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THE FUTURE OF PUBLIC HEALTH IN ENGLAND? SOCIAL CONSCIENCE AS WELL AS SCIENTIFIC INTENT
In this issue we carry several takes on the state of play with public health in England. Following the latest of what has become a monotonous series of structural reorganisations, the English National Health Service is now feeling its way back to its roots in local government. Increasingly, local directors of public health are joint appointments with local authorities, holding out the prospect of the sought of leverage over the determinants of health that was possible in what is sometimes held to be the Golden Age before 1974. In Public Health Past and Present, Martin Gorsky peels off some of the layers of nuance about the strengths and weaknesses of those earlier times, and reminds us of John Ryle’s aspiration for social medicine in 1942 as “social conscience as well as scientific intent”. In a related Theory and Methods paper, Jo Nurse and Paul Edmondson-Jones propose an ecological framework for the delivery of public health; and in our Continuing Professional Education Glossary, Margaret Whitehead tackles a typology of actions to address social inequalities in health. An editorial from Artazcoz and Rueda draws our attention to the challenge from public health research posed by social inequalities in elderly health; this is linked to a research report from Hyde and Rees Jones, which explores the association between exit from the labour market, socioeconomic position and self-rated health. See pages 468, 555, 473, 467, 533
As our authors have responded to the request to bring out policy and practice implications of their work, that section of the journal has expanded. Highlights this month include:
information on childhood conditions may increase our understanding of the determinants of early retirement, especially due to mental disorders; childhood adversities should be taken into account when considering the determinants of disability retirement and identifying groups at risk;
the prevalence of substance use in school is influenced by the school culture. Schools can influence health behaviour specific to early initiation to alcohol, heavy alcohol use, and regular illicit drug use;
living in low socioeconomic neighbourhoods and in environments where healthy food is not readily available is found to be associated with increased obesity risk;
in Finland, the total effects of education and, particularly, occupational social class on mortality have increased over time;
psychological exposure—the belief of individuals that they have been exposed to a hazard—has an effect on anxiety and symptom reporting over and above that of physical exposure in a complex emergency;
unfairness is an independent predictor of increased coronary events and impaired health functioning (in the Whitehall II study).
Research findings include a report from China on the use of verbal autopsies to provide death statistics in rural areas; a finding that neighbourhood environment is not an independent contributor to the incidence of clinically relevant levels of depressive symptoms (CRLDS) in middle-aged, urban African-Americans; and that in Italy, the most fragile parts of society pay the highest price in caring for those dying of cancer. Further evidence of the need for responsibility in reporting suicides in the media is provided from Hong Kong in a study of the long-term impact of celebrity suicide. See pages 519, 527, 547, 540