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Key points

  • This briefing paper assesses the extent of cuts to the public health grant since 2014/15 and projects the amount required per year to plug the funding gap that now exists.
  • Based on current spending plans, a reduction of almost a quarter in spending per person is expected between 2014/15 and 2019/20. There will have been a £700m real-terms reduction in the public health grant in that period.
  • These funding cuts come at a time when demand is increasing and key indicators of health are causing concern. Mortality improvements have slowed and there are large inequalities in health outcomes between local areas.
  • An extra £3.2bn of funding per year is required for the public health grant to be locally distributed according to an independent calculation by the Advisory Committee on Resource Allocation (ACRA), while restoring real-terms losses and preventing any local area experiencing a reduction.
  • At a minimum, the government should reverse real-term cuts and allow additional investment in the most-deprived areas by providing an additional £1.3bn in 2019/20. The remaining £1.9bn should then be allocated in phased budget increases by 2023/24, with further adjustments for inflation.

The public health grant allows local authorities to provide services that are vital to maintaining and improving people’s health, such as obesity programmes, drug and alcohol services and sexual health services. It also supports public health teams to steer the development of wider local policies and services, such as housing, planning and children’s services, to support improvements in health.

The paper highlights that cuts have not protected areas with the greatest deprivation or need. At a time of ongoing wider cuts to public services that directly impact on people’s health, and with the NHS under intense pressure, this approach risks widening health inequalities.

The recommended increase would bring a more equitable distribution of funding for public health but is still far short of the upgrade called for in the Five year forward view.

Further reading