Health secretary Alan Milburn may want to drag them from the ghetto, but public health professionals gathered at their annual conference in Bournemouth looked anything but cowed and beaten.
The UK Public Health Association conference began just as the health select committee launched its second report into public health. And in the event, it turned out to be public health report week.
David Hunter, professor of health policy and management at Durham University, was one of four advisers to the select committee. Amazingly, he was able to boil down at least 60 wide-ranging and at times rambling recommendations (see box for main ones) into eight 'key themes'.
They included 'a better balance between health and healthcare and up and downstream interventions' and the need for 'strong leadership' for the function.
While sagely stating that the present location of public health minister Yvette Cooper in the Department of Health does not promote enough joint working, the report opted for leaving her there, but 'empowering' her to show 'more positive and public leadership. . .'
Professor Hunter highlighted the report's emphasis on 'the need for strong local partnerships' and a call for less talk and more action.
But the report rejected 'major structural change' or a return to the pre-1974 set-up, when public health sat within local government.
President of the Chartered Institute of Environmental Health David Purchon was not impressed.
'I identified no strong themes.
Congratulations on finding eight, ' he said. 'It demonstrated a lack of leadership on public health and a political deficit. Although it made suggestions, it ducked a lot of issues.'
The select committee document would 'go nowhere, because it had no big ideas', whereas the still unpublished chief medical officer's Project to Strengthen the Public Health Function in England recommended a standing royal commission and wanted responsibility for public health to go to regional government.
It turned out to be a day of surprises. Professor Hunter said the select committee report had called for the earlier document - started by Sir Kenneth Calman almost four years ago and handed on to his successor Professor Liam Donaldson - to be published 'without delay'. It was supposed to be out by summer 1998. Lo and behold, it was suddenly announced that 700 copies were on their way to delegates.
Did it mention a royal commission on public health, then?
Curiously not. Some of the many proposals include a national strategy to raise awareness and knowledge of specific public health issues and to strengthen the coordination between government departments and agencies with an impact on health.
Figures and targets are notably absent.HSJ understands figures in the draft were taken out as recently as two days before publication.
The report points to the setting up of the National Forum of NonGovernmental Public Health Organisations in response to the recommendation for a national public health forum.
But UKPHA chief executive John Nicholson said the national forum had met a couple of times, and while not quite a 'dead parrot', had 'clearly been downgraded as a result of the NHS plan'. He said no one would use it as a main channel of consultation over public health.
In a separate session, director of statistics at the DoH John Fox talked delegates through the health inequalities targets announced by Mr Milburn in February. The two targets are:
By 2010, to reduce by at least 10 per cent the gap in mortality for children under one between manual groups and the population as a whole.
By 2010, health authorities to reduce by at least 10 per cent the gap between the five areas with the lowest life expectancy at birth and the population as a whole.
UKPHA chief executive John Nicholson told HSJ later that the targets were not ambitious. He stressed that the child mortality target excluded sole registrations - births to lone parents, who the UKPHA says have the greatest chance of entering poverty.
He says: 'I could live with two or three targets, if they were the right ones. If they (the government) try to fiddle the figures by de-registering one of the most povertyaffected groups, it will devalue the whole target approach. There are going to be more single registrations in poorer areas.'
Mr Fox said the outcomes for the children of sole registrations would be monitored, and if mortality for this group had gone up:
'I have no doubt we would be seen to have failed'.
Key points from the health select committee's second report
New high-level performance indicators should be developed around public health.
Every government department should have public service agreement to conduct health audits and health inequality audits.
Government's workforce development plan for public health must evaluate if primary care has the capacity to take on public health responsibilities.
PCGs and trusts should have extra dedicated officers from the local authority with 'broader public health remit'.
NHS regional officers could take a greater strategic lead, with the government 'clarifying structural arrangements'at this level as soon as possible.
Joint HA/local authority appointments of directors of public health should be jointly accountable to each authority.
Health Committee Second Report: public health. Stationery Office.£12.50. The Report of the Chief Medical Officer's Project to Strengthen the Public Health Function. www. doh. gov. uk