Putting the public back into public health

Public health in the British NHS has lost its way.1–5 It has been, or has allowed itself to be, driven down the narrow, and ultimately self defeating, road of health service performance management and finds itself unable to step back and examine the root causes of ill health in the populations served. Health is about more than simply treating illness. It must encompass improving people’s chances of living a healthy life throughout their lifetime. However, in the NHS, health is being interpreted through the narrow prism of ill health and disease. How will this enable the NHS to contribute to the struggle to create communities that are truly healthy, where people participate in creating a sense of wellbeing for themselves and for their communities? The issues are not confined to the British NHS but can be found to exist to a greater or lesser degree in many healthcare systems in Europe and elsewhere.6

Part of the problem may result from a lack of clarity over the public health function. Arguably, there exists no other function that seeks to embrace such a broad range of discrete activities to be undertaken by a single specialty or group of practitioners. The Faculty of Public Health suggests that there are three areas of public health practice that it seeks to cover in its work: health protection, health improvement, and health service quality. While displaying some overlap, each of these areas arguably demands its own particular skills, competences, and knowledge. Perhaps greater clarity and focus is required if public health is to deliver with equal confidence in each of these areas, especially in respect of health improvement that demands skills from a range of agencies outside the NHS and located within communities.

For many engaged in public health, its core purpose is …