Health Promotion International, Vol. 15, No. 1, 90-91,
March 2000
© Oxford University Press 2000
Resource Reviews |
Perspectives in Public Health
Sian Griffiths and David J. Hunter Radcliffe Medical Press, ISBN 1 85775 209 0
Pontypridd and Rhondda NHS Trust/Welsh, Institute for Health and Social Care, University of Glamorgan For all the talk of multi-disciplinary and multi-agency Public Health, it is actually quite difficult to find texts which take a genuinely broad approach to public health policy and practice. Perspectives in Public Health does just that and as such is a thoroughly worthwhile read both for students of Public Health and for those of us, more seasoned in the field, who are trying to keep pace with developments and fit them into the contemporary political context in Britain, and indeed elsewhere in the developed world.
The book has a Foreword by Tessa Jowell, UK Minister of State for Public Health, which serves to emphasize the fact that Public Health and Politics (with both a big and a little p) are never far apart, something which is very clear as the book weaves together the strands of policy and practice, history and future scanning. The highly contemporaneous nature of the book is in many ways its strength and its usefulness: the downside is that it runs the risk, in 5 years time, of becoming a document of historical interest.
The book is, in the first instance, very readable, with a continuity of style and format which belies the range of contributors. Lots of headings and bullet points make the text easily accessible and well suited to the snatched, sound byte reading mode which so many of us have to adopt. There is little in it which could be described as technical, and readers should find no difficulty in understanding the issues put forward by writers from disciplines other than their own.
The book opens with an introduction by the editors who bravely and sensibly jump straight into the ‘What is Public Health?’ debate: their quotation from George Bernard Shaw in the early part of this century adding a touch of dry humour:
take the utmost care to get well born and brought up. This means that your mother must have a good doctor. Be careful to go to a school where there is what they call a school clinic, where your nutrition and teeth and eyesight and other matters of importance to you will be attended to. Be particularly careful to have all this done at the expense of the nation.
Their key point, which sets the tone for the whole book, is ‘that the task of promoting the public's health lies with many people in many walks of life. Public health is everybody's business, regardless of whether they are politicians, employers, policy makers, professionals or members of the public.’
The book itself is divided into three main sections. Part 1 is entitled ‘Posing the problems: case studies in public health’, and offers discussion on a selection of policy issues including food, transport, housing as well as public health issues in relation to children and young people and to an ageing population.
Tim Lang's chapter on ‘Food as a public health issue’ is particularly cogent. He outlines a short social history of food and health, and describes the externalized costs of modern food production. In so doing he reminds us that public health in the UK—and this book does focus on the UK—is inextricably linked with developments at a European and global level. Our experience of health is largely influenced by the fact that we are in many respects a global village within a global economy, with increasingly global lifestyles and cultures, and political decisions have to take this into consideration. Common sense tells us that it is not rational to destroy, as Tim Lang records, 2.5 billion kg of fruit and vegetables within 1 year in the EU when many of our children have a seriously impoverished diet. But common sense also tells us that trade-offs are made to ensure economic stability and political security. The chapter was clearly written before the genetically modified food controversy hit the UK: this would no doubt have offered scope for interesting discussion, particularly in relation to the power of consumers in influencing policy directions in Public Health.
The second part of the book is entitled ‘Meeting the challenges: practice perspectives’, and has a dozen chapters written by different practitioners of Public Health including scientists, local government officers and medical staff.
As someone originally from a nursing background, I was particularly interested in what Jackie Carnell and Ron de Witt had to say about Public Health Nursing. They give a good overview of the issues and the opportunities presented by new legislation. I am personally less convinced about their strong assertions on the commonality between definitions of nursing practice and the broad-based approaches to public health and by their statement that ‘Public health is nursing practice’.
Of course the collective efforts of nurses contribute to the health of the public, but it has been my experience that most nurses focus very much on individuals and are quite uncomfortable about working at the population or community level. Nurses do indeed, as the authors of this chapter assert, witness daily the effects of poverty and the wider environmental issues of health on individuals and families, but so do many others. What matters is that they have the professional skills and resources to address those effects on more than the one to one level.
Perhaps it is more productive to consider what skills are needed to deliver Public Health rather than what skills we can assemble from the range of existing professional groups. This thought leads on to the final section of the book ‘Facing the future’ where Walter Holland and Susie Stewart look at the tasks at local, regional and central level which need to be addressed by Public Health practitioners. Kenneth Calman undertakes some horizon scanning, well-founded on the principles of Public Health, whilst the final chapter is contributed by Lord (Phillip) Hunt who focuses on the NHS/Local Government relationship and the prospects for effective joint working through ‘A complicated process of moving staff and organizations forward (which) cannot be underestimated’.
Sian Griffiths and David Hunter close the book with a combination of optimism and caution: optimism that the current political climate is putting public health centre stage and caution that collaboration between healthcare, local government and the voluntary sector requires a sophisticated understanding of cultural differences and the time to build mutual trust.
Optimism and caution are perhaps key words for all of us who strive to improve the Public Health at the present time. This book will undoubtedly give you optimism, should you need it, that multi-disciplinary and multi-agency Public Health is alive and well.
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