Introduction

In the late 1990s, England embarked upon a journey to create a multidisciplinary public health workforce marked by equality of opportunity and equality of status at specialist level. This was in response to pressure, building from the late 1980s, from public health professionals from backgrounds other than medicine for recognition of their contribution to public health and for access to training and development. It was also in response to a better understanding of the changing public health needs of the time, which called for a broader range of skills in the workforce. The implications have been far-reaching and have led England to have a model for its public health workforce that is different from other developed countries. Although the stimulus was for recognition at specialist level, the ramifications of the changes that took place have embraced those involved in the operational delivery of public health services and have also led to consideration of the public health contribution made by the wider health and social care workforces.

Changing perceptions of public health

Public health, as a specific discipline, came to the fore in England during the 19th century in response to crises in sanitation and infection control leading to epidemics of typhoid and cholera, as well as high mortality rates. Medical Officers of Health, located within each local authority and heading up large teams of public health inspectors and nurses, led the implementation of a raft of legislation to improve sanitation, housing, food inspection and control of infectious diseases.

Public health issues in the 21st century are very different from those perceived in the 19th century. Although a key area of work for the public health workforce continues to be combating new and reemerging infections (eg SARS and influenza, respectively), much more attention is now devoted to reducing obesity, maintaining health in an ageing population, improving sexual health and tackling widening health inequalities in the face of recession.

There is no internationally agreed definition of public health. The Alma Ata Declaration (WHO and UNICEF, 1978), ‘Health for all’ (WHO, 1981) and the Ottawa Charter (WHO Europe, 1986) contain the modern emphasis on securing well-being as well as absence of disease.