What is prevention? Defining HEG’s role in a changing public health landscape

As health systems across the UK face the mounting pressure of rising demand, persistent inequalities, and an ageing population, there is renewed urgency around prevention. Prevention is not new. But how we understand, deliver, and account for it must evolve. In this context, Health Equalities Group (HEG) is reaffirming its role as a trusted, locally grounded partner for systems seeking to address avoidable illness and the wider conditions that drive poor health.

In public health, prevention is typically described in four domains: primordial (addressing structural and environmental determinants), primary (reducing disease incidence), secondary (early identification), and tertiary (managing long-term conditions). But the practice of prevention often drifts into narrow, downstream interventions. Efforts to reduce risk too frequently translate into individual behaviour change programmes, obscuring the structural conditions that shape people’s choices and lives. At HEG, we advocate for a broader, more integrated approach. We understand prevention not only as a technical function, but as a political and strategic commitment to health equity.

That commitment means challenging the “right drift” in public investment, the slow but steady movement of funding and workforce capacity toward acute care and away from community services and preventative policies. It also means resisting “lifestyle drift”, where stated ambitions to tackle the social determinants of health gradually narrow into messaging about personal responsibility. To achieve a sustainable NHS, to narrow the health gap, and to deliver on the promise of the left shift, we must invest differently.

As a third sector organisation, we’re able to work across services and sectors, often stepping into spaces where system responsibilities are unclear or capacity is stretched. This flexibility allows us to support integration, connect workstreams, and respond to local priorities with a level of speed and coordination that can be harder to achieve within more formal structures. We use this position to help connect people and ideas, supporting local authorities, Integrated Care Systems and Primary Care Networks to deliver prevention in a way that reflects the strengths and pressures at place level.

HEG’s contribution to prevention lies in helping local systems turn ambition into action. We work with partners to develop frameworks that support the integration of public health into core functions, embedding prevention into planning, commissioning, service design, and workforce activity. Our approach is grounded in local context but aligned with national priorities, supporting a shift toward health-in-all-policies thinking and making prevention a more visible, routine part of how organisations and systems work.

We recognise that national strategies increasingly call for earlier intervention and stronger cross-sector collaboration. But we also understand the realities of delivery: tight budgets, shifting policies, and short planning cycles. That’s why our work focuses on practical, adaptable approaches that can be implemented at pace, while helping systems embed prevention into day-to-day practice and shift from reactive delivery to longer-term change.

The prevention agenda cannot succeed through rhetoric alone. It must be delivered through partnerships that are practical, credible, and grounded in the realities of local systems. Turning the ambition for prevention into action demands more than policy statements: it requires long-term thinking, collaboration, and a focus on what works in context. We welcome the opportunity to work with commissioners and system leaders to develop approaches that are realistic, proportionate, and focused on achieving equitable health outcomes.

For more information about our programmes of work, please click here.