Major public health problems have tended to recur continuously over the years, sometimes in slightly different guises or with modifications. There are four broad areas of concern:

i) Outbreaks of disease caused by infective or toxic agents - for example smallpox, typhoid, food poisoning, BSE, radiation and so on;

ii) Problems arising from social and environmental issues such as inadequate housing, unemployment, poverty, abortion, fluoridation of water;

iii) Behavioral concerns such as smoking, excessive consumption of alcohol, drug-taking, absence of exercise;

iv) Health service issues including assessment of health care needs and outcomes, and the effectiveness and efficiency of particular services.

Given that these types of problem will continue to be faced in the future, how can the practice of public health be improved to address them directly and try to find solutions for the modern age?

Public health, as a discipline, should not become involved in the management of clinical services whether in the community or within institutions - it lacks the expertise essential for this task. Its prime responsibility is to promote health and to prevent and control disease. It should thus have responsibility for surveillance and for the planning and co-ordination of measures which promote and maintain health. It should be involved in the planning and distribution of clinical services in accordance with measures of need and demand and the assessment of effectiveness.

Since the major academic disciplines of public health, epidemiology, medical statistics and some aspects of the social sciences including economics, are the unique bases of training in public health, their contribution to the inter-disciplinary work required to develop clinical services in accordance with criteria of need, effectiveness and resource availability are required, and accepted, by the other disciplines involved.