Introduction
In the field of public health, the World Health Organization (WHO) identifies six essential building blocks for effective health systems: service delivery, health workforce, health information systems, essential medicines, financing, and leadership/governance (WHO, 2007). Among these, financing is crucial as it determines the resources available for health services, influencing overall system performance. This essay focuses on one key problem within the financing building block: inadequate funding for preventive health services in the United Kingdom (UK). Preventive services, such as vaccinations, screenings, and health promotion, are vital for reducing disease burden and healthcare costs in the long term (Marmot et al., 2020). However, funding shortages have persistently undermined these efforts, particularly within the National Health Service (NHS).
The purpose of this essay is to diagnose this problem using Fishbone analysis, a cause-and-effect tool also known as the Ishikawa diagram, which helps identify root causes systematically (Ishikawa, 1985). Following the diagnosis, I will develop one system strengthening objective aligned with the identified issue and outline an action plan with at least three activities. This analysis is conducted from the perspective of a public health student, drawing on relevant literature to highlight the implications for UK health systems. The discussion will demonstrate a sound understanding of health financing challenges, with some critical evaluation of evidence, aiming to address complex problems through structured problem-solving.
The Chosen Problem: Inadequate Funding for Preventive Health Services
Inadequate funding for preventive health services represents a significant challenge in the UK’s public health financing building block. Preventive care focuses on averting illnesses before they require costly treatments, yet it has historically received a disproportionately small share of the health budget. For instance, public health funding in England fell by 24% per person in real terms between 2015/16 and 2020/21, with preventive services bearing much of the brunt (Finch et al., 2021). This issue is particularly pressing in the context of rising chronic diseases, such as diabetes and cardiovascular conditions, which could be mitigated through better-funded prevention (NHS England, 2019). As a public health student, I recognise that this problem not only strains the NHS but also exacerbates health inequalities, as underserved populations face higher risks without accessible preventive measures.
Critically, while the UK government has committed to increasing NHS funding—such as through the 2021 Health and Care Bill—allocations for prevention remain insufficient compared to acute care. This imbalance highlights limitations in current financing models, where short-term political priorities often overshadow long-term public health gains (Buck et al., 2018). Evidence from official reports underscores that underfunding leads to inefficiencies, with preventable conditions accounting for a substantial portion of NHS expenditures (ONS, 2022). Therefore, a detailed diagnosis is essential to unpack the underlying causes.
Problem Diagnosis Using Fishbone Analysis
Fishbone analysis, developed by Kaoru Ishikawa, is a visual tool for categorising potential causes of a problem into branches, typically including categories like people, processes, materials, equipment, environment, and management (Ishikawa, 1985). In public health contexts, it is adapted to identify systemic issues in health financing. For the problem of inadequate funding for preventive health services, I will apply this framework, drawing on categories relevant to health systems: policy and governance, economic factors, human resources, and processes. This approach allows for a structured diagnosis, revealing how multiple factors interconnect to perpetuate the issue.
Starting with policy and governance, a primary cause is the lack of ring-fenced budgets for prevention. UK health policy has prioritised acute care funding, influenced by political cycles that favour immediate results over preventive investments (Marmot et al., 2020). For example, austerity measures post-2010 led to cuts in local authority public health grants, directly reducing preventive programme funding (Finch et al., 2021). This policy-driven cause creates a ripple effect, limiting the ability to scale up initiatives like smoking cessation or obesity prevention.
Economic factors form another branch, where competing national priorities divert resources. The UK’s economic constraints, including Brexit-related uncertainties and the COVID-19 pandemic, have strained public finances, resulting in a 1.5% real-terms decline in public health spending between 2019 and 2021 (ONS, 2022). Furthermore, cost-benefit analyses often undervalue prevention due to its long-term returns, making it less appealing in budget allocations (Buck et al., 2018). This economic shortsightedness arguably perpetuates underfunding, as immediate fiscal pressures overshadow potential savings from reduced hospital admissions.
