For Debate: Public health 2020BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6962.1147 (Published 29 October 1994) Cite this as: BMJ 1994;309:1147
- S J Watkins
- District Offices, Stockport Health Authority, Stockport SK7 5AB.
- Accepted 11 October 1994
The aim of public health is to improve the health of people in communities and in populations (protection from environmental hazards and provision for health needs). The challenge for public health doctors is to re-establish public health leadership of communities, address social and environmental causes of ill health, and link with primary care (a) to improve the health of neighbourhoods and (b) to combine perspectives in commissioning services. Current threats derive from organisational philosophies. For example, focusing on market development does not allow for population based functions and so neglects the main influences on health. The way forward is a network model of organisation in which small teams collaborate with each other to the common good. For example, successful commissioning authorities would have the public health leadership of the director of public health and the support of the chief executive, treasurer, and representatives of primary care, including a medical adviser from the family health services authority.
Public health exists to improve the health of the people, firstly, by advising on the action communities can take to improve their health; secondly, by protecting populations from environmental and biological hazards; and, thirdly, by assessing populations' needs for health services.
I use the terms “communities” and “populations” distinctly. It is possible to assess the needs and protect the environment of, say, the population living in a square of the National Grid. But a community shares an identity, has a culture shaped by common media, and operates through common institutions and organisations. Public health doctors work on that identity and culture and those media, organisations, and institutions. They cannot do this for arbitrarily defined populations.
Improving health is more complex than other aspects of commissioning health care because it entails persuading other organisations to commit their resources or change how they carry out their …