Sandra Dawson, Zoë Slote Morris (editors). Future public health.

Some years ago, an editorial in the Lancet discussing the continuing challenges of both communicable and chronic disease control worldwide declaimed that ‘Public health has failed’. Although enormously irritating, the laconic words also implicitly acknowledged that things could be different. Future Public Health is a collection of 14 papers from a conference held in Cambridge, UK, in 2006, which considers some of the ‘burdens, challenges and opportunities’. The tone is cautiously optimistic, but the editors say that public health requires a ‘relentless realism in its chosen targets and a sustained commitment to evaluate … to capture the positive lessons’.

The book itself, also, is selective. There is nothing here on health service information or monitoring, disease aetiology or the wider determinants of health. And, apart from a nod to differences in politics between the constituent nations of the UK, a fact of life in most federal countries, there is no European comparative perspective. But two subjects are covered interestingly. First, a chapter by Corbett sets out the current ‘theories’ in health psychology, reviews the limited literature on effective interventions for health promotion and recommends that ‘health psychology must abandon the sterility of the laboratory in order to study social processes in practice’. Second, four papers by leading health economists offer cogent arguments for economics in public health, and challenging findings emerge: (i) ‘… a focus on investment in public health to reduce NHS costs is ill-founded … The reason for investing [is] to improve health and wellbeing …’; (ii) ‘Evaluation and investment in public health interventions by the private sector is limited … the onus must remain on government and charitable foundations’; and (iii) ‘… public heath interventions for which there is an evidence-base demonstrating effectiveness are highly cost-effective … [the existing] threshold for NICE guidance may be too high … fewer pharmacological and other medical procedures might pass the cost-effectiveness test’.

But missing from this book is a response to the challenge that ‘public health has failed’. The senior editor has been head of an institute of public management, and most of the contributors are academics, gaining a living by writing rather than doing, and seeing policy abstractly. The work of public health practice, transforming communities through health promotion, health protection and better health care gets only passing mention. For a future conference and publication could the organizers address how academics and practitioners in public health can work together to deliver impacts?