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Reforming the public health system in England

Lookup NU author(s): Emeritus Professor David Hunter



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. The abolition of Public Health England (PHE) during the COVID-19 pandemic has raised concerns about the future of the public health system in the UK, particularly in England. The two new bodies established in haste to replace PHE prompt reflection on the executive agency's fate and the need to identify any lessons to ensure that a public health system is put in place that is fit for purpose. The UK COVID-19 Inquiry provides an opportunity to make recommendations, but it will need to act quickly to avoid recommendations being ignored. Two areas of concern are highlighted in this Viewpoint: the respective remits of the new bodies and their governance arrangements. Both issues demand urgent attention if the new structures are to succeed and avoid a similar fate to that which befell PHE. But underlying these concerns is a much larger challenge arising from the UK's broken political system. The political system in the UK suffers from several systemic weaknesses, including departmentalism, poor implementation, an inability or unwillingness of those in power to listen to the truth, and chronic short-termism at the expense of long-term planning. Overhauling the UK's dysfunctional political system is a prerequisite for successfully improving the public health system.

Publication metadata

Author(s): Hunter DJ, Littlejohns P, Weale A

Publication type: Review

Publication status: Published

Journal: The Lancet Public Health

Year: 2022

Volume: 7

Issue: 9

Pages: e797-e800

Print publication date: 01/09/2022

Online publication date: 31/08/2022

Acceptance date: 02/04/2018

ISSN (electronic): 2468-2667

Publisher: Elsevier Ltd


DOI: 10.1016/S2468-2667(22)00199-2