Letters

Published: 20/12/2001, Volume III, No.5786 Page 22

Proposals in Our Healthier Nation, the chief medical officer's report to strengthen the public health function and numerous other government policy documents, envisage a multidisciplinary cadre of welltrained professionals fit for the purpose of properly and efficiently implementing the public health function.

Junior health minister Lord Hunt emphasised last month at the Royal College of Physicians that highly trained public health people must fill all public health director posts. These will be validated by registration (whether voluntary or statutory) which can guarantee the highest standards to the public and employers. Policy documents affecting public health practice foresee a new specialist grade in public health of dedicated, independent and well-trained practitioners who will no longer necessarily be medically qualified.

What, then, is Bobbie Jacobson referring to when she asks if they 'could really do their job unless they are public health physicians' ('Public domain', 6 December)? Why the reference to 'public health expertise - spread even more thinly' under the new plans? We require hard evidence that concerns about 'anyone other than a trained public health physician' performance-managing population health are well placed. We need evidence that the implied professional protectionism for doctors in public health is justified in terms of the public's health.

We need to recruit the brightest minds into public health, and her words reinforce ridiculous barriers to such practice that have existed ever since I entered public health around 1966, and will continue to hinder the proper recruitment (and training) of appropriate people. It is time that a mindset that persistently puts one discipline (clinical medicine) into a dominant position in public health practice is justified or forgotten. Now is (beyond) the time to get on with the serious business in hand - together. Why do even enlightened doctors often seem to have a problem with just that?

Klim McPherson Professor of public health epidemiology Bristol University