Letters: Public health

Published: 21/03/2002, Volume II2, No. 5797 Page 20

For too many decades we have endured doctors telling us that we do not know enough or understand enough to study for or to practise as specialists in public health. Richard Turner (letters, 7 February) merely continues that protectionist and de-skilling tradition.

The modern argument for public health is to emphasise the special contribution of (bright) doctors and the equally special (potential) contribution of other excellent public health specialists. We have no desire to belittle anyone's real contribution to that broad and complex agenda. Realising the full potential for public health is our singular objective.

Klim McPherson Professor of public health epidemiology Bristol University

What a shame to hear Richard Turner, a public health consultant, downplay the importance of the specialty's science base. The revolution that has swept through clinical practice called evidence-based medicine (EBM) develops and applies a science base in relation to individual patient care. This does not downplay professional judgement, but adds to it.

A similar approach is required for public health. The public health community should learn the lessons of EBM, develop its own methods and strive to collect and use relevant and appropriate data. Public health practitioners will earn the respect of their colleagues from other specialties if they have something to offer to decisionmaking beyond judgement and opinion.

Dick Heller Professor of public health Manchester University

I felt tired and dismayed at the tone of Dr Richard Turner's letter. I thought the argument had been fought and won long ago - not least by the government - that public health is about much more than medical interventions.

It is high time we moved beyond confrontation. Public health is a broad church which encompasses a range of professionals and functions.

Perhaps Dr Turner, if he seeks reassurance on this, should refer to the Faculty of Public Health Medicine's own 10 areas.

If he seeks reassurance on maintenance of specialist standards across competencies he should refer to the healthworks standards for public health specialists. He might also be aware that most regions now are training multi-disciplinary trainees alongside specialist registrars. Let's wake up to the 21st century and tackle the real issues together.

Jenny Wright Chair Honorary members committee Faculty of Public Health Medicine

Public health is a multidisciplinary specialty. What recent correspondence fails to acknowledge is that there are different skills required for different areas of specialist practice. As a standards-setting body we are concerned to ensure competence in the 10 key areas of practice. Public health specialists are not expected to be expert in every area. Some will need greater clinical expertise than others, and current organisational changes to the NHS heighten our awareness of this growing diversity.

It is futile to argue whether one type of specialist is better than another. What matters is having enough specialists to take forward the public health agenda in the wide variety of settings in which their skills are required - which will include recognition of the strengths of both medical and scientific training.

Professor Sian Griffiths OBE President Faculty of Public Health Medicine

No doubt medical expertise is required as part of multidisciplinary public health, but Dr Richard Turner seems to have missed the point.

Medical expertise is a contributor to, not necessarily a director of public health.

Indeed, in terms of creating or promoting health, the healthcare system comes a poor second to social and economic factors. In these circumstances, social science experience, expertise and occasionally a non-scientific opinion provide the broad, strategic perspective that public health leadership requires.

We should not forget that public health is a social objective, not a branch of medicine.

Dr Ann-Marie Coyne Health promotion manager North West Lancashire