The Speciality of Public Health Medicine - Has it lost its way?
Prior to 1973 there were differing approaches in the practice of Public Health Medicine in local authorities in the United Kingdom. Allegedly some Medical Officers of Health were resistant to change and others were actively promoting it.^1,2,3

However with the reorganisation of the National Health Service in 1973 the future of Public Health Medicine seemed assured. The creation of the Faculty of Public Health Medicine in the United Kingdom was swiftly followed by the creation of similar Faculties or organisations across the world. However it has to be acknowledged that Public Health Medicine does not trade solely under that name - Social Medicine, Medical Epidemiology, Social and Preventative medicine - all will strike chords and the key elements of the practice remain fundamentals. These include infectious disease, communicable disease, epidemiology, an understanding of statistics and, in general, an evidence-based approach to the practice of medicine.

Traditionally Public Health Medicine has worked closely in association with other organisations, disciplines and hierarchies who have had an interest in the health of the population - the Public Health. Examples are District Councils, Governments, non-governmental agencies, groups of clinicians, groups of individuals, universities or decision makers. In other words groups and individuals within and without medicine. Moreover there are, of course, many who have worked very closely with Public Health Medicine and with whom Public Health Medicine has worked very closely in order to deliver on the public health agenda. These include Environmental Health Officers, Nurses (particularly Health Visitors), Primary Care Physicians, Statisticians and Epidemiologists to mention but some. It must be clear, therefore, that this agenda could not be adequately addressed without the involvement of these different groups or individuals at different times who own a shared vision. This is not to say that all these groupings require to be part of the same organisation or part of the same professional club. Indeed it can be argued that greater benefit is to be had through joined up working than by an enforced commonality.

In the United Kingdom the different approaches adopted by the different health departments has meant, in effect, the development of four National Health Services rather than a common one. The different approaches have meant that Public Health Medicine has its focus at different points in the organisations and in England Directors of Public Health need no longer be medically qualified let alone trained in Public Health Medicine or, allegedly on occasion Public Health. This has led to a questioning in many quarters of the continued role of Public Health Medicine and the development of Public Health networks in an effort to address the increased isolation and apparent peripheralisation of many doctors practising within the specialty.

The point I would make, therefore, is that the traditions and origins of Public Health Medicine must not be forgotten. Core values remain as important now as they were a century ago and we must not forget the lessons of the past. Now is a time for sharing, for working together but not an artificial drive towards some abstract common goals. The position of Public Health Medicine within the firmament must be a matter of concern and must be protected, if not for our own sakes then for the sake of our forbears and our descendants.

Without the knowledge base of medicine, Public Health will be less effective and less significant. Are we wise in alienating the strong commitment of a branch of medicine devoted to promote better health through the understanding of the interaction of human biology, the environment and society?

References
1. Welshman J, The Medical Officer of Health in England and Wales, 1900-1974: Watchdog or Lapdog? J Pub Hlth Med 1997; 19: 443-450.
2. Diack L, Smith DF, Professional Strategies of Medical Officers of Health in the post-war period -1: "Innovative Traditionalism": The Case of Dr Ian MacQueen, MOH for Aberdeen 1952-1974, a "bull-dog" with the "hide of a rhinoceros" J Pub Hlth Med 2002; 24: 123-129.
3. McLaurin S, Smith DF, Professional Strategies of Medical Officers of Health in the post-war period -2: "Progressive Realism": The Case of Dr R J Donaldron, MOH for Teeside, 1968-1974. J Pub Hlth Med 2002; 24: 130-135.