Of all the medical specialties, it is public health that by its very nature is most affected by political, social and economic changes. Therefore the challenge to public health in the new millennium will be deciding how to adapt to the simultaneous changes in all these areas created by the forces of globalisation. Diseases will travel faster than every before, as will the information (and misleading pseudo-information) abut how to treat them. Information and mobility will bring great wealth to some and the troubles of the very poor, especially their health problems, closer to all of us. Existing political power structures will be challenged by the power of big business and, perhaps, small organisations, ranging from legitimate and well meaning pressure groups to terrorist organisations, newly empowered by modern information technology. International organisations such as the European Union, will develop as an attempt by nation states to rescue their power by sharing it.

The last great paradigm shift in social development was the industrial revolution of the 19th century. The transformation of an agrarian, socially stable society with little political or physical mobility into an urban society on the move in every sense, which was most noticeable in the United Kingdom but was mirrored throughout much of the world, shares many parallels with the impact globalisation will have. Back then the UK's 1848 Public Health Act and its successors were the finest examples anywhere of public health helping …