Intended for healthcare professionals


Past and future influences on public health

BMJ 1994; 309 doi: (Published 29 October 1994) Cite this as: BMJ 1994;309:1156
  1. R Bhopal
  1. Department of Epidemiology and Public Health, School of Health Care Sciences, Medical School, University of Newcastle, Newcastle upon Tyne NE2 4HH.

    EDITOR, - At the summer scientific conference of the Faculty of Public Health Medicine the chief medical officer, Dr Kenneth Calman, challenged delegates to identify the most important influences on public health in the past 20 years and to predict the major influences in the next 20 years. Colleagues and I conducted a Delphi-type consultation (two rounds of comment and analysis) in this department and have now come close to a consensus. The box shows the results.

    Most important influences on public health in past and next 20 years


    • Improvements in living standards, particularly arising from more disposable income

    • Environmental improvements - for example, housing, roads

    • Reduction in tobacco consumption

    • Improvements in education and communication

    • Better, more effective, and easier access to health services


    • High standards of living and lower unemployment rates

    • Decline …

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