care. The figures show 29 per 10,000 in Richmond-upon-Thames, 41 per 10,000 in Tower Hamlets. Most of these children could and should be placed for adoption with all the advantages (including to their health) of a permanent loving home. That would be transformational to the life chances of the children whether in Richmond or Tower Hamlets. If the gap narrowed, but the numbers in care rose, that would not be a positive outcome.
The Government is right to focus on economic growth – which would have a particular benefit on the health outcomes for those on low incomes. Wasting another £50 million on health inequalities research is not a useful way to advance that cause.