“ALE/HALE/DALE OR IMR”

In this issue, a feast of acronyms in two commentary pieces kick off a debate about the relevance of population health indicators. In particular, the argument is made that infant mortality is not an adequate summary measure of population health, and that with the demographic transition to an aging population and chronic non-communicable disease, other more appropriate indicators of the burden of disease are necessary. The debate should not stop there for, as we recognise with increasing force the upstream policy determinants of health, if we are to escape the straightjacket of a narrowly biomedical view of public health we desperately need practical, readily available horizontal measures of upstream action and effect. As the Victorians went for safe water, not a range of vertical programmes for each disease caused by insanitary conditions, so we should make full use of measures such as low birth weight, and self esteem, height and weight of school children, and level of education attainment, and of Titmuss’s “control over resources through time” to make reality of multidisciplinary, multisectoral public health. See pages 318, 319

This point is particularly apposite to our …