After waging war on doctors and nurses over their working hours, it seems that Health Secretary Jeremy Hunt has now turned his attention towards public health services designed to prevent weight-related health problems.
According to recent survey results from the Royal Society of Public Health, almost half of public health officials working for the NHS and local councils say weight management programmes have been rationed, and restrictions have been placed on the availability of exercise referral programmes. This could worsen, with a proposed £200m cut to the public health budget.
No-one disagrees that public services need to demonstrate they are making the best use of available resources. So rationalising budgets in the health service and beyond is not in question. Unfortunately choosing between prevention and treatment is not an option as there will always be some parts of the population who are in need and require attention by expert health services.
The idea behind public health is that through a range of programmes and initiatives it maximises opportunities for people to stay healthy and reduces the reliance on health services to fix things. Its ability to do so relies on appropriate and on-going investment, particularly in the context of ever changing multi-cultural societies and the constant advent of new and emergent diseases.
Prevention has long been the poor relation in the realm of improving the health and wellbeing of individuals and local communities compared to health care and treatment services, and subsequently a disproportionate amount of investment is made in them.
A Department of Health report warned that the 4% of the NHS budget spent on prevention needs to be at least maintained to ensure current levels of health in England do not worsen compared with other European countries. Making the case for continued investment in such issues as the growing epidemic of obesity is still an imperative.
Evidence based public health has done much in recent years to prove its worth. Recent research by health economic advisor Lesley Owen found that in absolute terms public health activities are cheap - some activities being cost saving.
In the case of obesity we already know what to do. Creating an environment which helps people maintain a healthy weight (without stigmatising) requires involvement of governments, local services and importantly the people who the services are targeted at. Institutions like the National Institute of Health and Care Excellence already provide us with the evidence to highlight things that work.
They highlight the role of local government in improving the environments where people live. Particularly encouraging routes for active travel whether that is by foot or bike; making more high quality fruit and vegetables affordable; promoting availability and access to affordable leisure facilities. It's not rocket science but it requires commitment and consistency amongst a range of professionals to get the message and the services right.
If we know that public health interventions to combat obesity work, and they are cost effective, then the government's ongoing and proposed cuts appear both short-sighted and potentially dangerous. Obesity is set to overtake smoking as the leading preventable cause of cancer in the West, and treating obesity-related health conditions costs the NHS around £6 billion a year.
When cuts are made, it's generally the 'system' that fails. An effective system is required to ensure that what we know from research impacts the real world. The system fails when governments aren't prepared to invest in the long term. Human beings in the system get displaced; fed up; and frustrated and disengage - meaning that the things we know can work - don't work because the government wants quick and easy fixes.
Disinvestment is a good thing, if there is evidence to suggest that the interventions currently in place just don't work. This is not the case with the interventions to stop the obesity epidemic getting any worse.
Disinvestment at this stage by the Department of Health also defeats the objective of their report "Healthy lives: a call to action on obesity in England" published in 2010, albeit by the coalition government, to reduce the level of excess weight average across all adults by 2020. Interestingly this documented a 'life course' approach (an approach for different key stages of life) which applies long term investment.
On a related noted, some argue that too much emphasis on supporting people to lose weight (when effective strategies should be about maintaining a healthy weight rather than continually being on a diet) will turn us all into paranoid anorexics! A positive way forward to avoid this is to place more emphasis on good mental wellbeing. Early interventions with children and young people that provide them with the skills and competences to support healthy decision making has much potential to make public activities even better value for money.
Antony Morgan, Professor in Public Health, GCU London