Making the case for prevention

What public health interventions are value for money and reduce inequalities?

Over the past 160 years, we have witnessed the fastest improvements in mortality in the UK in history, with life expectancy almost doubling for men and women. Progress was driven initially by preventing childhood deaths and subsequently by the prevention of illness in older people. Prevention has also improved the quality of the lives we live by delaying chronic diseases until later life. Over the past ten years, improvements in life expectancy have stalled, although not equally across all parts of society.

Responsibility for prevention is spread across several different organisations in the UK, but a mainstay is through the Public Health Grant to Local Authorities. Previous research has already shown that the Public Health Grant represents good value for money, especially when compared to NHS spend or HM Treasury thresholds.

There is now a considerable evidence base demonstrating the effectiveness of public health and preventative interventions, but not all interventions are equally effective or costeffective. A granular approach is needed to disentangle the effects of different interventions, from smoking cessation to physical activity and sexual health services. Furthermore, public health interventions will impact health inequalities differently; some may inadvertently increase inequalities, whereas others may reduce the gap.

This report, commissioned by Cambridge Public Health for the Health Foundation, reviews the effectiveness and cost-effectiveness of public health interventions paid for by the Public Health Grant.

It identifies 134 public health interventions that were cost-effective.The largest group was smoking interventions (67), followed by physical activity (14), public health advice (diabetes and skin cancer prevention) (8), sexual health (8), children’s services (8), health at work interventions (8), air pollution (6), substance misuse (6), public mental health (5), domestic violence and abuse (2) and weight management (2).

Investment in prevention represents excellent value for money compared to health care spend or HM Treasury willingness to pay values, as long as the funds are used for the evidence-based interventions. As the country emerges from an inequalities-compounding pandemic, there is good evidence that specific public health interventions, such as smoking and domestic abuse activities, will reduce the health gap.