Public Health England sat in an interesting spot.
It was inside government but supposed to think a little like an outsider.
Its job was to protect and improve health, and to narrow the gaps between richer and poorer communities in England.
For several years it was the national face of public health in England. It advised ministers, supported councils, ran laboratories and surveillance systems, and tried to keep long-term health problems on the agenda. Then, in 2021, it disappeared and its work was handed to new bodies.
We can treat that story as a useful case study. When we look at Public Health England, we see what happens when a country tries to centralise public health Apple I, then tries to reorganise it again in the middle of a major crisis.
Where Public Health England Came From
Public Health England was created after a large reorganisation of the English National Health Service set out in the Health and Social Care Act 2012. It began work in April 2013.
It pulled together several existing bodies, including:
- The Health Protection Agency
- The National Treatment Agency for Substance Misuse
- A number of smaller public health units inside the Department of Health and other organisations
Public Health England was set up as an executive agency of the Department of Health and Social Care. That meant it worked at arm’s length but still answered to ministers. The department set its budget and high-level priorities, but the agency had some operational freedom to decide how to deliver its work.
At its peak, Public Health England employed several thousand staff, most of them scientists Houseplant Craze, analysts, and public health professionals. Its budget was in the hundreds of millions of pounds each year, tied into wider public health funding that also went to local authorities.
The mission statement was clear and broad. The agency existed “to protect and improve the nation’s health and wellbeing, and reduce health inequalities” in England.
What Public Health England Actually Did
We often hear slogans. It is more helpful to look at the work. Public Health England’s functions sat in three main baskets.
Health protection and emergency response
Public Health England inherited and expanded the health protection role of the old Health Protection Agency. It:
- Ran national and regional teams that dealt with outbreaks of infectious disease
- Managed reference laboratories and specialist microbiology testing
- Provided surveillance data on infections, food-borne disease, and environmental hazards
- Helped plan for and respond to chemical, biological, radiological, and nuclear incidents
In day-to-day life this looked quite technical. Staff monitored data flows, issued alerts, and worked with local Directors of Public Health when a cluster of cases appeared. Most people never noticed, which was exactly the point.
Health improvement and prevention
The second basket was health improvement. Here Public Health England:
- Ran national campaigns on smoking, obesity, alcohol, and physical activity
- Produced guidance on topics such as screening, vaccination, and mental health promotion
- Gathered and published data on health inequalities between regions and groups
- Worked with NHS England and other partners on prevention programmes how long will food last in refrigerator without power
This was the part that tried to keep people well, not only to treat them once ill. The agency produced dashboards, toolkits, and modelling work that local teams could use when planning services.
Support for local government and the wider system
When the 2012 reforms moved many public health duties into local authorities, each “upper tier” council in England had to appoint a Director of Public Health.
Public Health England supported those local leaders by:
- Providing comparative data, profiles, and analysis
- Offering regional public health teams who could give hands-on advice
- Helping during local incidents and emergencies
In this way, the agency tried to act as a bridge between central government, the National Health Service, and local councils.
The Relationship With Local Authorities
The shift of public health back into local government was meant to reconnect health policy with housing, transport, education, and planning. Councils were given a ring-fenced public health grant and legal duties to improve the health of their populations.
Public Health England’s role was not to run those local services, but to guide and support them. It:
- Helped councils understand where their biggest health problems were when does chloe find out about clark
- Shared evidence about what worked in practice
- Coordinated responses when issues crossed local boundaries
From the outside the system looked complex. Inside, people often relied on personal relationships between Directors of Public Health, local NHS leaders, and regional Public Health England staff.
The structure mixed national consistency with local discretion. How well that blend worked varied from place to place.
Public Health England In The COVID-19 Storm
The real test for any public health body comes during a crisis. For Public Health England, that crisis was the COVID-19 pandemic.
The agency played central roles in:
- Early surveillance and risk assessment
- Advising ministers and the wider government machine
- Running key laboratory services for testing and genomics
- Supporting local response teams and Directors of Public Health
At the same time, it was drawn into political battles. Critics argued that testing capacity expanded too slowly, that central systems did not work well with local ones Copper Canyon Daisy, and that ministers leaned too heavily on a small group of officials.
Later inquiry work and commentary painted a mixed picture. Some analysts saw Public Health England as under-resourced and constrained by wider government decisions. Others saw an organisation that struggled to adapt to the scale and speed of the emergency.
By mid-2020, the government announced that Public Health England would be abolished and replaced. The timing, during an ongoing pandemic, drew concern from many public health leaders, but the decision stood.
