Future role of public health medicine.

Frada Eskin in her contribution to the debate on the future role of public health medicine makes interesting points on the interrelationship between leadership, politics and public health. In particular, she laments that public health doctors have been too involved in ‘unnecessary detail’, as their job is to ‘create the vision’ so that ‘others can make it happen’. Although a firm believer in multidisciplinary public health, one detail that I think would be useful to get right is the correct attribution of professional background. In the first sentence of her paper, Eskin refers to the German writer Virchow as a ‘sociologist’. Rudolf Virchow (1821–1902) was in fact medically qualified; indeed, he was an early, brilliant exponent of cell theory, holding the first chair of pathological anatomy at the University of Wuerzburg. By application and interest, however, Virchow could indeed be described as a sociologist. He fully comprehended the connection between economics, industrial and everyday life, and patterns of disease and ill health. Virchow was elected to the Berlin City Council, and through this position dealt with public health matters ranging from sewage disposal and meat inspection to school hygiene. To get to my point, the public health field should be populated by committed ‘leaders’ of all professional stripes, ranging from medically qualified polymaths like Virchow to ordinary mortals (and sociologists) such as the current writer. The role of leaders is not only to set out the vision – ensuring that coworkers and local communities are full participants – but also to have the acumen, experience and capacity to carry it out. By implication, there is no room for a public health ‘officer class’ that thinks it is a cut above everyone else – and if there ever was, that time is surely over.