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Neglect of public health has led to current crisis | Letters

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Polly Toynbee is right to highlight the chaos for public health caused by the 2012 health reforms (The lesson of lockdown 2: never again run-down England’s public health defences, 3 November). Moving public health into local government was not in itself the problem – many of our improvements in public health have been down to local councils. The problem is this was done in a confused way and without adequate funding. For the two-tier local authorities, public health was moved into the upper tier, whereas much work is done at the lower level, closer to communities. In particular, environmental health officers (EHOs) often became marginalised, and yet they could have been effective in local contact tracing and able to get essential messages out to those who can be hard to reach.

EHOs could also have been used better to ensure businesses operate as “Covid safe”. In New South Wales, Australia, certain businesses have to be registered as such before they can operate. In New Zealand, local authority EHOs throughout the country were involved with contact tracing and helped at the borders with incoming passenger surveillance. These examples have not been followed in England.

Environmental health in local government has been an easy area to cut over the past 10 years, and all too often EHOs have been seen as just “regulators” which, in an era of red-tape cutting, is not a good way to be seen and has contributed to the present situation.
Dr Stephen Battersby
Chartered environmental health practitioner (retired); vice-president, Chartered Institute of Environmental Health

• Polly Toynbee is absolutely right to emphasise the urgent priority to establish an integrated public health system for England. The Lansley reforms resulted in damaging disruption at national, regional and local levels.

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At the same time, we should acknowledge the role played by many local directors of public health during the pandemic. They have demonstrated how to work with local communities and partners across health and local government, interpreting the science and building local understanding. This was all in the best traditions of public health, and an excellent foundation for a future service which must be explicitly public rather than private.

Better to work with this experience than impose Dido Harding, plus management consultants. Then we can create a public health service able to combat future threats and tackle the stark health inequalities that the pandemic has revealed.
Sheila Adam
Staveley, Cumbria

• As Polly Toynbee’s article indicates, it is the systemic underfunding of public health under recent Conservative governments that has caused the current shortage of beds and staff. It is poetic justice that it is this that has forced Boris Johnson’s government to apply forms of state intervention that the right wing of the Tory party finds so abhorrent.

And, of course, the underfunding was driven by the financial crisis caused by deregulation initiated by Margaret Thatcher. Many chickens are coming home to roost.
Tony Watts
Cambridge

• I was surprised that Polly Toynbee didn’t mention the principal message associated with the major HIV public health campaign mounted by the Thatcher government in the 80s. “Don’t die of ignorance” is only one word longer than the favoured three-word slogans of the present administration, but is a fine rebuttal to the “world-beating” nonsense emerging from the mouths of such reputable epidemiologists as Graham Brady, John Redwood and Iain Duncan Smith (The lockdown rebels preparing to defy No 10 on Covid restrictions, 2 November).
Les Bright
Exeter, Devon



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