Public health the vision and the challenge By Walter Holland and Susie Stewart Nuffield Trust 254 pages £30

This is an interesting, if uneven, account of the history of public health and public health medicine in the UK over the past 150 years or so, by Walter Holland - one of the acknowledged giants in this field - and his collaborator, Susie Stewart.

Commissioned by the Nuffield Trust as the basis for the 1997 Rock Carling lecture, it consists of a review of principal developments in public health from the 1830s to 1948, followed by a detailed analysis of the role and contribution of public health doctors since then.

The historical section is a mine of information. It covers Chadwick's contributions to a healthier water supply, Ebenezer Howard's visionary development of garden cities, the genesis of the Beveridge report and the creation of the NHS, among other subjects.

The second part is principally an account of the trials and tribulations of the public health medicine specialty in its long and usually losing battles with rival medical empires. The conflict between the role of the public health director as successor to the medical officer of health, who could speak out without fear of dismissal, and their role as a loyal member of the health authority's corporate management team is particularly well described.

To resolve this dilemma without diminishing the importance of the specialty, the authors propose three options for its future:

to return to local government, as recreated medical officers of health;

to become a 'third force', employed by an independent national commission; or to continue within the NHS, but in an advisory and co-ordinating role. With this option, there would be no direct accountability for the commissioning of services; public health directors and their teams would focus on collecting information and using it to inform the work of all relevant sectors in the local community.

Since the authors see the medical officers of health option as effectively sidelining the specialty, and the independent commission as ideal but politically impracticable, they settle for the third as the best future for the profession.

This is, therefore, in effect two different books - a historical summary of the work of health and social reformers since the last century and a personal view of the difficulties faced by public health doctors since 1948.

It is also flawed in a number of respects. While admirably up to date, it shows signs of having been produced in a great hurry, with much duplication and a lack of clarity on some important issues - for example, the role of the medical officer of health from 1948-74 is never made clear.

More seriously, although the book ironically contains numerous references to the obstructive attitudes of the medical profession, there is an assumption throughout that 'public health' is an activity best led by doctors, with everyone else in supporting roles.

Worse still, the authors use the term 'public health' to mean many different things. For example, at the outset they accept Acheson's definition: 'the science and art of. . . promoting health through the organised efforts of society'.

They then go on to confuse it with 'public health medicine'. On page 219, they say: 'Public health. . . has made massive inroads into disease' - where they mean the efforts of society. But on the same page, they also say: 'We perceive public health as the central medical specialty of the future' - society need not apply.

Much of this book is not about public health at all. It is about public health medicine. But provided this limitation is understood, and the dinosaurs - like, for example, the attitude to non-doctors - are ignored, the work has much to commend it.

Walter Holland and his co-author have many acute observations to make on a field in which he has been a leading figure for more than 40 years.

Donald Reid Chief executive, Association for Public Health.