EDITOR, - Andrew Harris and Jonathan Shapiro's strident criticisms of the tunnel vision of the Abrams report are misplaced.^1,2 Their analysis shows naivety and a lack of understanding of the real imperatives in public health. The ire that they direct at the Abrams report - without any explanation to readers of what it recommends - is misdirected. Sadly, the narrow focus of the report is needed since the government has shown little legislative commitment to public health.

Moreover, local evidence suggests that mergers of district health authorities and family health services authorities, instead of strengthening public health, have in some cases resulted in a “rationalisation” and loss of public health resources in the name of economies of scale. But the authors' most glaring error is to have equated the public health function with the purchasing activity of district health authorities and family health services authorities. Have they forgotten that most health is gained or lost outside the NHS?

The authors should not let their personal views of public health physicians cloud the real issues about the importance of securing an independent public health voice for local populations. Our energies should be directed instead at developing local alliances to ensure that the real public health issues are still heard. When we have secured this let us argue about the qualifications for leadership in public health.

The Abrams report, while it missed an opportunity to recommend how local public health alliances might be strengthened, should not be held solely responsible for this omission. Its predecessor, the Acheson report, focused almost exclusively on the role of public health physicians.3 Neither report has helped health authorities to build strong, multidisciplinary links with either primary care or, more importantly, local authorities, whose services have a much greater impact on health than the NHS. …