Multidisciplinary public health: what sort of victory?

Multidisciplinary public health (MDPH) has been a phenomenon in the UK of the 1990s and the early 21st century. Its achievement has been seen as a victory for non medical interests. While acknowledging this, the paper questions what sort of victory this represents. Public health in its sanitary phase in the mid-19th century was, after all, what passed for multidisciplinary with its mix of engineers, doctors and statisticians. Is the present simply a return to the sanitary phase? The paper argues that it is not, and that contemporary public health badly needs clearer definition. It identifies three dimensions of recent public health. Public health can be an occupation; a discourse or movement, and also an institutional location of which public health research is part. Looked at in this frame, public health has been multidisciplinary in the post war period. The development of public health research out of social medicine in the 1950s was multidisciplinary. Public health campaigning, separate from public health professionals, has also been multidisciplinary since the 1970s. Public health as an occupation has been preoccupied with its professional positioning. Will the wider multidisciplinary impetus of public health now be lost in a preoccupation with status?     

Missed opportunities? Locating health promotion within multidisciplinary public health

This paper examines the complex interconnections between the development of health promotion and multidisciplinary public health, respectively. Health promotion takes a distinctive interdisciplinary and multiprofessional perspective on health. Historically, it has brought together practitioners from varied disciplinary backgrounds, education and training. It therefore brings real advantages to the public health enterprise, where the goal is to bridge organisations, professions and partners to collectively address key determinants of health in the most effective manner. This paper debates the contribution health promotion has made to the development of multidisciplinary public health over the past 30 years and explores the principles, values, professional bases and practices of both. It is argued that health promotion's contribution to the development of 'the new public health' was critical, while its status and role within multidisciplinary public health remain problematic and unresolved. The nature of these dilemmas is discussed, reflecting on missed opportunities and possible resolutions.     

Public health in practice: the three domains of public health

This paper outlines a conceptual model for public health practice by proposing the three domains as a framework to organize and to deliver public health programmes. The model builds on the recognition that public health is everybody's business and therefore, needs a common definitional base. Different levels of skill and a wide range of contributions are needed if public health programmes are to make the most impact. The different domains of practice help to construct a basis for understanding the necessary elements of the public health system and their interactions. Using teenage pregnancy as a case study of a public health programme highlights the characteristics of the model. It demonstrates not only the importance of the role of directors of public health in taking a population-based overview, but also the need for multi-sectoral, multidisciplinary working. The relevance of the public health approach not only to primary care but also to the hospital-based sector becomes apparent, as does its relevance to communities, voluntary sector and local government. Integration of the three domains, a common definition and the framework for the public health system will support effective delivery of health improvement.     

Through the glass ceiling - and back again: the experiences of two of the first non-medical directors of public health in England

In 2001, the English Department of Health announced a radical re-organisation of the NHS under the banner of 'shifting the balance of power'. As part of this re-organisation health authorities were abolished and the main NHS public health responsibilities devolved to the new primary care trusts (PCTs) from April 2002. Following several years of campaigning by the Multidisciplinary Public Health Forum (MPHF), in November 2001 the Acting Minister for Public Health, Lord Hunt, announced that PCT director of public health (DPH) posts would be open to 'suitably qualified' candidates from any discipline. From April 2002 a number of new DsPH from backgrounds other than medicine were appointed. This paper reports on the experiences of two such DsPH who shared a commitment to multidisciplinary public health, but who did not wholly share the objectives of the MPHF. We place the opening of PCT DPH posts in the context of tensions within NHS public health between a focus on health services versus the wider determinants of health, and the development of multidisciplinary public health. The paper reflects on both the degree of change this opening represented and the limitations and tensions such appointments exposed.     

A short history of the Multidisciplinary Public Health Forum

The Multidisciplinary Public Health Forum (MPHF) was a 'network of networks' that was formed through grass roots public conferences held during the mid 1990s. It championed the development of a trained, developed and accredited multidisciplinary public health workforce in the UK. This paper draws on documentary evidence and from a series of semi-formal interviews held with individuals who were involved in the development and work of the Forum, to explore why the Forum was influential, the key milestones of the journey and the lessons that we might learn for the continued development of the public health function.     

