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

I agree with Bobbie Jacobson that strategic health authorities will need public health leadership; they are likely to need a senior medical officer, too. But it does not follow that the public health lead for performance management of population health needs to be medically qualified.

Many experienced public health specialists come from a variety of backgrounds. It could be argued that social, environmental and economic expertise are vital in a public health leader, given these are the root causes of much ill health and many health inequalities.

Government seems to strongly endorse multidisciplinary public health, and I hope this will be carried through in guidance for future appointments at all levels.

With regard to public health directors' reports, we do need clarity about their future.

However, we also need to ensure they are used to trigger action.

Lee Adams Professor of public health Sheffield Hallam University