Education And Debate For and against

Public health does not need to be led by doctorsForAgainst

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7302.1593 (Published 30 June 2001) Cite this as: BMJ 2001;322:1593

Public health does not need to be led by doctors

For years lead positions in public health have been restricted to those with a medical background, and it is still impossible for individuals to be accredited as specialists in public health without medical training. But does such exclusivity have repercussions? Here a professor of epidemiology and two directors of public health present their views.

For

  1. Klim McPherson, professor of public health epidemiology ([email protected])
  1. Cancer and Public Health Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. a Shetland Health Board, Brevik House, Lerwick, Shetland ZE1 0TG
  3. b Gwent Health Authority, Mamhilad Park Estate, Pontypool, Gwent NP4 0YP

    Public health is the science and art of promoting, protecting, and improving health and wellbeing through organised efforts of society.1 It encompasses all influences throughout life and, because the diversity is crucial, must be multidisciplinary.2 Whether medical training enables unique qualities for leadership in public health is certainly plausible but unproved, and justifications have so far been little more than special pleading. Public health in the United Kingdom is, and has been, led by many people from several core disciplines: Chadwick, Chalmers, Cochrane, Day, Davey Smith, Doll, Farr, Greenwood, Hill, Morris, Nightingale, Peto, Rose, Titmus, Stacey to name but a few. It will surely continue to do so.

    Yet for half a century a medical hegemony (legitimate or otherwise) has implied medical ownership and protection of careers, training, and accreditation in public health. All top public health jobs in the NHS and elsewhere from the chief medical officer down are protected, if not by law, by the BMA. It remains impossible to be accredited as a specialist in public health and, until quite recently, to attend postgraduate public health courses without a medical training. Funding for training and career opportunities are still grossly unequal and all this has clearly tended to confine others to roles different from, or ancillary to, public health. Until the need for this is satisfactorily justified it is a scandal. The academic sector is only now becoming an exception, where for too long the research, the teaching (exclusively of doctors), …

    Correspondence to: Edward Coyle

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