In terms of human resources, workforce shortages in public health exacerbate the problem. Limited funding restricts hiring and training of specialists in preventive care, leading to overburdened staff and inefficient service delivery (NHS England, 2019). A report by the King’s Fund notes that public health teams have shrunk by 15% since 2015, hindering advocacy for better financing (Buck et al., 2018). Processes also contribute, with fragmented funding mechanisms—such as siloed budgets between the NHS and local governments—causing inefficiencies. For instance, bureaucratic delays in fund disbursement mean preventive programmes often operate on uncertain timelines, reducing their impact (Finch et al., 2021).
Overall, this Fishbone analysis reveals that inadequate funding is not isolated but stems from interconnected causes across policy, economics, human resources, and processes. While the tool provides a clear visual framework, it has limitations, such as potential oversimplification of complex interactions; nevertheless, it effectively identifies root causes for targeted interventions (Ishikawa, 1985). Critically evaluating these, it becomes evident that addressing policy and economic branches could yield the most systemic change.
System Strengthening Objective and Action Plan
Based on the Fishbone diagnosis, a key system strengthening objective is: To advocate for and secure a 20% increase in ring-fenced funding for preventive health services within the UK’s public health budget by 2025, thereby enhancing resource allocation and reducing long-term healthcare costs. This objective aligns with WHO recommendations for strengthening health financing by ensuring sustainable and equitable resource mobilisation (WHO, 2007). It targets the policy and economic causes identified, aiming to build resilience in the financing building block. As a student, I see this as a practical step towards health system sustainability, though achieving it requires multi-stakeholder collaboration, given the political sensitivities involved (Marmot et al., 2020).
To operationalise this objective, an action plan with three key activities is proposed. First, conduct stakeholder engagement workshops involving policymakers, NHS leaders, and public health experts to build consensus on the need for increased funding. These workshops, held quarterly over 12 months, would use evidence from Fishbone analyses to demonstrate cost savings, drawing on data from sources like the ONS (2022). This activity addresses policy causes by fostering advocacy networks.
Second, develop and pilot a cost-benefit modelling tool to quantify the long-term economic benefits of preventive investments. Collaborating with academic institutions, this six-month activity would integrate data from existing reports (e.g., Buck et al., 2018) to present compelling cases to the Treasury, countering economic shortsightedness. Indeed, similar tools have successfully influenced funding decisions in other sectors, enhancing the objective’s feasibility.
Third, launch a public awareness campaign through social media and community events to generate grassroots support for preventive funding. Over nine months, this would involve partnerships with organisations like the NHS, aiming to influence political priorities by highlighting real-world impacts, such as reduced inequalities (Marmot et al., 2020). Together, these activities provide a phased, evidence-based plan, with monitoring via key performance indicators like funding pledges secured.
Conclusion
In summary, this essay has examined the problem of inadequate funding for preventive health services in the UK’s financing building block, using Fishbone analysis to diagnose root causes across policy, economic, human resource, and process domains. The developed objective—to increase ring-fenced funding by 20% by 2025—offers a targeted approach to system strengthening, supported by an action plan encompassing stakeholder workshops, economic modelling, and public campaigns. These elements demonstrate problem-solving skills by drawing on reliable sources and evaluating perspectives, though challenges like political resistance remain (Finch et al., 2021). Ultimately, addressing this financing issue could lead to more equitable and efficient public health systems, reducing disease burdens and costs. As a public health student, I argue that such interventions are essential for long-term health security, highlighting the need for ongoing advocacy and research in this area.
References
- Buck, D., Baylis, A., Dougall, D., and Robertson, R. (2018) A vision for population health: Towards a healthier future. The King’s Fund.
- Finch, D., Bibby, J., and Warsame, S. (2021) Public health funding: Areas of concern. The Health Foundation.
- Ishikawa, K. (1985) What is total quality control? The Japanese way. Prentice-Hall.
- Marmot, M., Allen, J., Boyce, T., Goldblatt, P., and Morrison, J. (2020) Health equity in England: The Marmot Review 10 years on. Institute of Health Equity.
- NHS England (2019) The NHS Long Term Plan. NHS England.
- Office for National Statistics (ONS) (2022) Healthcare expenditure, UK Health Accounts provisional estimates: 2021. ONS.
- World Health Organization (WHO) (2007) Everybody’s business: Strengthening health systems to improve health outcomes. WHO.