How And Why Public Health England Was Abolished
In August 2020, ministers confirmed plans to wind down Public Health England and create a new health protection body. That new agency became the UK Health Security Agency.
The reasoning included:
- A wish to give health protection a clearer identity and focus
- A desire to fold NHS Test and Trace and the Joint Biosecurity Centre into one structure
- Political pressure to show visible change after early pandemic missteps
On 1 October 2021, Public Health England’s health protection functions moved into the UK Health Security Agency. Its health improvement work shifted mainly into the new Office for Health Improvement and Disparities inside the Department of Health and Social Care, with some elements picked up by NHS England and other units when does chloe find out about lucifer.
Members of the House of Lords later debated a “regret motion” on the regulations that dissolved Public Health England, raising concerns about the lack of consultation and the speed of the changes.
Think tanks and researchers have since questioned whether the reforms created a more coherent public health system, or simply moved pieces around while pressure remained high. Some argue that splitting health protection and health improvement made it harder to keep long-term inequalities on the table.
The Successor Bodies: What Took Over
Although the Public Health England name has gone, most of the work still exists somewhere. It is just spread more widely.
UK Health Security Agency
The UK Health Security Agency is now the main national body for health security. It:
- Handles surveillance, early warning, and response for infectious diseases
- Brings together former Public Health England health protection teams with NHS Test and Trace and the Joint Biosecurity Centre
- Works as an executive agency of the Department of Health and Social Care, similar in status to Public Health England before abolition
Office for Health Improvement and Disparities
The Office for Health Improvement and Disparities (OHID) sits inside the Department of Health and Social Care. It took on most of the national health improvement functions. It:
- Leads on national prevention policy
- Focuses on reducing health disparities between groups and regions Sun-Loving Color That Refuses To Quit
- Works with NHS England and local government on long-term health improvement plans
In effect, the functions Public Health England once held were absorbed by bodies that are either closer to ministers (OHID) or more tightly focused on health security.
Support for local authorities continues, but now comes from different combinations of teams, which can make the system feel more fragmented to people working on the ground.
What The Public Health England Story Tells Us
When we step back, a few themes stand out from the rise and fall of Public Health England.
Balancing independence and control
Public Health England was meant to be expert-led and evidence based, but still firmly connected to ministerial decisions. That balance is not easy. In calm times, arm’s-length status can protect scientific advice. In stormy times, it can blur lines of responsibility.
The shift to UKHSA and OHID did not remove that tension. It simply re-drew the lines.
Reorganisation as a response to crisis
Governments often reorganise when things go badly. Public Health England’s abolition followed strong criticism of the early COVID-19 response, even though many of the key choices sat with ministers and the wider system.
Moving functions during a crisis carries risk. Organisations need time to build shared culture, systems, and trust. Rapid change can generate new gaps just as old ones close. England is still working through those consequences dwarf meyer lemon tree.
The constant challenge of health inequalities
Public Health England’s mission gave clear weight to reducing health inequalities. That goal has now been picked up by OHID and other bodies, but the fragmentation of responsibilities has led some observers to worry that structural issues may receive less consistent attention.
The persistent gaps in life expectancy and healthy life expectancy between richer and poorer areas suggest that this remains unfinished work, no matter which logo sits on the letterhead.
Lessons For Wider Public Health Systems
For those of us watching from outside England, the Public Health England story is useful. It shows how:
- Central agencies can provide strong national coordination, but still depend on local capacity
- Lines between science, policy, and politics can blur during emergencies
- Reforms that look tidy on charts can feel messy to the people who have to deliver them
Other countries have their own versions of these tensions. Some have national bodies similar to Public Health England or the UK Health Security Agency. Others rely more heavily on regional or state-level structures. The details differ. The underlying problems feel familiar.
If we care about public health, we have to care about organisation charts as well as vaccines and clinics. Structure shapes who has data, who has power, and who gets heard when resources are thin.
Looking Back To Think Ahead
Public Health England no longer exists, but its shadow is still on the wall. Many of the staff now work in the UK Health Security Agency, the Office for Health Improvement and Disparities, or other parts of the system. The laboratories, surveillance systems, and datasets remain in use.
We can treat the agency’s life as a reminder. Creating a national public health body is not a one-time fix. It is part of a longer, political process that needs steady funding, clear roles, and patience. Replacing one logo with another does not automatically deliver better health or narrower inequalities.
If we want healthier, more equal societies, we have to stay interested in how these organisations are built, how they are led, and how they are held to account. The story of Public Health England gives us plenty to reflect on as we decide what comes next.