The creation of the Faculty of Community Medicine (now the Faculty of Public Health Medicine) of the Royal Colleges of Physicians of the United Kingdom

The National Health Service Act 1946 transferred responsibility for the non-voluntary hospitals and certain clinical services from the public health departments of counties and county boroughs to new regional hospital boards, thereby substantially reducing the functions of their medical officers of health and creating a separate cadre of doctors concerned with the planning and management of hospital and specialist services. At around the same time there was pressure to develop in each medical school a department of social and preventive medicine with full-time staff involved in research work. Reviewing the situation 20 years later, the Royal Commission on Medical Education recommended that doctors in public health, medical administration or related teaching and research should form a single professional body concerned with the assessment of specialist training for and standards of practice in 'community medicine'. Immediately after the publication of the Commission's Report in 1968, J. N. Morris invited leaders in the three strands of activities to meet and discuss the proposal. A series of informal meetings led to the setting up, in 1969, of a Working Party (chairman, J. N. Morris) which negotiated with the Royal Colleges of Physicians of Edinburgh, Glasgow and London for them to create a faculty of community medicine. In November 1970 the Colleges set up a Provisional Council (chairman, W. G. Harding), later Board, and the Faculty formally came into existence on 15 March 1972. The key decisions and some of the complications and hitches encountered in achieving this radical outcome are described in this paper

COVID-19 data on the fringes:the Scottish story

COVID-19 hit at a time when the United Kingdom was vulnerable, reeling from its exit from the European Union and wracked by ongoing issues over the devolved nations, particularly Northern Ireland and Scotland, both of which had voted to remain in the EU during the 2016 referendum. Scotland had its own 2014 referendum on independence from the UK, which was narrowly won by the “No” side. While a pro-Brexit, right-wing Conservative government rules in London, the devolved administration in Edinburgh is led by the center-left Scottish National Party (SNP) government and first minister Nicola Sturgeon. However, when the pandemic first hit the UK in the early months of 2020, there was no discernible difference in approach between the Scottish government and the UK Government. In March 2020, both Scotland and the wider UK imposed lockdowns later than in other European countries. By mid-March, both had abandoned manual contact tracing around the same time that “Big Tech” firms such as Palantir were invited to meetings with the UK government. Later that month, NHSX (the English public health service unit tasked with setting policy and best practice for digital technologies and data in health) started developing a contact-tracing app amid techno-deterministic claims from the Johnson administration in London that we could digitize our way out of the pandemic

Active Mobility – the New Health Trend in Smart Cities, or even More?

Active mobility (AM), including walking and cycling as single trips or in combination with public transport, has recently been promoted by health professionals – with WHO leading the way – to tackle health problems caused by physical inactivity. In fact only 1/3 of the European population is estimated to meet the minimum recommended levels of physical activity by the WHO of 30 minutes of moderate-intensity activity 5 times per week. Being aware that we spend between 70 to 80 min per day travelling and that 50% of all car trips (in Europe) are shorter than 5 km, active mobility has an enormous potential to get people more active. However, how is this knowledge of proven positive health effects of AM been taken into account – either by urban and transport planning authorities or by health administration? Is this „new health trend“ visible in strategies, cooperation or – what’s even more important – in implemented measures in smart cities? “Physical activity through sustainable transport approaches” (PASTA1)” is a European project addressing and analyzing the promising link between transport and health. It pursues an interdisciplinary approach involving scientists and leading experts from a range of disciplines, including (among others) transport and urban planning, public health, environmental sciences, climate change and energy, and transport economics. The overall aim of the project is to generate knowledge about the effects of AM in consideration of health effects. This paper reveals backgrounds and relationships between transport and health work in seven European case study cities (Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zurich) based on workshops and stakeholder interviews conducted in PASTA. Considering cities‘ framework conditions (strategies and policies, infrastructure and other measures promoting AM etc.) and comparing stakeholders‘ perspectives bring out that cities have to struggle with similar barriers and challenges. Otherwise they take promising approaches and efforts towards sustainable and healthy urban development; increasing synergies between the health and transport sector seems to be one of the missing links between transport and health. Good practices and new ideas for transport planners and health experts are provided aiding to create livable conditions through well-planned infrastructure, a safe environment and attractive public space, awareness-raising activities and various broader policies – including the health policy. After all AM should not just be an ephemeral health trend, but common (health) practice

