It is a pity that Donald Coid and Desmond Ryan ('Historical novel', page 28-29, 15 April) presented their important comment on the challenge of de-industrialisation in such a gratuitously negative way, and arguably several years behind events.

Surely new government policy, especially in Scotland, is moving precisely in the direction they advocate. Social inclusion, social marketing, and the New Deal for Communities are all intended to reduce the isolation and inequality among poorer people that society's loss of manual work - with us for at least a decade - has compounded.

The evidence that such strategies will be effective in reducing hopelessness and low self-esteem is yet to emerge, although there are indications from other countries that rebuilding communities does reduce isolation and, ultimately, ill-health. But to suggest that social reality is still missing is to have misread government strategy for the past two years.

Mr Coid and Mr Ryan are even more seriously wrong in claiming that the medical profession, particularly public health medicine, should be leading and claiming the sole credit for addressing the need for new ways of living and working in a post-industrial world.

Even 150 years ago it was legal and medical expertise which led to the first Public Health Act; today, HSJ readers are well aware of the multiple contributors attempting to improve the public's health. And if the authors' concern is a lack of descriptive and analytical epidemiology, they could update their references with names such as George Davey Smith, Graham Watt or Sally McIntyre.

They might also draw some comfort from the evidence submitted by public health in Scotland to the current review of the public health function: there is an urgent need to develop population- based information which collates the diverse factors relevant to the white paper agenda. They should reflect a wide range of influences including prosperity, enterprise, the physical and social environment, health-related behaviours, sense of well-being, personal function and disease rates.

Population-based epidemiology, enhanced by description of communities and how they live, is alive and well and living in Scotland. Mr Coid and Mr Ryan's very topical comments on self-esteem should certainly be part of the agenda.

Professor Elizabeth Russell


Office for Public Health in Scotland