Public health medicine and primary health care: convergent, divergent, or parallel paths?
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Historically, general medical practitioners and public health doctors have striven for health goals by different means. General practice has concentrated on personal, continuing health care focused on the consultation, usually at the request of the patient. Public health doctors have emphasised changes in the environment, society, and health service provision and organisation as the basis of interventions impacting on whole populations, or on marginalised groups of the population. Changes in medical practice, social and health care organisation, and political and public expectation have forced a radical reappraisal of the traditional relationship between these two branches of medical practice. These changes include the incorporation within general practice of staff such as health visitors and district nurses spurring on the concept of primary health care; the deliberate and successful shift, continuing to gather momentum, towards preventive health care in general practice; and the move towards greater administrative involvement of general practitioners in the management, organisation, and development of health services, hastened by the NHS reforms and best exemplified by fund holding general practices. The increasing focus of public health medicine on the assessment of health and health care needs, the development of policy and strategy, the promotion of health, the control and prevention of disease, and the organisation of services (activities undertaken at the expense, in practice if not in principle, of the control of environmental hazards and the advocacy role) has coincided with these changes in general practice. In the UK the fusion of the district and family health services authorities, and the increasing involvement of general practitioners in commissioning, and the requirement of health authority staff to support general practice commissioners make a strong relationship between the two medial specialties essential. In what direction has the relationship been moving?