Devolution of power, revolution in public health?

Katikireddi, Srinivasa Vittal and Smith, Katherine E and Stuckler, David and McKee, Martin (2017) Devolution of power, revolution in public health? Journal of Public Health, 39 (2). 241–247. ISSN 1741-3842

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    Abstract

    On 8 May 2015, the Conservative party won an unexpected majority in the UK general election.1 Commentators argued that a potentially decisive factor was concern in England about the Scottish National Party (SNP) forcing a minority Labour government to ‘dance to the SNP’s tune.’2 Meanwhile the SNP won a historic number of seats in Scotland, capturing 56 of the 59 Westminster constituencies. The election took place against a backdrop of debate about the future of the UK. Although the Scottish independence referendum was lost, it was widely agreed that the status quo no longer remained feasible. At the same time, there is pressure to revisit Welsh devolution3 and the Westminster government has proposed devolving certain powers to locally elected decision-makers in English regions.4 Meanwhile, the new Conservative government has committed to a referendum on continuing European Union membership, reflecting calls for ‘Brexit’.5 Although initially emanating from those on the right of the political spectrum, there is now some support from the left,6 making it a real possibility and likely to trigger a second Scottish referendum. One way or another, substantial political change is looming. If we conceive of ‘health’ as ‘health care’ (as many political scientists do), it could be argued that further devolution has little significance since responsibility for the NHS is already devolved to each national administration.7 Yet, most of the major determinants of population health and health inequalities lie outside the health system, often in areas for which responsibility has so far remained in Westminster.8,9 For example, macro-economic and welfare policies have large health impacts, potentially more so than health services and,10 while the relatively modest scale of devolution has not yet led to marked divergence in such policies, this looks set to change. We apply a political science framework focussing on ideas, interests and institutions to demonstrate potential opportunities and threats to public health arising from political change, so that researchers and practitioners can better engage with the political determinants of health.