Letters

Britain's first minister of public health

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7099.54 (Published 05 July 1997) Cite this as: BMJ 1997;315:54

National centre for public health is needed

  1. John Powles, University lecturer in public health medicinea,
  2. Nick Day, Professor of public healtha,
  3. Klim McPherson, Professor of public health epidemiologyb,
  4. Martin McKee, Professor of European public healthb,
  5. Tony McMichael, Professor of epidemiologyb,
  6. Iain Chalmers, Directorc,
  7. George Davey Smith, Professor of clinical epidemiologyd,
  8. John Gabbay, Professor of public health medicinee,
  9. David Marks, Professor of psychologyf,
  10. Imogen Sharp, Directorg,
  11. Richard Wilkinson, Visiting professorh,
  12. Michael Marmot, Professorh
  1. a Cambridge University, Cambridge CB2 2SR
  2. b London School of Hygiene and Tropical Medicine, London WC1E 7HT
  3. c UK Cochrane Centre, Oxford OX2 7LG
  4. d Bristol University, Bristol BS8 2PR
  5. e Southampton University, Southampton
  6. f Health Research Centre, Middlesex University
  7. g National Heart Forum, London WC1H 9LG
  8. h Centre for Health and Society, University College London
  9. i Faculty of Public Health Medicine, London NW1 4LB
  10. j Association for Public Health, London WC1H 9TX

    Editor—Like Noel Olsen, we welcome the appointment of a minister for public health1; structural and policy changes are clearly required to strengthen the effectiveness of public health. The broad policy options raised by Olsen should not, however, distract attention from the need to help existing public health services do a better job.

    “Public health” is too often identified with the activities of public health doctors, who now spend most of their time rationalising clinical services. Can a country with an unrivalled record in achieving value for money from its clinical services do no better in public health? National policy on prevention is greatly weakened in practice by the scant attention given to developing scientific and professional infrastructures commensurate with the difficulty of achieving goals that include, for example, mass behavioural change, although the NHS research and development programme clearly emphasises some aspects. The operational public health services use most of the public health pound as best they can. This generally means working in settings that are physically and professionally isolated, with limited scientific support and derisory opportunities for further education.

    Many scourges of the public's health are improving dramatically: coronary heart disease and stomach cancer, for example. Some, like …

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