The need to end the exclusion of public health was the theme of Commons health select committee discussions this week. Ann McGauran listened in

Public health needs to get out of the ghetto if it is to take a leading role in improving the quality of people's lives, says the chair of the Commons health watchdog.

The health select committee had already heard that the area is too medically dominated, not broad enough in its scope and should be working much more closely with local government.

The committee hearing came the week before public health is set to get a strong boost from the government's national plan.

Speaking at the first session of the committee's review of public health, chief medical officer Professor Liam Donaldson admitted placing public health wholly within the NHS had 'some down sides'. But despite the government talk on joined-up public health policies, Professor Donaldson seems adamant that it should stay firmly within the Department of Health.

'We are in a very strong position now and we have good tools to deliver the job. I think the function is better placed in health, where I am working with a set of ministers at the coalface.'

He did concede, however, that there were serious problems with the structure that needed to be tackled.

'You could say it has been too medically dominated and not broad enough. But it has been well resourced, because a good director of public health is able to influence the direction of a lot of goals.'

Committee chair and Labour MP David Hinchliffe said it was time for public health to reexamine its location in the NHS, given health secretary Alan Milburn's description of a 'ghettoised' service.

He added: 'Hasn't it been sidelined in a way that is not particularly helpful?'

Liberal Democrat committee member Dr Peter Brand believes public health is fading away, with no profile outside the DoH. The solution, he told the select committee, was to give a minister of public health a place at the Cabinet table.

But Professor Donaldson considers Yvette Cooper, the junior minister for public health, is doing a sterling job.

Leaping to her defence, he said: 'It may be perceived in that way, but that's not how it's seen internally. I think there has been a lot of joined-up government on a scale I would have liked to have seen when I was in a health management role 10 to 15 years ago.'

Liverpool health authority public health director Dr Ruth Hussey called on her counterparts to work with local government and others to improve the health of local communities.

She said: 'The question is, how do we influence the system best? I want a situation where you can sit at the table where decisions are made - whether it's the health service or local government.'

But Dr Hussey said she would be concerned if public health went it alone and lost its traditional management tie with HAs.

'My worry if it became an independent resource is that we would not be able to influence more directly. At the moment it's helpful to be able to influence directly by being part of the management.'

Labour MP Dr Howard Stoate told Professor Donaldson that many GPs would have difficulty naming their director of public health, and a number had approached him to say they did not understand what the public health function was .

'Many people don't know the difference between primary care and public health.'

The Community Practitioners' and Health Visitors' Association has yet to give evidence to the select committee.

In its written submission it says it fully supports initiatives such as health action zones, healthy living centres, education action zones, health improvement programmes and community plans, but sees 'too much focus on systems' instead of content.

Labour member Stephen Hesford asked Professor Donaldson whether there was going to be a third wave of HAZs - one of the main government tools for improving the health of local communities.

The professor replied that the priority now was to review what could be learned from the first two waves of HAZs and new additions were a question for ministers. He added: 'We have to decide whether the present structure of HAZs linked to existing statutory structures should continue in perpetuity.

'Only a proportion of GPs have direct experience of community development - working with local agencies such as primary care groups, going to local housing offices with statistics, talking to education services about the problems of poor nutrition. These are the areas in most need of support and development.'

NHS managers were very clear on their accountability for the patient care element of their role, but accountability was not so clear for public health because of the number of agencies involved, said Professor Donaldson. Asked if multi-agency delivery was a weakness or a strength, Professor Donaldson said: 'There is no perfect structural solution.'

A healthier nation?

Britain ranks only 14th in the latest World Health Organisation survey of healthy life expectancy, behind Spain, Italy and Greece.

The gap between the health of the richest and poorest groups in society is growing: life expectancy at birth for a boy is over nine years less in the lowest social class than in the highest.

There are serious variations between health authority areas: coronary heart disease rates in men under 65 in some HAs are more than three times that of others.