A comparison between the public health methods of London and Paris

A comparison of the Public Health methods of London with Paris must necessarily be in- complete , The difficulties of such a com- parison rendering it so . These might be classified under the following heads of funda- mental differences;- racial, climatic, dimen- sional, and "constitutional". The Parisians have the lightheartedness and gaiety of the Southern nations . Much of their life is spent out of doors , they have their favourite cafes, where they meet their friends and often transact their business. Their meals and their meal times are essentially different to those of the Londoner. The cloud- covered skies, the frequent rains, fogs, and the high relative humidity of the atmosphere tend perhaps to produce a sober or gloomy state of mind in the Londoner. His mental reserve must not ho ever be put down wholly to climate for Ireland has a climate not less humid than has England but her inhabitants vie with the Southern nations in lightness and brightness of spirits.London and Paris differ in size and popula- tion, both are situated on the banks of a river but one has the advantage as far as drainage is concerned of being near a tidal estuary. The altitude of London is 50 feet, of Paris 210 feet, above sea level. The entanglementof authorities with a certain unavoidable overlapping inseper- able from administration areas of such enormous dimensions and such heterogeneous agglomerate bodies corporate, is, certainly since the new French Law of 1902 (regulating among other things the respective duties of the Prefect de Police and the Prefect de la Seine more marked in London. These various points are however dealt with in the appropriate section of the thesis,which are as follows; -Law, administration, authorities statistics; Hospitals; Infectious diseases etc. Disinfection; Housing; Water; Drainage; Street cleansing etc. Pood InspectionIn conclusion I would remark on some points of difference between the two capitals, what is better managed in each, what might be improved.In London there is much confusion owing to the multiplicity of authorities. It is for instance,doubtful even to legal experts, how far the Local Government Board can interfere with the Corporation of the City of London, or with the Post Office, who possess certain rights. The London County Council can intervene to a certain extent as regards the Metropolitan Boroughs, but not as regards the city. As I mention- ed in the section on drainage, the methods of the L. C.C. are not always above criticism. An idea prevails that it panders to the more attractive schemes. As regards investigation into contaminated watercress beds and such like, as I mentioned, such are better done as in the case of the oyster beds by the Local Government Board, who have authority, and can act fearlessly, and the information gained can then be of value. In July 1904, a Conference of representatives of the Metropolitan Asylums Board and Metropolitan Boroughs' Councils, was held on the administration of the "Public Health (London) Oct. 1901," with the idea of exchanging views and laying down principles with a view to the Laws relating to p.TH. being equally and uniformly inforced throughout London. But with what result? Twenty nine authorities were invited to send representatives. 25 (not including the City or Westminster) accepted. A heated dispute arose as to whom should have the right to vote, as a result, 2 representatives from Paddington (according to their instruct- ions), had to withdraw. The conference was drowned in talk, resolutions were passed, but there is no evidence that any betterment will result from the meeting; jealousy between the different boroughs exists to such an extent. One of the Boroughs (Poplar), is said to be on the verge of bankruptcy, and the L.G.B. is at present holding an enquiry into its affairs. In short London requires, greatly, (a) One single authority under the Local Government Board to control public health matters. (b) A water supply from Wales. (c) The Main Drainage extended sufficiently to be efficient in the vet season.With regard to Paris, Paris is certainly behind, as regards house drainage, the old systems have not been rooted out, that takes time. Things move slowly in France, it takes time for the people to be educated to the new methods, and not resent interference. In regard to this mutter I stumbled on the following quotation in referring to a French work, "La maison du citoyen anglais défie toutes les forces de l'etat. Ce peut n' e'tre qu'une..,nasure; elle peut étre déla- brée; le toit peut s'étre effondre le vent peut y entrer; la pluie peut y entrer; mais le roi d'An - gleteue ne peut pas y entrer." It is the well known utterence of William Pitt, but now in Britain the sanitary inspector does what the King could not, and it is becoming so likewise in France. The new French' Laws of 1902 -1903 are bringing about a vast change. The 'Casier sanitaire, "an idea got from Brussels and Berlin, is well worthy of imitation in this country, as we have imitated the creches, milk depots, and slaughter houses. There is now no confusion of authority in Paris. Each prefet has his duties defined, but it is to be regretted, I think, that the Prefet de Police still retains in part duties connected with vaccination and infections disease, which might have been wholly transferred to the Préfet de la Seine. It is also regrettable, I consider, that the tax taken off temperance drinks (boissons dites hygiéniques ), has been placed on private gardens. These should be encouraged, cities have every need of these open spaces

