Public health and English local government: historical perspectives on the impact of 'returning home'

Abstract

This article uses history to stimulate reflection on the present opportunities and challenges for public health practice in English local government. Its motivation is the paradox that despite Department of Health policy-makers’ allusions to ‘a long and proud history’ and ‘returning public health home’ there has been no serious discussion of that past local government experience and what we might learn from it. The article begins with a short resumé of the achievements of Victorian public health in its municipal location, and then considers the extensive responsibilities that it developed for environmental, preventive and health services by the mid-twentieth century. The main section discusses the early NHS, explaining why historians see the era as one of decline for the speciality of public health, leading to the reform of 1974, which saw the removal from local government and the abolition of the Medical Officer of Health role. Our discussion focuses on challenges faced before 1974 which raise organizational and political issues relevant to local councils today as they embed new public health teams. These include the themes of leadership, funding, integrated service delivery, communication and above all the need for a coherent vision and rationale for public health action in local authorities.

Commissioning for health improvement following the 2012 health and social care reforms in England: what has changed?

“…Our findings have demonstrated how, in this new environment, existing public health capacity has been both freed and stifled. Public health professionals have the opportunity to take on a more significant role in shaping local places, but will need to find a balance between ‘service’ public health and academic ‘social medicine’ [23]. …”

The return of public health to local government in England: changing the parameters of the public health prioritization debate?

“…Perhaps ironically, given that local government is often perceived as the natural home for public health, 23 the study exposed differences between NHS-based public health and local authority-based public health in views over evidence, priority-setting processes and the role of local democratic decision-making. Generalisability of findings is limited by the small number of case study sites and by public health still being in transition in late 2013, with the public health budget largely 'rolled over' with few changes to previous contracts.…”

Why policy needs history (and historians)

“…These focussed on the role of leadership; funding; communication; and vision and rationale. Public health leaders had the opportunity to shape an integrated service on the model of the pre-war local authority model (Gorsky et al, 2014). But not all agree and the published article led to debate from 'one who was there' who thought the move back to the local authorities was a retrograde one (Holland, 2015).…”