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Public Health at the Crossroads: Achievements and Prospects; Making Sense of Public Health Medicine; Progress in Public Health

BMJ 1999; 318 doi: (Published 13 February 1999) Cite this as: BMJ 1999;318:472
  1. Max O Bachmann, senior lecturer in epidemiology and public health medicine.
  1. Department of Social Medicine, University of Bristol

    Public Health at the Crossroads: Achievements and Prospects

    Robert Beaglehole, Ruth Bonita

    Cambridge University Press, £17.95, pp 258

    ISBN 0 521 59373 X

    Making Sense of Public Health Medicine

    J Connelly, C Worth

    Radcliffe Medical Press, £17.50, pp 164

    ISBN 1 85775 1868

    Progress in Public Health

    Ed Gabriel Scally

    RSM Press, £19.99, pp 302

    ISBN 0 443 05938 1

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    Ed Gabriel Scally

    RSM Press, £19.99, pp 302

    ISBN 0 443 05938 1

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    Public health professionals perennially ponder the future and scope of their discipline, for good reasons. Their changing roles are largely determined by incessant reforms of the health sector, and their responsibilities are immodestly claimed to embrace anything relevant to the wellbeing of everyone. So are there any limits to, or at least priorities for, public health practitioners? Should they be involved in improving health care, or should they instead concentrate on improving income distribution, education, nutrition, and physical environments?

    Three books address these questions from different perspectives. Public Health at the Crossroadsprovides the broadest overview, reviewing the changing influences on global health, developments in epidemiology, and public health organisation in wealthy

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    and poor countries. Its inclusiveness is valuable, as are the data showing dramatic global trends and differences in health and the diverse country studies. Making Sense of Public Health Medicine, in contrast, focuses on the current preoccupations of public health physicians in the NHS. The authors are often refreshingly opinionated and critical, and they eclectically invoke different philosophical, historical, and political views to support their arguments. In Progress in Public Health leading UK writers review recent developments in subjects ranging from community development to small area statistics and from European integration to control of communicable diseases. The first book would be best for newcomers to public health and anyone wanting a summary of global health issues, the second for UK public health physicians and trainees, and the third for those wanting a more advanced update on UK research, practice, and ways of seeing.

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    Two revealing key words crop up repeatedly. The commonest is “challenge.” It is often unclear whether challenge means threat, difficulty, priority, opportunity, or duty, and this ambiguity suggests either sophistication or confusion. The other key word is “advocacy.” Beaglehole and Bonita, among others, believe that public health professionals should not be sucked into work on health care and should instead direct their energies into advocating a better and more equitable society. Sadly, the effectiveness of advocacy by public health professionals has yet to be shown. Surely, if a tiny number of marginal professionals want to change the world's economy, physical environment, and social ethos they need to know, on the one hand, their limitations and, on the other, how to maximise their political influence through organisations and alliances. Meanwhile, it should be recognised that power is where the money is—in healthcare organisations —and that harnessing and directing health care can help to prevent death and illness while saving money for more important things like jobs, education, and welfare.

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