‘Everywhere and nowhere’: locating and understanding the ‘new’ public health☆
Section snippets
New spaces for a new public health?
The NHS Plan (Department of Health, 2000) recognised the ‘outdated’ and ‘archaic’ nature of the current health service, and called for a breaking down of familiar structures to allow greater local flexibility in provision for a contemporary, more selective and participatory set of ‘consumers’. However, the nation's health is not seen as the sole preserve of medics. Publications such as Bringing Britain Together (1998) from the Social Exclusion Unit, or the public health White Paper, Saving
Locating public health
Wylie et al. (1999) recently described public health as being ‘everywhere and nowhere’. It is omnipresent, yet hard to pin down and recognise. This image captures the idea that public health is shaped by a range of social, environmental and physiological influences and it is therefore everywhere and ‘everyone's business’. This was reflected symbolically in the wide range of ministers who were signatories to the recent public health White Paper (Saving Lives: Our Healthier Nation, 1999). It is
What kind of maps? from water pumps to conceptual landscapes
From its earliest days as a discipline public health has drawn on maps and mapping techniques to describe, analyse and propose solutions to the problems it faces. Perhaps one of the earliest triumphs of the map in public health was the example of John Snow pinpointing the water pump in London's Broad Street as the centre of a cholera outbreak. Interest in mapping public health has continued and become ever more sophisticated with developments in computer graphics packages, Geographic
An example of map reading: where is partnership?
Our task is to trace the way in which policy is woven through the webs and relations between individuals, organisations and discourses across time and space; to study through the complexity (Shore and Wright, 1997). We have therefore decided to trace one recurring and dominant concept in the rhetoric of public health, that of ‘partnership’. Focusing on partnership gives us a keyword to locate in the public health terrain and allows us to begin to compare experiences at different levels.
Some reflections
The idea that we inhabit an increasingly ‘reflexive’ society in late modernity is gaining currency (Beck, 1992). We believe this is a useful framework for the study of recent changes around public health in the UK and also elsewhere. The public health map is changing worldwide, and a host of new agencies, arrangements and concepts are appearing. Here we have suggested that this is partly a reflection of wider structural changes which could be considered to be part and parcel of a move towards a
Conclusion
Changing boundaries and lack of clarity are no new thing for public health. We are simply entering the latest phase as those involved adjust to the new agenda. To return to Wylie et al. (1999), the current spaces of public health are to some extent shifting, vague, almost ‘everywhere’; they also remain partly unknown or ‘nowhere’. However, at the same time we can see public health is located across a variety of terrains, from central policy rhetoric to local ‘on-the-ground’ actions, and in the
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The work informing this paper was undertaken during a Department of Health funded study entitled ‘Public Health and Primary Care: developing the health improvement agenda’. This research, previously based at the Institute for Public Health Research and Policy at the University of Salford, is now based at the Institute for Health Research, University of Lancaster.