In England, the Secretary of State for Health and Social Care has revealed his vision for how he plans to transform the Government's approach to prevention, laying down the foundations for a green paper in 2019.
Acheson (1988) described public health as the art and science of disease prevention, extending life and promoting health through the organised efforts of society. Activities to strengthen public health capacities and service aim to provide conditions under which people can maintain health, improve their health and wellbeing, or prevent the deterioration of their health. None of this can be achieved without input from nurses. Public health has as its focus the entire range of health and wellbeing and is not only concerned with the eradication of particular diseases. A great deal of public health activity is targeted at particular populations but public health services will also include the provision of personal services to individual people, such as vaccinations, behavioural counselling, or health advice.
The proverb ‘prevention is better than cure’ means it is easier to stop something happening in the first place than to have to repair the damage after it has happened—very appropriate in health and social care settings. It makes sense to put more emphasis on health protection and disease prevention strategies and to engage communities to take action.
Pressures on health services and budgets across the country are increasing due to a number of factors: the ageing population, rising expectations regarding health and the impact of socioeconomic problems, such as social exclusion and unemployment. At the same time, there are environmental changes, and changes in the workplace that have led to new illnesses and diseases while increasing population mobility is creating conditions in which communicable diseases could spread more rapidly.
It is right that there are plans to transform the Government's approach to prevention, but these transformations must not be inhibited by budgetary restraints or an economic slowdown. Continuing to invest in service models that were based on the needs of yesteryear is immoral, for many reasons. Contemporary health and social care systems require a vision that is future-proofed, dynamic and appropriate, setting out a much greater focus on prevention, not just cure, but with this comes commitment and spending. With an ageing population, with people living with complex comorbidities, it is vital that the emphasis on prevention and not just cure is made a reality. We want to see people kept well, living in their community and staying out of hospital for longer. The focus should be on providing services that will target the sources of poor health and promote the health of the whole individual, as opposed to treating only acute illnesses. The Department of Health and Social Care (2018) has acknowledged that such a change in direction will require greater funding for pre-primary, primary and community care—as well as support for those staff who are working in those services.
Every nurse is a public health nurse. There can be no argument about the spirit of this initiative and each nurse should back this policy. We must assess the policy with its core messages and work with these. Having done this we must then hold the Government to account for further development and sustainability. Prevention is better than cure, true, but only if the preventive methodologies used are appropriate and robust. You cannot provide high-quality, community-focused public health on a shoestring. Without investment in public health this will become yet another well-intended piece of work that is destined to fail. To use another well-versed proverb, you have to put your money where your mouth is.