We would argue that a return to the era of the Medical Officer of Health would risk another sidelining of the specialty at a time when it must be at the centre of the health scene. The radical option of the establishment of an independent public health commission is of course attractive, but it does not seem feasible that any government of whatever political complexion would be willing to fund and support such a body persistently at an adequate level. We therefore, favor the third option of modifying and extending the present structure, powers and functions of public health within Health Authorities and boards but with the addition of a national, and several regional institutes.

Public health is now at a cross-roads where it can either accept the status quo or confront realistic change and challenge and seek to regain its former independent voice. It is more than time, for example, to nail the “libertarian” myth that individual freedom and the right to choose are worth more than an improvement in the health of the population as a whole. Public health does not and should not seek to patronize, nanny or coerce the population into “health”, as is sometimes suggested by powerful critics with vested interests.

But the specialty surely has a duty to inform the public responsibly on public health matters, to fight the active promotion of products such as cigarettes, which have a well proven and damaging effect on health, and to seek vigorously the introduction of simple public health measures, such as fluoridation of public water supplies, which would provide enormous benefits, particularly in more deprived sectors of the population.

We perceive public health as the central medical specialty of the future. It now has a clear and workable definition of its proper functions and we hope it will find the courage and unity to face the challenge of realistic change in pressing for the return of its independent voice.

Of course this is a personal view. But the political climate now seems right for such a move to lay the foundations for a real improvement in the nation’s health in the next century. The Labor Government, elected in May 1997, has in principle accepted the central importance of public health in its creation of the new post of Minister of Public Health. And public health has surely learned from the lessons of history the real power of political expediency, opportunism and realism. This we hope will be the new vision and challenge for public health.