Public health: Whole society, whole government - whole medicine

The Health Service Journal isn't cheap so here every issue as a subscriber is a valuable resource.

In a September issue (1st) there were some really good opinion pieces and articles. One by Graham Burgess (p.17) concerned the coherence of public health. He started with the struggle that has been public health in England for the past 50 years; it has failed to define the problem to be solved.

Things may be set to change with the shift to local government that helps define public health on a social level, not just as a medical preoccupation - a distraction in fact from the disease health service perspective.

The word holistic that we all band-about was brought into stark relief by Mr Burgess as he nailed some w-holistic ecologies in referring to the 'whole of society' and 'whole of government' approaches necessary to build on the finding by the National Audit Office that only 15-20% of the inequalities in mortality rates can be directly influenced by health sector interventions.

There is a need to look further field than the supposed macrocosm that is the NHS: physical health - mental health.

Mental health is a whole world so frequently set apart from 'medicine'. Mental health contains a range of services that all shout: 'I am Cinderella!' So, Mr Burgess both frames the public health line up; and as I see it highlights the holistic scope of what are crucial and still emerging concerns. Still emerging ...? Well in the sense of having new - local authority - legs and thus endowed - how much further can public health run - and what tools are needed?

NAO Department of Health:
Tackling inequalities in life expectancy in areas with the worst health and deprivation