Whither public health?

Recently, the Australasian Faculty of Public Health Medicine (AFPHM) was asked: “How do we know we’ve made a difference?” Most responses would include the 10 great public health achievements of the 20th century identified by the US Centers for Disease Control — vaccination, safer and healthier foods, healthier mothers and babies, family planning, fluoridation of drinking water, control of infectious diseases, motor vehicle safety, safer work places, declining deaths from coronary heart disease and stroke, and recognising tobacco as a health hazard. These are prodigious, so why the current soul searching? Does public health have an identity crisis? It would seem so!

The AFPHM and others have now called “for a clear vision for public health”. Further, Richard Horton, editor of The Lancet, has written that “public health has not only lost its direction but also its passion . . . [and] . . . needs to reignite its social flame”.

Such collective soul searching usually reflects the uncertainty that accompanies change (indeed, the emphasis in public health is shifting to health inequalities and population health, to socioeconomic equity and ecological sustainability, and from advocacy to activism in policy and politics). But could the increasingly tenuous relationship between public health and medicine be another factor?

Since early in the 20th century, public health has progressively separated itself from mainstream medicine. This trend has limited its intellectual base as well as its exposure to criticism and questions of relevance. The marginalisation of public health has been acknowledged by a recent AFPHM call “to explore and develop relationships with clinical medicine”.

Whither public health in the new century is more than an academic question.