Public Health
Volume 123, Issue 7 , Pages 463-464, July 2009

Essential public health

Royal Society for Public Health, 3rd Floor Market Towers, 1 Nine Elms Lane, London, SW8 5NQ, UK

published online 21 July 2009.

Article Outline

 

For many years, one of the best loved textbooks used by public health specialists in training within the UK has been known simply as ‘Donaldson’. The actual title of the book is something of a microcosm of UK public health history. Starting life as “Essential Community Medicine: Including Relevant Social Services”, it passed through versions entitled “Essential Public Health Medicine” and “Essential Public Health” until now – some quarter century later – when a new edition has been published under the title of “Donaldson's Essential Public Health”.1 Any publisher will tell you that including the word “essential” is a part of the overall positioning of the textbook in the market. It is a way of suggesting that this is the one book that you need to buy. Yet in the present context of a pandemic of Influenza A/H1N1 the term ‘essential public health’ is taking on more urgent meanings.

For many of us, dealing with seasonal influenza is part of the everyday ‘essential public health’ service that is provided. In some years this is a very minor part of health protection activity, in others less so. The availability of annual influenza vaccination – and the use of organised immunisation campaigns targeted on the more vulnerable – is all part of the routine health protection effort. The impact of such a targeted influenza immunisation campaign is described in a paper we are publishing this month from Spain.2 The fact that Influenza A/H1N1 is being shown to have an increased attack rate amongst younger people3 makes this study all the more timely. The evidence for general uptake of preventive health care in this group may, however, be a cause for concern in planning for an A/H1N1 immunisation campaign using existing distribution routes.

At a time of pandemic, ‘essential public health’ has also taken on a different meaning as public health departments and services are diverting resources away from more routine functions to meet the expected demands associated with identifying and treating influenza cases and their contacts. In such circumstances, what constitutes an ‘essential public health’ service is being explored very carefully, especially in developing countries where there are already concerns about the availability of medical and nursing staff to meet the existing health care requirements.4 Against this background, would it be pertinent to consider whether TB management in India will remain a public health services priority?5 Or will management of high risk behaviour amongst young people in prisons be forced to come second to influenza containment or mitigation?6 And will seeking to address the poor mental health literacy amongst rural populations be sidelined?7 If the pandemic – as many expect – extends into the latter half of 2009 and into 2010, how long will routine health surveillance resources be able to monitor general indicators of health8 or specific indicators of vulnerability amongst marginalised populations?9

These are not idle questions or musings. Public health functions in many countries are having to work through these issues and provide expert advice not only on the emerging pandemic and its management, but also on the continuity of health and social care services which will be affected by it – a factor which was previously considered in a paper which we published in 2006 on pandemic preparedness.10

For those of us fortunate enough to have taught from, or had personal use of, consecutive editions of ‘Donaldson’ over the years, it has been possible to see the steady evolution of public health concerns within the UK. Yet were we to sit down with each version and edition of the book what would be most striking would be the observation that several core themes of the book – including prevention, maternal and child health, disability, and health in older age – have remained constant. Whilst we might look most closely at the sections dealing with communicable disease control right now, we would be forced to acknowledge that meeting the public health needs of the people we serve is a matter of balance and of focus. So, quite rightly, the book has always reflected the needs of good, yet pragmatic, public health practice, which change over time and geographically, in response to objectively identified priorities for the protection and promotion of health, the core elements of which have remained the same from the very beginning.

In this issue

 

At a time when public health systems across the world are dealing with the A/H1N1 pandemic, we are pleased to publish a new study on influenza vaccination coverage amongst Spanish children. It is a study that will give some pause for thought for many planning their influenza responses. This is not the only health protection issue in this edition as we present papers on TB management in public and private hospitals in India and a letter updating us on the powers of detention of non-compliant TB patients in Ireland. More broadly, factors relating to health behaviours are explored in a number of papers that consider high risk behaviours in Pakistani prisons, social capital and smoking in Sweden, smoking in pregnancy in Germany and mental health literacy in rural India. We also present, in a growing area of public health practice, new data on the impact of domestic violence on residential mobility in Denmark. With a further paper from the ISARE III collaboration on health indicators representing health intelligence and a study of repeat attenders at National Health Service walk-in centres to represent health services efficiency and quality, this edition of Public Health is another one to cover the whole public health spectrum. Not forgetting another very timely paper – on health policy and its philosophical underpinnings.

Back to Article Outline

References 

  1. Donaldson LJ, Scally G. Donaldson's essential public health. Oxford: Radcliffe; 2009;
  2. Lopes-de-Andrews A, Hernandez-Barrera V, Carrasco-Garrido P, Gil-de-Miguel A, Jiménez-García R. Influenza vaccination coverage among Spanish children, 2006. Public Health. 2009;123:465–469
  3. WHO . WHO Technical Consultation on the severity of disease caused by the new influenza A (H1N1) virus infections. Available from: http://www.who.int/csr/resources/publications/swineflu/Report_20_05MayTeleconferencex.pdf2009;[accessed 14.06.09]
  4. Stilwell B, Diallo K, Zurn P, Vujicic M, Adams O, Dal Poz M. Migration of health-care workers from developing countries: strategic approaches to its management. Bull World Health Org. 2004;82:595–600
  5. Vandan N, Ali M, Prasad R, Kuroiwa C. Assessment of doctors' knowledge regarding tuberculosis management in Lucknow, India: a public-private sector comparison. Public Health. 2009;123:484–489
  6. Altaf A, Janjua NZ, Kristensen S, Zaidi NA, Memon A, Hook EW, et al. High-risk behaviours among juvenile prison inmates in Pakistan. Public Health. 2009;123:470–475
  7. Kermode M, Bowen K, Arole S, Joag K, Jorm AF. Community beliefs about treatments and outcomes of mental disorders: a mental health literacy survey in a rural area of Maharashtra, India. Public Health. 2009;123:476–483
  8. Wilkinson J, Berghmans L, Imbert F, Ledésert B. Ochoa A, the Members of the ISARE III Project Team. Health indicators in the European regions: expanding regional comparisons to the new countries of the European Union – ISARE III. Public Health. 2009;123:490–495
  9. Elklit A, Shevlin M. Sexual victimization as a risk factor for residential mobility: A case-control study using the Danish registry system. Public Health. 2009;123:502–505
  10. Bunting CJ. Pandemic flu: are we properly prepared?. Public Health. 2006;122:591–596

PII: S0033-3506(09)00170-X

doi:10.1016/j.puhe.2009.06.016

Public Health
Volume 123, Issue 7 , Pages 463-464, July 2009

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