The restructure of public health must not weaken our climate change response

‘The first responsibility of any government is the protection of its citizens. And threats to public health are among the most important of all.’

These were the Health and Social Care Secretary’s words when he announced in August 2020 that Public Health England (PHE) was to be disbanded and replaced with the National Institute for Health Protection – now the UK Health Security Agency (UKHSA) and the Office for Health Promotion.

But when it comes to protecting citizens from climate change, which is one of the greatest threats to human health globally, very little has yet been said about the role of the UKHSA. Public health plays a critical role preparing for the health consequences of climate change. Yet while momentum is building in government and within the NHS to tackle climate change by charting a path to net zero, preparing for the effects of climate change often receives less attention.

In 2021, when the spotlight is on the UK to demonstrate climate leadership as the host of COP26 (the UN climate change conference to be held in November in Glasgow), we need strong national public health leadership on climate change and health.

Climate change and public health

Climate change is a public health emergency. Climate change impacts health directly through weather extremes (eg heatwaves and floods), and indirectly through disruption to natural systems (eg changing patterns of disease), social systems (eg forced migration), and interactions between them. In the UK, the effects of climate change will not be felt equally and are likely to increase health inequalities. At the same time, there are significant health opportunities in responding to climate change. Many solutions to address climate change, such as promoting active travel and healthy sustainable diets, are public health interventions that also bring benefits to health.

How PHE responds to climate change

Responsibilities for responding to climate change are distributed across national and local government, with long-term strategy for reducing emissions led by the Department for Business, Energy and Industrial Strategy.

PHE has had a number of specific roles to protect people in England from the health risks of climate change, working in collaboration with regional and local teams. These include:

• Developing national strategies and plans to deal with a changing climate – for example, planning for heatwaves, cold weather, floods and changing patterns of vector-borne disease.
• Emergency preparedness, planning and response – ensuring national and local arrangements are in place to prepare for health emergencies, including climate change.
• Monitoring risks of climate change to health – collaborating with the Met Office to provide early warnings of high temperatures and managing disease risks through vector surveillance programmes.
• Understanding the health impacts of climate change – supporting research, such as the longitudinal national study on flooding and health, and collaborating with multi-agency partners to enhance understanding of the health impacts of climate change.

The future of public health and climate change

The government has outlined its proposals for the new design of the public health system. So far, there has been no specific mention of where climate change responsibilities will sit, though it seems likely that many functions will transfer to the UKHSA.

In our 2020 briefing on the future of the public health system in England, we argued, based on learning from previous health system reorganisations, that there are a number of risks to mitigate during the transition to a new public health system. In the short term, these include the risk of a loss of talent and productivity, disruption to data and analytics, and the potential for functions to fall through the gaps. In the longer term, reorganisation can risk the loss of resources and create undesirable system fragmentation.

So – considering these risks – how can the government ensure that the new public health system is fit to respond to the growing threat of climate change?

First, it is critical that expertise, resources and focus on health and climate change are retained through the structural changes. In addition to maintaining current activities, PHE has outstanding actions in the National Adaptation Programme to deliver by 2023, including publishing an updated report on the health effects of climate change, developing a single adverse weather and health plan, and enhancing cross-government contingency planning for dealing with insect vectors (responsible for the spread of human diseases). This vital work cannot be delayed.

Second, regardless of where climate change functions sit, we need coherent strategies and strong leadership to ensure that health and inequalities are key considerations of a cross-government response to climate change. This reorganisation will split the public health function of health protection from health improvement at the national level (with health care public health yet to be decided), but what we need are strategies and structures which support a coordinated approach to climate change.

Finally, national climate change functions need strong relationships with local public health and health protection teams. The links that local teams have into their communities are critical to implementing plans and policies to respond to climate change and protect their local populations health. National support will be particularly important in the context of the current challenges facing local government and public health, including the long route to COVID-19 recovery as well as the continued erosion of funding (this year’s public health grant allocations represent a 24% cut in real terms compared with 2015/16).

In the year that the UK hosts COP26, we need a cohesive strategy and collective action on climate change and health. There must not be any weakening of policy on climate change and health as an unintended consequence of public health reorganisation.

Genevieve Cameron is Programme and Research Manager in the policy team at the Health Foundation.

Dr Anya Göpfert (@AnyaGopfert) is a Public Health Registrar and member of the Faculty of Public Health’s Climate and Health Committee.