The wicked and complex in education: developing a transdisciplinary perspective for policy formulation, implementation and professional practice

The concept of 'wicked issues', originally developed in the field of urban planning, has been taken up by design educators, architects and public health academics where the means for handling 'wicked issues' has been developed through 'reflective practice'. In the education of teachers, whilst reflective practice has been a significant feature of professional education, the problems to which this has been applied are principally 'tame' ones. In this paper, the authors argue that there has been a lack of crossover between two parallel literatures. The literature on 'wicked issues' does not fully recognise the difficulties with reflective practice and that in education which extols reflective practice, is not aware of the 'wicked' nature of the problems which confront teachers and schools. The paper argues for a fresh understanding of the underlying nature of problems in education so that more appropriate approaches can be devised for their resolution. This is particularly important at a time when the government in England is planning to make teaching a masters level profession, briefly defined by the Quality Assurance Agency for Higher Education (QAA) benchmark statement as 'Decision-making in complex and unpredictable situations'. The paper begins by locating the argument and analysis of 'wicked problems' within the nature of social complexity and chaos. The second part of the paper explores implications for those involved in policy formation, implementation and service provision. Given the range of stakeholders in education, the paper argues for a trans-disciplinary approach recognising the multiple perspectives and methodologies leading to the acquisition of reticulist skills and knowledge necessary to boundary cross. © 2009 Taylor & Francis

Factors that are associated with the risk of acquiring Plasmodium knowlesi malaria in Sabah, Malaysia: a case-control study protocol

Introduction Plasmodium knowlesi has long been present in Malaysia, and is now an emerging cause of zoonotic human malaria. Cases have been confirmed throughout South-East Asia where the ranges of its natural macaque hosts and Anopheles leucosphyrus group vectors overlap. The majority of cases are from Eastern Malaysia, with increasing total public health notifications despite a concurrent reduction in Plasmodium falciparum and P. vivax malaria. The public health implications are concerning given P. knowlesi has the highest risk of severe and fatal disease of all Plasmodium spp in Malaysia. Current patterns of risk and disease vary based on vector type and competence, with individual exposure risks related to forest and forest-edge activities still poorly defined. Clustering of cases has not yet been systematically evaluated despite reports of peri-domestic transmission and known vector competence for human-to-human transmission.Methods and analysis A population-based case–control study will be conducted over a 2-year period at two adjacent districts in north-west Sabah, Malaysia. Confirmed malaria cases presenting to the district hospital sites meeting relevant inclusion criteria will be requested to enrol. Three community controls matched to the same village as the case will be selected randomly. Study procedures will include blood sampling and administration of household and individual questionnaires to evaluate potential exposure risks associated with acquisition of P. knowlesi malaria. Secondary outcomes will include differences in exposure variables between P. knowlesi and other Plasmodium spp, risk of severe P. knowlesi malaria, and evaluation of P. knowlesi case clustering. Primary analysis will be per protocol, with adjusted ORs for exposure risks between cases and controls calculated using conditional multiple logistic regression models.Ethics This study has been approved by the human research ethics committees of Malaysia, the Menzies School of Health Research, Australia, and the London School of Hygiene and Tropical Medicine, UK

Bringing Anglo-governmentality into public management scholarship : the case of evidence-based medicine in UK health care

