Cumberland Council's Colin Cox on shaping the future of public health

The pressures on the NHS, already strained by the legacy of Covid, grow as people are becoming unhealthier in later life, with some dying before retirement.

For Colin Cox, director of public health at Cumberland Council, the key is preventative care, keeping people healthy as they age, and tackling root societal causes of ill health – attacking the cause rather than simply the symptom.

From declining life expectancy and a rapidly ageing population to the rise in mental health conditions, Mr Cox is navigating complex terrain.

He believes the healthcare system must shift from a reactive model to one focused on prevention and public engagement.

His work, alongside council initiatives like the ‘Live Longer Better’ programme, shows an adaptation towards advocating for helping people take control of their health while ensuring services are equipped to meet the evolving demands of today’s society.

Life expectancy at birth, after steadily rising for decades, has started to decline, but it's the fall in healthy life expectancy that concerns him most, he said.

"Healthy life expectancy at birth is now less than the retirement age, so we’re at a point where people aren’t expecting to retire in good health."

The ramifications of this are significant.

As the population ages, the strain on health services grows.

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"With all the massive challenges facing services, many of which are created by our significantly ageing population, it’s important we work to keep people healthy as they get older," Mr Cox said.

"Supporting them into a healthy older age is crucial for their well-being."

This growing pressure on health services is exacerbated by rising multimorbidity, where individuals suffer from several chronic conditions simultaneously.

Obesity, poor diet, diabetes, and high blood pressure are just a few of the factors contributing to a population in increasingly poor health.

Mental health, too, has become a major concern in recent years, with changing patterns of distress and anxiety.

Mr Cox said a change in mental health patterns and people’s perspectives on it are changing significantly.

This is important, but it raises questions about the best ways to address mental health issues, he said.

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"We need to reassess our services, as they are currently geared towards supporting people when they are unwell, but not towards preventing illness in the first place," he explained, adding that the Live Longer Better programme aims to get older people to stay physically active to improve health.

He said: “This is important for maintaining physical health, and mental well-being, and preventing issues like bone health deterioration, cardiovascular disease, and falls.”

But despite these efforts, there is still much to be done to support healthy ageing, and Mr Cox believes the public has a role to play in their health.

"We need a partnership with the public because people have responsibilities to look after themselves.

"It’s not just about the NHS fixing things when they go wrong.

“People need to take action to support their own health."

As the demand for NHS services continues to rise, difficult decisions are being made about how the system should respond.

"As demand rises, the threshold for NHS action inevitably changes.

"Without increasing capacity to meet rising demand, the NHS will focus more on serious cases, a trend we’ve seen over many years.

“This has diverted attention from preventative services, but ironically, when preventative care is neglected, the demand for urgent care grows."

How the NHS tackles this problem with limited funding is a huge challenge.

"Tough decisions will have to be made about what the NHS can and cannot do for people," Mr Cox warned.

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A particularly educational time for all in public service was the Covid pandemic, which Mr Cox described as a ‘major crisis’ but which resulted in a greater understanding of the good that can be achieved when everyone pools resources to solve problems, ‘incredible things can happen’.

He remains cautiously optimistic about the UK's preparedness for future pandemics.

He has previously published a report following the national Covid inquiry on the need to learn from government failings.

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The inquiry revealed that the UK had prepared for the wrong type of pandemic, a sentiment Mr Cox echoed for Cumbria, which followed national guidelines designed for an influenza pandemic.

He noted that local and national plans did not account for measures like masking or lockdowns.

"We’ve had pandemics fairly regularly over the last few decades, but none as severe as Covid since the Spanish flu," he explained.

"There was a tendency to forget how serious pandemics can be, but now more people understand what it takes to respond."

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A potential future health threat, Mpox, has also come into the spotlight, but Mr Cox is clear that it won’t be ‘another Covid’.

"Mpox doesn’t spread nearly as easily as Covid or flu.

"Although it has a higher mortality rate, it requires much closer contact to spread,” he said.

The nation’s health system is much better prepared to deal with something like this, comparing it to Ebola which, though featuring a greater mortality rate when contracted, had a lower infection rate and was easier to contain.

Preparedness can also affect how we address rising demand for mental health treatments.

In his annual report, Mr Cox placed great emphasis on mental health and neurodiversity in the Cumberland Council area, and questioned whether the current model of treatment is the most effective.

"We’ve seen a rise in demand for mental health and neurodiversity services.

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“It’s important to recognise the distress people are experiencing, but I also question whether the medical model is necessarily the right one for addressing mental health.

“We’re seeing such a large rise in people seeking support for mental health problems and the pace of rising demand is so quick that it must be driven by social factors.”

Helping patients understand the root cause of their mental ill-health, such as poverty or abuse, and how to counter those, would be more prudent, pointing to the phenomenon of children experiencing ‘climate anxiety’ as an example.

“It’s perfectly reasonable to be anxious about the future of the planet, but instead of treating it as a mental health condition, we should be addressing climate change itself."

This would ultimately be more effective than prescribing antidepressants which provide a brief, temporary fix to the surface level symptom.

"I’m not against the use of antidepressants - they can help people overcome initial challenges - but they aren’t a long-term solution.

"The distress people feel is real, but the solutions we offer often don’t address the underlying problems."

A similar approach might be taken to obesity which has also risen, including among children.

While the government has proposed a ban on junk food adverts before 9pm, more could be done.

“Junk food advertising bans are helpful but insufficient.

“The root problem is that our society and economy are stacked against people.

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"The food system is designed to sell unhealthy products because that’s where the money is."

In his view, large commercial interests that profit from unhealthy food need to be held accountable.

Broader reforms to the food environment, such as the sugar tax, are necessary to encourage healthier choices, he said.

As Cumberland faces these public health challenges, Cox remains focused on giving people a sense of control over their own health.

"We need to engage the public in discussions about what it means to be healthy, and what they can do to support themselves," he says.

Finally, Mr Cox also said he sees the potential for public health improvements through devolution, as the government continues to explore handing more power to local authorities.

"This government, and the previous one, have been keen on devolving powers from Westminster to local areas, and I think there’s a lot of scope for that.

“Doing things more locally is generally a better idea."

As the healthcare landscape continues to evolve, the focus on prevention, public engagement, and addressing root causes will be key to ensuring a healthier future for all.

“That sense of giving people a sense of control over their own health and well-being, and that there are things people can do to support themselves, is going to be important for the future."