Spending on public health could potentially be highly cost effective. Prevention is, as they say, better than cure. It is a way of easing the burden on the NHS and making us more productive. But there is a great distinction between the potential and the reality. The trouble with all these claims about each pound spent on public health saving five pounds, or ten pounds, or whatever figure is chosen, is that they imply this spending will be effective.
I have already written about the evidence from my own Council, Hammersmith and Fulham, that Public Health spending in practice is astonishingly wasteful. It cost £55,571 for each person who gave up smoking.
Now a report from the TaxPayers Alliance confirms just how widespread such problems are.
“In 2015-16, public health authorities in the UK spent an extraordinary £230 million on programmes to stop people eating sugary foods, drinking alcohol or smoking.
Bills for changing just one person’s behaviour can run into the thousands.
“The TaxPayers’ Alliance has found that taxpayer-funded programmes – which seek to police our lifestyle habits – have proved to be remarkably bad value for money, with some costing more than £9,000 per person.
“The new report examines the spending and delivery of four public health initiatives in every public health authority across the UK. Out of 171 local public health authorities contacted, over 50 confirmed that they do not measure for cost effectiveness for any of their projects.”
Among the findings:
- The London Borough of Richmond upon Thames made the highest outlay per person for their physical activity programmes, spending on average £2,212 for each person who subsequently took up sport.
- On average, each public health authority spent £368,047 on obesity programmes which seek to reduce the weight of participants. This amounted to £912 for each person who lost weight. Liverpool City Council made the highest outlay per person for their obesity programmes, spending on average £7,222 for each person who lost weight.
- On average, each public health authority spent £1,059,136 on alcohol intake reduction programmes. This amounted to £4,601 for each person who reduced or stopped their consumption of alcohol. The Royal Borough of Kensington and Chelsea made the highest outlay per person for their alcohol programmes, spending on average £9,957 for each person who reduced their alcohol intake.
- Bury Metropolitan Borough Council gave £7,500 to the ‘Bury’d Treasure’ scheme. This is “a pirate adventure game that’s perfect for families to have fun together.”
Keep in mind that many councils do not even attempt to measure the effectiveness of their interventions.
John O’Connell, Chief Executive of the TaxPayers’ Alliance, said:
“Taxpayers have had enough of being told what to eat, drink and how to spend their leisure time. Those who do want to make lifestyle changes are free to do so if they choose – there is no need for bureaucrats to blow our taxes on good behaviour schemes, especially if they are not measured for cost effectiveness. Education and information will mean that people can make up their own minds without the need for expensive and meddlesome projects.”
Some may be tempted to blame localism. But I doubt that when Public Health spending was undertaken by the NHS it was any better. The problem is rather that councils have tended to just carry on as before. As the budget is “ring-fenced” little attention has been paid to it.
Certainly the Government should slash spending on Public Health – not just on these nannying elements identified in this report but the overall £3 billion or so. Ironically one of the most worthwhile items of public health spending – on vaccinations – does not come under the public health budget. But councils also need to start taking an interest in ensuring that whatever money they are provided with, delivers worthwhile results.