The public health system in England

Author/Editor(s):

David J. Hunter, Linda Marks, Katherine Smith

Format:

Paperback , 200 pages , 234 x 156 mm
Other formats available

ISBN

9781847424624

Published:

10 Mar 2010

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Health inequalities remain the most stubborn of adversaries for public health practitioners, policy makers and activists. But new challenges are emerging: climate change and pandemic flu being perhaps the most compelling. This text addresses the two themes, the old and the new using the system itself as the unit of analysis.
Mike Kelly, Director of the Centre for Public Health Excellence, NICE

An important new review of an old and intractable problem: our health system is incapable of keeping people healthy. This trenchant analysis must help to kick-start a radical shift in policy and practice.
Anna Coote, New Economics Foundation

About This Book

Health systems everywhere are experiencing rapid change in response to new threats to health, including from lifestyle diseases, risks of pandemic flu, and the global effects of climate change but health inequalities continue to widen. Such developments have profound implications for the future direction of public health policy and practice. The public health system in England offers a wide-ranging, provocative and accessible assessment of challenges confronting a public health system, exploring how its parameters have shifted and what the origins of dilemmas in public health practice are. The book will therefore appeal to public health professionals and students of health policy, potentially engaging them in political and social advocacy.

Author Biography

David J. Hunter is Professor of Health Policy and Management at Durham University. He is Director of the Centre for Public Policy and Health, School of Medicine and Health and a Wolfson Fellow in the Wolfson Research Institute. He has extensive research experience in health systems and public health and has published widely on these subjects. His last book, The Health Debate, was published by The Policy Press in September 2008. Linda Marks is Senior Research Fellow at the Centre for Public Policy and Health, School of Medicine and Health, Durham University and a Wolfson Fellow in the Wolfson Research Institute. She has previously held posts at the King's Fund as Fellow in Health Policy Analysis and in the NHS as a Non Executive Director of a Primary Care Trust. Research interests include health policy, health inequalities and public health governance.Katherine E. Smith is a Research Fellow in Applied Policy Research in the School for Health at the University of Bath. She was previously a Research Fellow in the Centre for Public Policy and Health at Durham University. Her research interests include: the relationship between public health research and policy, corporate policy influence in Europe (and its public health consequences), and health inequalities in the UK.

Contents

Introduction
Public health and a public health system
The evolution of the public health function in England (1) 1974-97
The evolution of the public health function in England (2) 1997-2009
Current issues in the public health system in England
Looking to the future.

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The public health system in England
This book is an eloquent and valuable attempt by three health policy analysts to understand the nature of public health in the English political and organisational context. Through conceptual, historical and policy analysis, as well as through the results of a small number of interviews with individuals working in public health, David Hunter and his colleagues try to understand the paradox of public health that while it is something often featuring in political rhetoric, its progress and practices in the real world are frequently limited.,,At the core of the book is an attempt to define and describe public health, and the nature of ‘the public health system’. This is partly done through showing how the public health function has altered and developed in England since 1974, when for muddled political reasons it was removed from local authorities and put under the not always benign charge of the NHS. One of the principal arguments of Hunter and his colleagues is that the ethos and values of public health (or at least broad understandings of the domain) fail to match with the dominant treatment and care concerns of the Health Service. Public health is in the wrong place, organisationally speaking, and because of this its practitioners struggle to establish and work effectively on the kind of broad agenda that is required if health is genuinely to be improved and not simply disease or illness treated. ,,This analysis leads to the identification of a number of current issues facing public health in England, including the challenge of how to engage in commissioning for health and well being, and how to develop genuine partnerships for health improvement. The authors conclude by drawing us towards considering the huge public health challenges of the 21st century, notably environmental degradation and global inequalities.,,The arguments within the book are complex, but they are drawn clearly and expertly. The inclusion of extracts from interviews adds to clarity and give a 'real- life' feel to the text. At certain points, boxes are used to bring out or analyse a particular issue. As Hunter and his colleagues conclude, perhaps what is needed now as we face the public health challenges of the third millennium is a revival of the spirit of Alma Ata, the 1978 WHO declaration that began the movement known as 'Health for All'. Some might see it as depressing that we are being encouraged to step back in this way in order to have a chance of moving forward. But it is a credit to the analytic adroitness of this book that looking back at the historical and conceptual problems of public health seems essential if we are properly to work out the way ahead. ,
Reviewed by Peter Duncan

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