Public health medicine advice to local authorities:Does it happen?

Abstract

The views of public health physicians on the extent and quality of their specialty'scollaboration with local government in Scotland was ascertained by postal questionnaire. Responses were received from 84 out of 97 (85%). Consultants in Public Health Medicine (CPHMs) working in Scottish health boards. Those working in health boards were more likely than colleagues in university departments to consider their service department to be sufficiently aware of and involved in issues having a bearing on health but not directly related to provision of health services (48/70 vs 4/12, RR 2.1, 95% CI 1.1–3.8). Seventy CPHMs gave advice to local authorities. They were in contact with amedian of two local authority departments (range 0–6); most commonly Social Work (38 CPHMs), Environmental Health (36), and Education (26). CPHMs participated in a median of one multi-disciplinary group (range 0–3); most commonly Health Promotion (16 CPHMs), Child Welfare (9), Emergency Planning (9). The majority, 42 of 67 (63%), valued this contact highly, only three considering it of doubtful utility. Difficulties with bringing an item to the attention of a local authority department were identified by six out of 56 (11%) CPHMs and 32/69 (46%) recorded problems in ensuring Public Health Medicine input to local authority committees. In most health boards (12/14) there were formal meetings between CPHMs and heads of local authority departments; in each these were supplemented by informal meetings. One Director of Public Health and eight other CPHMs reported neither formal nor informal with local authorities. Spontaneous comments from respondents indicated a desire to strengthen the links with local authority departments. The proposed reorganisation of local government provides an opportunity to redefine and strengthen Public Health Medicine input.