Published: 13/05/2004, Volume II4, No. 5905 Page 20 21

Thanks, HSJ, for highlighting two simultaneous appeals to refocus public health practice, through 'better management at a local level' (news, page 7, 22 April) and comprehensive public health outcomes (Regulation Ideas, pages 16-17, 22 April).

These were timely, given the details of the proposed standards for better health and the urgent need for the new Healthcare Commission to see the wood for the trees when learning to assess public health.

The 'seventh domain' of these standards means that all health service organisations would face assessment on the core standard of 'making an appropriate and effective contribution to local partnership arrangements including local strategic partnerships and crime and disorder reduction partnerships'.

What does 'effective'mean, in reality? Acute trust accident and emergency departments should actually reduce future rates of child abuse, injury, self-harm (and death) through reciprocal arrangements with the local children's trust.

Pressure on police work from late-night assaults near pubs or weekend call-outs for domestic violence should be reduced through more proactive engagement by the alcohol service of the local mental health trust to tackle hazardous drinking patterns in young males.

Within primary care, specialist school nurses and community midwives might reduce youth suicide and teenage pregnancy through outreach to those care homes and homeless hostels for which their local authority has contracts.

Woody Caan Professor of public health Anglia Polytechnic University