The politics of public health in the United Kingdom between medical, social, and local

Abstract

Abstract Background Public health in the UK exists on a continuum from a national and medical pole to a local and social pole, with each end threatening obliteration as a distinctive field of expertise and action. The national-medical produces a subfield of medicine, with a range of highly developed skills including epidemiology. The local-social, manifested in social medicine as well as equivalent approaches in social work, education, and local government, produces health, which need not be medical, as a result of investment in integrated services that enable solidary, dignified communities. This model is more invested in local communities and local governments, and more likely to blur borders with social work, leisure, and other areas, and have an overtly social democratic ethics and set of arguments. Methods A comparative historical analysis (CHA) based on government documents, law, and secondary sources. Results Public health in the UK has changed shape many times, from the end of most formal public health between 1948 and 1974, to the creation of a public health function in the 1980s, to the moment of divergence in 2012 when England reverted to a local public health and the devolved administrations did not. Conclusions The scope of public health might formally be the causes of avoidable ill health. In practice, the accepted expertise and autonomy of public health is found in narrower areas related to medicine: communicable disease control, health education, a few social services such as outpatient and outreach mental and sexual health, and the search for politically acceptable policies to address NCD threats. With public health moved to local government in England, its relationship with the NHS and medicine is likely to weaken further, to the likely detriment of the formal public health function and public health.