The role of the Faculty of Public Health (Medicine) in developing a multidisciplinary public health profession in the UK

The Faculty of Public Health (FPH) started out its life as the Faculty of Community Medicine. Its initial membership was drawn from the ranks of Medical Officers of Health (MOsH), medical administrators and consultants working in communicable disease. Born under the aegis of the three Royal Colleges of Physicians, it was de facto for members of the medical profession. This was despite the intention of some of the prime movers in its creation that its membership should reflect the multidisciplinary nature of specialist public health. As such, whilst the Faculty's establishment was indeed a triumph, the triumph was only partial, since many senior public health professionals were precluded from full membership. Over the years this situation has changed, but the road to the Faculty's current open policy, based on achieving public health excellence rather than holding a professional badge, has not been a smooth one. The fears of many medical members that the specialty would be down graded through opening up its membership posed successive presidents with many, often justifiable, challenges. In this article we, former presidents, reflect on the key events during our successive tenures.     

Politics and prospects for health promotion in England: mainstreamed or marginalised?

This paper critically examines the public policy environment that underpins the politics of health promotion in England. English health policy from the late 1970s to the mid 1990s was not receptive to health promotion. The new Labour government elected in 1997 claimed to embrace a ‘Third Way’ between the free market and socialism that would appear to embrace a community-centred approach to health promotion that would through partnership-building promote equity; perversely, however, the election of this government rhetorically committed to healthy public policy was accompanied by a crisis in health promotion delivery. Despite apparent commonalities between the Third Way and health promotion, the Third Way was in many respects a neoliberal ideology and so has contributed to the marginalisation of health promotion. Although some might argue that health promotion has been mainstreamed, it is argued here that in terms of the crucial National Health Service infrastructure underpinning the health promotion movement, that the organisational capacity for health promotion has been significantly weakened. Thus the question is how you revive a movement that has lost its way? The answer must include taking a historically informed approach to analysing the problem and identifying solutions. Wider systems issues in England include the emergence of multidisciplinary public health, the sequence of changes to national health promotion organisations and the wider marginalisation of the public health movement. It is only by critically analysing and addressing these systemic issues that the prospects for health promotion in England can be revived.     

Collaborative work in public health? Reflections on the experience of public health networks

This paper aims to stimulate critical reflection and debate on the future development of multidisciplinary and collaborative public health practice. Focusing on the early experience of public health networks, it suggests that various processes of professional boundary maintenance combined with perceptions of public health amongst the wider community of practitioners may constrain the establishment of new ways of collaborative working between specialist public health practitioners and the wider public health workforce within and beyond the NHS.     

Grasping physical exercise through recreational running and non‐representational theory: a case study from Sofia,Bulgaria

To become and maintain being physically active encompasses more than purely mindful and rational decision‐making. Physical activity requires theoretical‐methodological approaches that provide more subtle understandings of the variety of contextual factors. Nettleton and Green have recently argued persuasively for the need for the sociology of public health to embrace social practices. It is also necessary to think about the spaces, affects and technologies of engagement in physical exercise. This article examines the practices of recreational runners in Sofia, the capital of Bulgaria. The article has three aims; (i) to draw attention to the promise of non‐representational theory as an additive for health research and the contextual factors of health practices, (ii) to examine recreational runner's practices and techniques of engagement in light of non‐representational theory, and (iii) to highlight how interventions in Sofia and beyond can incorporate elements of non‐representational theory into their strategies for improved public health. In drawing attention to the promise of non‐representational theory and social practices this article concludes by emphasising their importance for public health interventions in physical activity strategies.     

Food Standards Agency multidisciplinary workshop: children's food choice in the family setting

Summary   There has been relatively little research on public health nutrition interventions for families and children, compared with, for example, work in schools. In Spring 2007, the UK Food Standards Agency held a multidisciplinary workshop on food choice in families and children, bringing together researchers from psychology, social sciences, public health and nutrition. The objectives of the workshop were to form an up-to-date view of the influences on children's and young people's food choice within the family, and identify future research needs. The participants identified six key areas for future research: multidisciplinary collaboration; using mixed research methods; developing new research methods; identifying family-related diversity and tailoring interventions towards this; understanding the effects of different parenting styles and the relevance of these to implementing interventions; and developing a more sophisticated understanding of barriers and motivators to food-related change in families.