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Public health
Is the ethos of medical practice in community paediatrics compatible with that in public health?
  1. Health Services Research Unit
  2. Department of Public Health, University of Oxford, Oxford, UK
  3. email:

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Public health and community paediatrics go back a long way together. At times, in their history, the two have been so closely linked as to be indistinguishable. Two early “public health” initiatives in the UK—the establishment of the school health services, and of maternal and child welfare clinics—bear witness to early awareness that measures to improve children's health may be important for the health of adults. Infant mortality rates have long been regarded as a key indicator of the overall health of a nation in international comparisons, and in the UK doctors working in community child health services were first based in departments of public health. At other times the two specialties have seemed very separate. The 1974 NHS reorganisation and the concomitant development of two separate medical specialties—community child health (as community paediatrics was then called) and community medicine (as public health medicine was then called) pulled them apart. Several different forces are encouraging the two back together again: the political glasnost on social inequalities in health, and recognition at professional level that these inequalities have their most noxious impact on children1 ,2; the need to join forces, in the face of powerful financial interests, to advocate for a healthier environment for children (against the tobacco industry, the motor industry, and baby milk manufacturers); the need to maintain high levels of immunisation and the need to modernise the child health surveillance programme3; the rediscovery of the “life course approach to health”4 ,5 and of “cycles of disadvantage”6; and the publication of research which shows that it is possible to have an impact on intractable adult public health problems by intervention in early childhood.7 ,8Some have proposed that the development of a new specialty—child public health—is the best …

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