Promotion of healthy lifestyles and the prevention of ill health is a fundamental principle behind public health and improving the public's health. The phrase 'prevention is better than cure' is often attributed to the Dutch philosopher Desiderius Erasmus in around 1500. It is now a fundamental principle of modern health care and inherent within health and social care strategies across the UK (See: England, Northern Ireland, Scotland, Wales).
Prevention is about tackling the upstream causes of ill health, this in itself is not controversial. The challenge is how it is paid for. See: King's Fund - Prevention is better than cure, except when it comes to paying for it. The results are not easily defined; as numbers of people treated or where health has improved. It is not easy to see where illness has not happened.
The Department of Health and Social Care's Green Paper talks about the UK's rich history of focusing on prevention, from Edward Jenner's smallpox vaccine in 1796 to John Snow using data analytics to determine the cause of the cholera outbreak in 1854.
Nursing is essentially about providing quality evidence-based care and support to individuals and populations to improve health and well-being throughout life. In the past, public health has been seen as a niche specialty far removed from the typical image of nursing and only practiced by those with very specific qualifications.
Nursing and midwifery staff are now increasingly recognised as being important to improving the public's health and are instrumental in supporting this at an individual, community and population level. All nursing and midwifery staff are well placed to do this and need to embrace the contribution they can make to prevention. The ongoing challenge is having enough staff with the skills and time to make this essential contribution.
The RCN have been campaigning for many years for a greater focus on prevention with adequate funding. This is particularly pertinent in England, following the transfer of funding for public health to local authorities in 2012 and thereafter significant year on year cuts to local authority budgets. The 2019 spending review has announced a real terms increase to the public health grant, which we welcomed.
However, there remains little detail on the amount being suggested and it is likely that it will fall short of the amount needed to offset the years of cuts. Public health is also about more than health services; it needs to also consider the wider determinants of health, for example, education, transport and employment, which need to be addressed alongside health services in a more systematic way.
The RCN’s commitment is for a properly funded prevention strategy with a nursing workforce who are able to deliver this. The RCN have key alliances with a number of organisations to support lobbying on public health. For example we are members of the Alcohol Health Alliance who have recently called for £1 billion spent in tax to alcohol industry to be spent on funding 40,000 nurse vacancies. Also the Obesity Health Alliance and as such we have helped strengthen the case for stronger legislation on unhealthy foods.