イギリスの資金削減と公衆衛生

タイトル: Inequalities in local funding cuts to environmental and regulatory service expenditure in England from 2009 to 2020

概要: BackgroundLocal authorities have been subject to substantial reductions in funding, placing strain on local services. Environmental and Regulatory (ER) services provide essential functions including infectious disease prevention and control via Food Safety and Animal and Public Health Infectious Disease Control services (APHIDC). This study investigates inequalities in local funding cuts to these services. MethodsWe used a generalised estimating equation model to estimate the annual percent change of ER service expenditure between 2009/10 and 2020/21 in addition to Food Safety and APHIDC expenditure change overall, and as a share of total ER expenditure. Models analysed trends by deprivation level, local authority structure and population density. ResultsAreas of higher deprivation had the largest reduction in expenditure, with ER and Food Safety and APHIDC cuts of 2% and of 23% respectively, compared to a 1% and 8% reduction in the least deprived areas. The share of ER expenditure spent on Food Safety and APHIDC decreased by 13% in the most deprived authorities compared to 6% in the least deprived areas. Environmental and Regulatory services saw the largest cuts in unitary authorities, declining by 2%. London boroughs had the greatest reductions in Food Safety and APHIDC expenditure, decreasing by 10%. Both ER and Food Safety and APHIDC expenditure decreased with increasing population density. ConclusionThe unequal distribution of cuts shows the need for increased and equitable investment into these services to enable resilience to emerging infectious disease threats, and to prevent widening of health inequalities. Key MessagesO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIAusterity measures have led to substantial reductions in local funding placing increased pressure on local authority services in England, research shows reductions vary by deprivation level of an area, rural - urban classification and local authority structure. C_LIO_LIIt is unknown how local funding cuts to Environmental and Regulatory services, which provide essential services for public health protection, vary by these characteristics. C_LI What this study addsO_LIWe investigate inequalities in austerity-enforced changes in Environmental and Regulatory service expenditure and sub-spending lines of Food Safety and Animal and Public Health Infectious Disease Control over time by deprivation, local authority structure and population density from 2009/10 to 2020/21. C_LIO_LIThe largest cuts were in the more deprived areas and with increased population density for both Environmental and Regulatory and Food safety and Animal and Public Health Infectious Disease Control services. The largest cuts in Environmental and Regulatory services were seen in unitary authorities whereas Food safety and Animal and Public Health Infectious Disease Control saw largest cuts in London boroughs. C_LI How this study might affect research, practice or policyO_LIThis research provides strong evidence of inequalities in local authority service expenditure in Environmental and Regulatory services and highlights where investment should be focused, in order to protect environmental and public health. C_LI