Promotion of healthy lifestyles and the prevention of ill health is a fundamental principle behind public health and improving the public's health. The phrase 'prevention is better than cure' is often attributed to the Dutch philosopher Desiderius Erasmus in around 1500. It is now a fundamental principle of modern health care and inherent within health and social care strategies across the UK (See: England, Northern Ireland, Scotland, Wales).
Prevention is about tackling the upstream causes of ill health, this in itself is not controversial. The challenge is how it is paid for. See: King's Fund - Prevention is better than cure, except when it comes to paying for it. The results are not easily measured, because it is not easy to see where illness has not occurred.
The UK has a rich history of focusing on prevention, from Edward Jenner's smallpox vaccine in 1796 to John Snow using data analytics to determine the cause of the cholera outbreak in 1854.
While there has been huge progress across many public health trends, life expectancy in the UK has stalled and in some parts of the UK, has even decreased. There are worrying trends in health inequalities, with an unprecedented reversal in life expectancy for some groups and stark inequalities between healthy life expectancy between the most and least deprived areas. Increasing rates of alcohol and drugs-related deaths and hospitalisations, STIs, and obesity and a shift in the pattern of ill health towards multiple health conditions are also indicative of the need for action.
Nursing is essentially about providing quality evidence-based care and support to individuals and populations to improve health and well-being throughout life. In the past, public health has been seen as a niche specialty far removed from the typical image of nursing and only practiced by those with very specific qualifications.
Nursing and midwifery staff are now increasingly recognised as instrumental in improving and supporting the public’s health at an individual, community and population level. All nursing and midwifery staff are well placed to do this and need to embrace the contribution they can make to prevention. The ongoing challenge is having enough staff with the skills and time to make this essential contribution.
The RCN have been campaigning for many years for a greater focus on prevention with adequate funding. This is particularly pertinent in England, following the transfer of funding for public health to local authorities in 2013 and thereafter significant year on year cuts to local authority budgets and to the public health grant.
The RCN welcomed the announcement in the recent 2019 spending review of a real terms increase to the public health grant, which we see as a step in the right direction. However, indications are that the increase will likely fall short of the amount needed to offset the years of cuts and is not based on an assessment of population need. Improving public health and preventing ill health is about more than health services; and requires action to address the wider determinants of health, for example, education, transport and employment, which need to be addressed alongside health services in a more systematic way and with cross-government action and investment.
The RCN’s commitment is for a properly funded cross-government prevention strategy with a nursing workforce who are able to deliver this. We are calling for a long term sustainable investment in public health and prevention, which is based on assessment of population need and an understanding of health inequalities. The RCN has key alliances with a number of organisations to support lobbying on public health. For example we are members of the Alcohol Health Alliance who have recently called for £1 billion spent in tax to alcohol industry to be spent on funding 40,000 nurse vacancies. Also the Obesity Health Alliance and as such we have helped strengthen the case for stronger legislation on unhealthy foods.