Previous chapters have indicated the potential breadth of a public health system. Chapters Three and Four are devoted to providing a historical account of the public health function in England. This chapter takes 1974 as its starting point, which is when lead responsibility for public health was transferred from local government to the NHS, where it has remained ever since. It covers the period between this significant change and 1997, when there was a change of government, which had significant implications for public health policy. The next chapter picks up the story from 1997 to 2009.

The evolution of public health policy and practice in England since 1974 has been underpinned by a number of overlapping and recurring themes and schisms, several of which were described in the last chapter. Principal among these, and in no particular order, are the following:

• • what constitutes public health policy and practice, and how the function (that is, the organisation with main responsibility) is defined;

• • the optimal location of the public health function;

• • the relationship between health improvement and inequalities in health;

• • the population focus of public health vis-à-vis attempts to influence individual lifestyles;

• • the nature and conceptualisation of the workforce, in terms of both capacity and capability;

• • the nature and scope of the public health system;

• • the balance between collective responsibility and individual choice;

• • the balance between ‘upstream’ public health interventions and health care services;

• • the extent to which primary care focuses on population health;

• • public health's advocacy role in relation to its corporate identity (that is, activist versus ‘technician-manager’ roles) (Berridge, 2006: xxiii).

Debates about each of these issues have recurred in cyclical fashion during the evolution of the public health function since the 1970s and most remain contested and largely unresolved issues for current policy and practice. The first part of this chapter examines the rise of the new public health in the UK, which occurred in the late 1970s, and which encouraged practitioners and policy makers to focus on the wider health agenda and break free from a restrictive obsession with health care and ill health. The second part of the chapter provides a brief account of the main developments in the location and organisation of the public health function since 1974.