This country has had a long history of response to threats to public health, from Snow's cholera-infected Soho pump in 1854 onwards. We had local boards of health, and medical officers of health, one for each local government area. They ensured that adequate provision was made for burials, clean water, sewers and other public health infrastructure - but above all they were the nation's first line of defence against epidemics. Cholera, Typhoid, TB, Diphtheria. Being 'modern' is no defence against zoonotic or parasitic epidemics - as this paper, describing the challenges to public health post-1945 in Germany, describes -
... the following years were characterized by deficiencies of hygiene which had not occurred previously in Middle Europe during the 20th century. There were focuses of typhus, typhoid fever, tuberculosis, diphtheria, scarlet fever, and meningitis. Insufficiencies in the removal of faeces caused high incidences of shigellosis, hepatitis A, and ascariasis. As a result of insufficient body care, many people were infested with fleas, lice and scabies. The migration of large proportions of the population resulted in an increasing prevalence of syphilis an gonorrhea.Our experiences in liberated Europe renewed our commitment to local public health, and a generation of Medical Corps officers who dealt with these conditions at first hand moved into environmental and public health positions in local government. For many years we benefited from their experience. The Guardian takes up the story from this point;
The system of local communicable disease control was established in the 19th century. After the NHS was set up in 1948, it was supported in England and Wales by national, regional and more than 40 local public health laboratories. But since local medical officers of health were abolished in 1974 – replaced by community physicians at different levels of the NHS – the system has been gradually but relentlessly eroded, fragmented and centralised.The woeful failures of Public Health England, which we have catalogued, are not the only consequences of woke centralisation. PHE effectively abandoned their responsibilities for epidemic control, implemented an unworkable and ineffective central system and concentrated their resources on the faddish obsessions of the middle-class woke well - smoking, alcohol and sugar. As the authors of that Guardian piece also point out, the concentration on NHS 111 - telephone helplines that simply collapsed under the weight of hundreds of thousands of anxious callers - left local GPs with direct local knowledge completely unused.
Communicable disease control was centralised in the Health Protection Agency in 2003, and local public health laboratories transferred to NHS hospitals. Public health was then carved out of the NHS in England in the 2012 Health and Social Care Act, which abolished local area health bodies, created Public Health England to fulfil the government’s duty to protect the public from disease and charged local authorities with improving public health – but with limited proactive scope for infectious disease control and woefully inadequate resources.
The utter abandonment of their key responsibilities has not been the only negligent direction that PHE has taken. As John Ashton reported to the Telegraph, PHE officials have run up 5.1 million air miles over the past 3 years on 'the global health security agenda'. It's easy to see what's happened. They've utterly neglected their fundamental local public health responsibilities in favour of quasi-academic junkets to Florida or Singapore, business class travel and international hotels on the public purse, when they should have had their heads down sewer-covers in Birmingham. As Ashton, a former Director of Public Health, comments carefully "PHE's time would have been better spent ensuring testing facilities were up to scratch throughout the country" he said. "It's been inadequate and they have failed to catch up with themselves even when it was shown to be inadequate," he told The Telegraph.
We must keep pushing the absolute necessity for localisation and decentralisation. We must keep exposing the manifold failures of the central Whitehall machine. They are costing lives.
|Levels of TB in London greater than Iraq, Ethiopia or Afghanistan are a damning public health indictment|