The act's qualities of imagination and determination are still needed today

Editorial p 550 Recent advances p 584 Education and debate pp 587-98

The 1848 Public Health Act is 150 years old. Its context, origins, content, and compromises are extensively reviewed in this issue by Hamlin and Sheard (p 587).1 It was an exercise in effective politics, technically remarkably well informed, yet also an imaginative legislative attempt to deal with some still very current issues. How can the best technical public health competence be created in both the essential aspects of the public health discipline—knowledge and action? How can this technical competence be allied to effective combinations of central and local governance and administration? What is the role of law, and enforcement? How can the multisectoral content of public health be addressed? How can communities and individuals best be involved? How can private and corporate influences be brought on board? Above all, how can public health be made to count? These are formidable questions, yet the act shows what can be achieved with imagination and determination. We need to find these same qualities today if public health is to move centre stage.

There is no doubt that it needs to do so. Internationally health is improving, but not enough.2Although average life expectancy has been increasing throughout the 20th century, three out of four people in the least developed countries today are dying before the age of 50. Within Europe a …