Introduction

This chapter sets the scene for later, important, developments in the multidisciplinary public health movement. The story starts in the early 1970s, when the public health system for England, which had been in existence since the introduction of the National Health Service (NHS) in 1948, was radically changed. Public health doctors, who had been employed within the local government structure since the 19th century, commonly heading large teams and with substantial responsibilities and budgets, were transferred in 1974 to the new health service structures. This chapter charts the development of this fledgling medical specialty within the NHS between 1970 and 1990 and outlines how insecurity and a desire for self-preservation among public health doctors contributed to a retention of a medically led public health model in the face of increasing opposition from public health professionals from backgrounds other than medicine who sought greater recognition of their roles.

The public health medical workforce and model for public health from 1948

Public health was a multidisciplinary endeavour from the mid-19th century but it was always medically led. Public health doctors worked within the local government structure: helping to implement major public health sanitation legislation for amenities such as clean water and battle infectious diseases; managing and leading the work of teams of public health nurses and sanitation engineers; and overseeing and running community health services.

Public health as a discipline for doctors was embedded into postgraduate medical training from this time through the Diploma in Public Health, a well-respected qualification offered by a number of UK institutions. The Local Government Act 1888 established the role of Medical Officer of Health in all provincial districts, creating a cadre of doctors with a licence to practise preventive rather than curative medicine (Berridge, 2007).