The dangers to public health of a recession

The health and well-being of communities and individuals in the UK will not be immune from the effects of the evolving economic downturn in which we are now enmeshed writes Frank Atherton, the president of the Association of Directors of Public Health.

A recent policy workshop attended by directors of public health from across the UK mapped out some of the downturn's likely consequences on health, together with measures that could mitigate these effects.

The most immediate and pressing problems are likely to relate to increasing redundancies and a rise in unemployment. Being in work has a protective effect on physical and mental health.

As the number of people out of work rises inexorably past the two million mark, we can expect to see increased mental health problems. Health commissioners will wish to review their population's access to psychological therapies with a view to ramping up capacity to deal with a significant increase in presentations related to stress, anxiety and depression.

Undoubtedly, the relatively better off will cope with these straitened times better than their more deprived neighbours. The consequent increase in inequalities is likely to devalue current initiatives. Health secretary Alan Johnson, known to be robust in championing the inequalities cause, may need to promote further and stronger measures.

Wider effects

The NHS will not be alone in wondering whether the economic downturn will lead to backtracking on indicators we thought were generally moving in the right direction.

For example:

• The government's strategy to reduce the numbers on incapacity benefit may be undermined.
• Police and the criminal justice system are already reporting a rise in shoplifting incidents and it is likely that statistics related to household burglaries, alcohol-related crime, and domestic violence could all be heading in the wrong direction.
• Community safety partnerships (crime and disorder reduction partnerships) will need to keep a close view on the data and be ready to provide cross-agency support to preventive services and to assisting the victims of crime.
• Difficulties in meeting mortgage repayments are already translating into house repossessions with a consequent increase in the homeless population. Barack Obama's reported intention to place a 90-day moratorium on US house repossessions may be one that public health advocates would like to see replicated in the UK.

Cost-saving messages

National efforts to promote healthier lifestyles are threatened by unemployment and by the consequent reduction in household and personal spending.

Discretionary spending on health commodities such as gym membership is likely to fall. Whether this effect will be counterbalanced by a commensurate increase in active transport remains to be seen. Local partnerships may want to consider promoting active transport solutions such as walking and cycling on the basis of cost-saving rather than health promotion.

Similarly, a strengthening of the cost-saving stop-smoking message may mitigate any tendency towards increases in smoking.

Helping the vulnerable

Levels of fuel poverty are likely to be rising in the UK already, underlining the need for agencies to be particularly active in promoting campaigns such as Warm Front, which aims to protect vulnerable members of society from the additional morbidity and mortality which we see every winter in the UK and which disproportionately affects the elderly, the infirm and the poor.

Food standards

Supermarkets are already feeling the pressure of reduced footfall and shifting purchase patterns. Commercial entities are invariably quicker to respond than the public sector and most of us will have noticed a profusion of 'value brands' in major supermarket chains as they seek to stem a market shift towards 'pile 'em high and sell 'em cheap' retailers.

The Food Standards Agency is already undertaking important work to ensure these value brands do not carry higher than average unhealthy contents (such as saturated fat, added sugars and salt), but this is an issue on which it would be legitimate for all health organisations to lobby producers and retailers.

Alcohol concerns

The price of alcohol should be a continuing and deepening concern to policy makers and public sector organisations. The twin evils of binge drinking and social unrest, together with implications for chronic ill-health at ever younger ages, are likely to be further inflamed by price-cutting competition between retail outlets anxious to retain or expand their market share.

Focus on prevention

The Wanless message, that NHS costs will only be reduced with robust public health prevention programmes, has even more resonance with the possible spectre of a reduction in NHS funding. Funding for such programmes must not be sacrificed to shorter-term goals.

Unexpected benefits

Although the overall health impact on individuals and communities is likely to be negative, there may be paradoxical environment improvements. Forward thinking health organisations with an awareness of their carbon footprint may be able to capitalise on initiatives such as car sharing, flexible working and home working. This would be an excellent time for all organisations to review their transport and sustainability policies.

• This article first appeared in the Health Service Journal and is reproduced with kind permission.