What principles ought to underpin ‘Radical Prevention Funds’? Ten principles capable of addressing social determinants to promote public health

The UK Government has increasingly concluded that ‘prevention is better than cure’ on the basis that preventive health interventions are more cost-effective than reactive services in delivering additional years in good health for the population. However, UK health and care systems are under intense financial pressure that preclude their shifting resources upstream to address social determinants of health. A separate Radical Prevention Fund (RPF) that supports such upstream interventions by addressing social determinants has been developed by UK Mayoral Combined Authorities as part of a package of long-term reform. This article sets out 10 principles to shape the use of such funds that lack, at present, cogent interpretation and coherent design. In place of inequality promoting and health damaging Rawlsian approaches, we assert a consequentialist approach that upholds the lexical priority of an equality principle instrumentally before setting out a series of interpersonal, institutional and geographical foci that are critical to achieving better outcomes in public health. We draw on a growing body of evidence on means of addressing social determinants to suggest that this may well mean, for example, providing money directly to those who need it rather than a more politically palatable, but less effective, service that only partially mitigates negative effects of an issue over an extended period. In this way, we ensure that an RPF is necessarily radical and preventive.