In all the noise generated by the collapse of the NHS, you hear one refrain over and over again. The basic point is so obvious as to be almost banal: as the chaos deepens, it is a reminder not only of how much the health service has been underfunded and neglected, but of the UK’s deep problems with the questions of disease prevention, lifestyle and nutrition bundled up in the term public health. Doctors I have spoken to recently have explained the grim experience of seeing the same patients come in and out of their wards for years. We are all familiar with that litany of conditions that account for so many admissions – diabetes, heart disease, high blood pressure – and the fact that they are often rooted in obesity, sedentary ways of living, bad diets and all the rest. Behind older people’s falls and fractures, moreover, lie many of the same factors. Once again, the necessity of a more preventive approach to health is screamingly clear, but what it might mean in practice is still largely a mystery. Clearly, this is a country that needs to get better at looking after itself. But while glaring facts about the intersection of poverty and ill health are serially ignored, public health is also hindered and damaged by a dismal failure to join up one area of policy with another. If you want particularly vivid proof of that very British syndrome, try this: as hospitals break and buckle, local leisure centres and swimming pools are also in the midst of crisis. Piece through the news archives, and there it all is: recent closures in such places as Huddersfield, Milton Keynes, Rye in East Sussex, Coventry and Hull. In Gateshead, people are waiting for a council decision about two big leisure centres, which could spell the end of pools, gyms and squash courts. One high-profile local doctor recently nailed what is at stake: “Take a poor area with massive health inequalities. Remove the last remaining public exercise facilities from the poorest bits of said poor areas. Watch what happens to health. It’s an experiment that the people of Gateshead don’t deserve to be a part of.” In many cases, the heating bills for public pools have tripled. Last week, the government announced its new energy bills discount scheme, which will last for a year and have two levels of financial help for businesses, charities and the public sector. The most generous tier is reserved for “energy and trade-intensive industries”. Museums, libraries and even “botanical and zoological gardens and nature reserve activities” are on the list, but pools and leisure centres have been excluded. As the national governing body Swim England sees it, that is a “hammer blow” that “flies in the face of previous statements from the government about the importance of physical activity and reducing pressures on the NHS”. There is a longer story here. Lots of pools and sports centres were built from the 1960s onwards. Swim England puts the average life of a public swimming pool at 38 years, which means that large numbers of local facilities are now in a state of decay. As with so many things, the mess bears the fingerprints of George Osborne: because local public spending was so slashed in the mad frenzies of post-2010 austerity, they have been neither refurbished nor replaced – and unless something changes, by 2030 the number of pools in England threatens to fall by more than 40%. To make things even worse, the pandemic blew a huge hole in councils’ leisure budgets that has yet to be mended. The result is a burgeoning tragedy. Swimming is a basic human skill that everyone ought to have, and a perfect way of keeping fit and sharing the company of others. Public pools usually work with schools to provide swimming lessons. But a quarter of the children who left primary school in England in 2022 were unable to swim 25 metres, and that deficit threatens to be passed on: as the former Olympic swimmer Greg Whyte recently put it, “Non-swimming children become non-swimming adults … and non-swimming parents have non-swimming children.” Beyond that lies a whole range of stuff, much of it directly tied to health provision: my mum, for example, has a heart pacemaker, and is part of an organised group of older people who meet at their local leisure centre once a week and use the gym. Amid closed-down libraries and community centres, what we often think of as sports facilities are also a central part of communities’ remaining defences against isolation and loneliness. If they shut, what remains? There is a small but vital part of this story that is too often ignored: rural places that have outdoor pools, which are often the only spaces for exercise and recreation left. There is a cluster of examples in and around Dartmoor – such as the small Devon town of Buckfastleigh, where child poverty runs at 30%, and the local pool has been in existence for 125 years. Three local primary schools use the pool for swimming lessons. It is fully open between May and September, but at this time of year it offers cold-water swimming on Sundays. In 2019, its annual energy bill came in at about £8,000. It is now £26,000, and looks set to rise to as much as £34,000. The hole in its running costs currently stands at £20,000. Last week, I spoke to Pam Barrett, one of the key people who keeps the pool in business. “It’s our last standing leisure facility,” she said. “We’ve got football and rugby clubs for fit young men, but what about everyone else? For women, kids, disabled people, older people, it’s the pool. This is it.” Exactly the same applies to other outdoor pools not far away, in such places as Chagford, Moretonhampstead, Ashburton and Bovey Tracey. “We’re really, really worried,” Barrett told me. “I have no idea how we’re going to find that £20,000 a year. How can we sustain the fundraising?” There are some obvious answers to the pool’s predicament, which also apply to much bigger local assets: changes to the tax arrangements that cover pools and sports centres, ringfenced increases in the money that goes from central government to councils, and an urgent placing of the places where we exercise at the highest level of help with energy costs. In their absence, this story will only continue to fester: one more blow to the flimsy fantasy of levelling up, and further proof of our current national condition – sickness and chaos in all those wards and surgeries, and at the top a quite terrifying stupidity. John Harris is a Guardian columnist