The future of public health: lessons from the pandemic

woman in white and black polka dot shirt with face mask

The Coronavirus pandemic (COVID-19) has impacted all sectors of our society, but none more-so than public health services.

Last month, The Health Foundation hosted a webinar discussing the lessons from the pandemic and the future role of public health. The webinar drew on the findings from The Kings Fund report “Directors of public health and the COVID-19 pandemic”.  It considered the issues facing public health as a result of COVID-19, and proposed steps to rebuild the healthcare sector and begin tackling the problems left as we slowly move out of the pandemic.

Lack of resources

One of the main themes of the webinar was raised by Shilpa Ross of The Kings Fund, who explained that a lack of resources and shortages in public health existed long before the COVID-19 pandemic. The impact of longer term reductions to the public health grant meant that health services were not ready for the pandemic, nor for how long it has lasted. This has had a knock-on effect elsewhere in the NHS. A Care Quality Commission report noted that in July 2021, almost 300,000 people were waiting more than 52 weeks to begin hospital treatment.

On top of this, public health has faced staff shortages. Because so many healthcare services are “fishing in the same pond for recruits,” Shilpa explained that it has been especially hard to fill vacancies. In addition, many healthcare workers have experienced short and long-term effects of the virus, and the additional workloads have left many stressed and burnt out. The disruption to education could further delay the training and employment of potential new healthcare workers.

While the NHS has in some cases set up drop-in sessions for support and made efforts to provide even basic support, such as bottled water to aid hydration, these cannot fill the hole created by healthcare staff shortages.

Widening inequalities

Professor Kevin Fenton of Public Health England argued that “inequalities have defined the pandemic,” and would be the legacy of the last year and a half. A 2020 report by the Institute of Health Equity, commissioned by The Health Foundation, found that in England members of Black, Asian and minority ethnic groups (BAME) were more likely to be affected by COVID-19. The report attributed this partly to people in these groups living in more deprived areas, working in occupations with a higher exposure risk to the virus (such as healthcare or customer service roles), and in some cases living with multiple generations in their home (complicating self-isolation). The authors contended that while inequalities in social and economic conditions were present before the pandemic, they contributed to the unequal death toll resulting from COVID-19.

These inequalities have widened, partly due to the shortage of resources and staff. It has only grown more difficult to address the ever increasing numbers of people needing treatment, both urgent and non-urgent. As a result, the most vulnerable in society have fallen by the wayside.

Changing how public health works

The webinar also discussed how public health can move forward as the country slowly returns to a new form of normal. In addition to the restructuring of Public Health England, a new tax – the Health and Social Care Levy – will put an additional £12 billion into health and social care over the next three years. However, money alone is not enough – the webinar participants agreed that the infrastructures and inner workings of public health must evolve as we move towards a more efficient system of working.

Professor Fenton stressed the importance of engaging with local communities, and that the response towards the pandemic going forward must be grounded in their experiences, and what they need from both the public health system and also local authorities. He noted that while there may be pressure to go back to the way things operated before the pandemic, we must move forward: by understanding what worked and what didn’t, progress and better services can be achieved. Shilpa Ross added that a more targeted and tailored approach to health inequalities has provided more significant results in terms of vaccination and testing rates. This has in turn raised levels of trust within communities that public health teams may not have engaged with before the pandemic. All of this, however, takes up precious time.

Professor Jim McManus, Director of Public Health for Hertfordshire County Council, highlighted the importance of prevention not only for COVID-19 moving forward but other health conditions.  He stated that they must be tackled at a place where they can stop others continuing to be affected, in addition to treating those who are currently being affected.  Robin Tuddenham, Accountable Officer for NHS Calderdale Clinical Commissioning Group, agreed, and stressed that problems like homelessness and poverty should not be seen as separate from health but rather as important factors in the prevention of ill health.

Concluding thoughts

Highlighting the underlying issues and difficulties affecting public health before the pandemic is one step towards addressing them.

The webinar demonstrated that the pandemic has shifted how public health is perceived and valued. It has reminded all of us how important access to efficient, well-supported and high quality healthcare really is. Those working in decision-making roles in the healthcare sector are clearly looking towards the next steps for public health and how to give people the highest quality and most efficient care possible. With this in mind, the pandemic may have created a stepping stone towards a better healthcare system.


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