The field of public administration and management exhibits a limited number of favored themes and theories, including influential New Public Management and Network Governance accounts of contemporary government. Can additional social science–based perspectives enrich its theoretical base, in particular, analyzing a long-term shift to indirect governance evident in the field? We suggest that a variant of Foucauldian analysis is helpful, namely “Anglo-governmentality.” Having reviewed the literatures, we apply this Anglo-governmentality perspective to two case studies of “post hierarchical” UK health care settings: first, the National Institute for Health and Clinical Excellence (NICE), responsible for producing evidence-based guidelines nationally, and the second, a local network tasked with enacting such guidelines into practice. Compared with the Network Governance narrative, the Anglo-governmentality perspective distinctively highlights (a) a power–knowledge nexus giving strong technical advice; (b) pervasive grey sciences, which produce such evidence-based guidelines; (c) the “subjectification” of local governing agents, herein analyzed using Foucauldian concepts of the “technology of the self” and “pastoral power”; and (d) the continuing indirect steering role of the advanced neoliberal health care State. We add to Anglo-governmentality literature by highlighting hybrid “grey sciences,” which include clinical elements and energetic self-directed clinical–managerial hybrids as local governing agents. These findings suggest that the State and segments of the medical profession form a loose ensemble and that professionals retain scope for colonizing these new arenas. We finally suggest that Anglo-governmentality theory warrants further exploration within knowledge-based public organizations

Addressing ethnicity in social care research

This article surveys recent developments in relation to the dimensions of ethnicity and ethnicdisadvantage in social policy research and practice, with a focus on social care. While therehas been limited increase in attention to ethnicity within general policy discussion andincreasing sophistication within specialist debates, advances in theory and methodology havelargely failed to penetrate the research mainstream, let alone policy or practice. This is along-standing problem. We advocate more focussed consideration of ethnicity and ethnicdisadvantage at all levels. Failure to do so creates the risk of social policy research being leftbehind in understanding rapid changes in ethnic minority demographics and patterns of migration, with increasing disadvantage to minorities

Primary care-led commissioning and public involvement in the English National Health Service. Lessons from the past.

Background: Patient and Public involvement (PPI) in health care occupies a central place in Western democracies. In England, this theme has been continuously prominent since the introduction of market reforms in the early 1990s. The health care reforms implemented by the current Coalition Government are making primary care practitioners the main commissioners of health care services in the National Health Service, and a duty is placed on them to involve the public in commissioning decisions and strategies. Since implementation of PPI initiatives in primary care commissioning is not new, we asked how likely it is that the new reforms will make a difference. We scanned the main literature related to primary care-led commissioning and found little evidence of effective PPI thus far. We suggest that unless the scope and intended objectives of PPI are clarified and appropriate resources are devoted to it, PPI will continue to remain empty rhetoric and box ticking. Aim: To examine the effect of previous PPI initiatives on health care commissioning and draw lessons for future development. Method: We scanned the literature reporting on previous PPI initiatives in primary careled commissioning since the introduction of the internal market in 1991. In particular, we looked for specific contexts, methods and outcomes of such initiatives. Findings: 1. PPI in commissioning has been constantly encouraged by policy makers in England. 2. Research shows limited evidence of effective methods and outcomes so far. 3. Constant reconfi- guration of health care structures has had a negative impact on PPI. 4. The new structures look hardly better poised to bring about effective public and patient involvement

Delivering reform in English healthcare: an ideational perspective

A variety of perspectives has been put forward to understand reform across healthcare systems. Recently, some have called for these perspectives to give greater recognition to the role of ideational processes. The purpose of this article is to present an ideational approach to understanding the delivery of healthcare reform. It draws on a case of English healthcare reform – the Next Stage Review led by Lord Darzi – to show how the delivery of its reform proposals was associated with four ideational frames. These frames built on the idea of “progress” in responding to existing problems; the idea of “prevailing policy” in forming part of a bricolage of ideas within institutional contexts; the idea of “prescription” as top-down structural change at odds with local contexts; and the idea of “professional disputes” in challenging the notion of clinical engagement across professional groups. The article discusses the implications of these ideas in furthering our understanding of policy change, conflict and continuity across healthcare settings