Health systems everywhere are experiencing rapid change in response to new threats to health arising from lifestyle diseases, risks of pandemic flu, long-term conditions and the global effects of climate change and other threats to sustainable development. Issues that were previously viewed as distinct and separate are now regarded as inextricably linked through their impact on health with the result that a significant refocusing of policy is under way, albeit with varying degrees of success. Such developments have profound implications for future public health policy and practice. Public health, as a function embracing a wide range of skills and expertise, is, or should be, at the forefront of this refocusing of health policy and practice. If it is to succeed, public health needs to adapt to the changing context and, in doing so, to address a number of long-standing issues that have hitherto hampered the public health function and prevented it from realising its full potential.

As the first decade of the 21st century comes to a close, this book assesses the state of the public health system in England. It is the first in a series of public health texts drawing on research largely funded by the National Institute for Health Research (NIHR) Service Delivery and Organisation (SDO) programme. The SDO launched its public health research programme in 2007, funding seven studies examining key aspects of contemporary concern and relevance to the organisation and delivery of public health. The book series will provide a platform for the findings from these studies. The purpose of this first book is to set the scene for the series by comprehensively assessing and critiquing the current state of the public health system in England. It places contemporary challenges and concerns in their historical context, tracing the dominant influence of a medical paradigm on the public health profession and exploring how this has given rise to difficulties for those who subscribe to social or structuralist paradigms. The history of public health is marked by struggles between these competing perspectives and recent policy developments have pointed in contrasting directions. While the public health profession has been actively encouraged to embrace a multidisciplinary perspective, it has simultaneously come under mounting pressure to contribute more effectively to achieving targets through clinical interventions.