Mr. Bevan, Minister of Health speaking at the annual dinner of the Society of Medical Officers of Health in London last night, said he the present year was memorable because it had witnessed the launching of the great Health Act.  The period of controversy was behind them, and they were looking forward to fruitful cooperation.

There was a section of the community more harrassed than any other by the possibility of surgical and hospital bills, and that was the middle and professional classes. He had feared that unwholesome propaganda might persuade them to stand outside the Act. That would have been unfortunate from every point of view, but the danger was past. The last figure he had was that between 92 and 93 per cent of the population of Great Britain had already signed up with their doctors. They were coming in now at the rate of about 150,000 a week, and it appeared that by the end of the year, practically 100 per cent of the population would be in. He was delighted. It meant that the health service would be a classless service and every section of the community would be in full enjoyment of its benefits.

Rush for Spectacles

There had been complaints from some quarters about the numbers of spectacles that had been supplied. The only misgiving he had was that now nearly everybody would be able to read some of the nonsense that had been written about the Act. It was to be expected that in the first year there would be a rush for some of the facilities, but that would settle down when the novelty wore off. When it was possible to get out figures he thought they would be surprised at the number of old age pensioners who had bought spectacles from cheap stores and even inherited spectacles. He was also delighted to see that dentists were now coming in more quickly. He had no doubt that before long most of them would be in the scheme.

The Public Health Horizon

The National Health Service Act of 1946, which came into operation on 5th July of this year, is designed to provide a comprehensive medical service for persons who are sick, in body or in mind. This service includes hospital care, consultant and specialist services, and medical treatment – at home or in “health” centres – from the family doctor. All these services are provided free of cost at the time of need for every man, woman and child in the realm. Good: this will surely develop into the finest and most complete medical service in the world. Critics have put forward the plea that the Government should have introduced, at one and the same time, a comprehensive health service. This argument was answered by the Minister of Health by the counterstroke that a complete health service is already in existence, built up by successive generations of local authorities and their medical officers of health. Excellent: now let us see what has happened to this brave structure, and then take a swift glance at its future shape.

The immediate effect of the National Health Service Act is to take away from the local authorities all responsibility for the care of persons who are sick, by the transfer of hospitals of every description to the new regional boards – and the term “hospital” denotes a wide variety of clinical institutions. In the course of time all forms of treatment, including the medical care now undertaken by local education authorities, will be appropriated by general practitioners, when the “health centres” contemplated by the Act have become a reality. These hospital and other clinical services have been, in the past two decades, a staple of interest to medical officers of health, especially in the larger towns. These medical officers of health enjoyed hospital administration, and many of them organised the services transferred under the Local Government Act of 1929 with outstanding success. In addition, a far larger number of less senior health officers have long been accustomed to undertake clinical work on a part?time basis ? in hospitals, clinics and schools. This provided a happy variety of interest in a career that pointed ultimately towards pure administration. Under the new regime a number of these medical officers will devote themselves wholly to clinical work and leave the local authority service; others will stay put, casting wistful eyes on their diminishing clinical opportunities; and others, again, will take up the Public Health service as their life-work.

What are the prospects for those who practise in the public health services? Most people will admit that the practice of preventive and social medicine must be more closely linked with the medical care of the individual, and that it should, therefore, be in the hands of the family doctor because he is the one person who can regard the family as a unit, and his patient as a member of that family. On the other hand, preventive medicine has a community aspect .which is no less important – the prevention of disease and the promotion of health. These wide acres of public health have been cultivated by several generations of faithful medical officers of health, first through sanitary reform, later by means of personal health services for mothers, infants and children, and now more and more by the adoption of new techniques in health education.

The price of a good sanitary environment and the control of pestilence is eternal vigilance on the part of the medical officer of health. The promotion of health in a community – in the home, at work, and at play – demands his constant attention, in co-operation with the sociologist; and education in health needs for its fulfilment a completely new approach, with teacher, psychologist, and health officer in joint harness. In fact, when the prospects of a true health service, relieved of the burden of the medical care of the sick, are properly examined, one is amazed and enchanted by the gleaming horizon. The medical officer of health of the future will be, first and foremost, a teacher. It will be his job to promote health and wellbeing in the homes, the schools, the factories and other places of work, and the playgrounds of the people. Secondly, he will be a skilled medical adviser of the people, on such matters as clothing, food and nutrition, ways of living, and conditions favourable for growth and nurture. In the third place, the medical officer of health must be like some watcher of the skies – for portents, not merely of epidemic disease, but of anything likely to have an adverse effect on health. For this purpose medical statistics place a most powerful instrument in his hand; if he can but use it wisely. And lastly, the health officer must be an interpreter: It is his job to translate the advances of medical science into terms which a layman can understand, and to express them in a programme of action. He can do much to reduce the time-lag between discovery and its application to everyday life.

If this picture is true in substance, then how shall we train the medical men and women who choose public health as a career, and what are their prospects when trained? The first essential is to lay a good foundation for any career in public health, and then offer a substantial choice of superstructure for those who wish to follow special interests. The system of basic and elective subjects, now adopted by many teaching schools, affords this degree of flexibility in post?graduate teaching and research. Fortunately, the emphasis on elective subjects varies with each university, so that the prospective student should study the syllabuses of a number of teaching schools before making his choice. Broadly speaking, the basic subjects are sanitary law and administration, medical statistics, epidemiology, and applied physiology (including nutrition). Elective subjects include industrial health, tropical hygiene, parasitology, medical entomology, as well as senior courses in administration, nutrition, statistics, etc. The course for the diploma in public health is no longer a study for a particular job; it is an admirable basis for any form of medical administration, for a career in the personal health services, such as child health, tuberculosis, or venereal disease, and as the gateway to the important new developments in the field of industrial health. The prospects of those who take the D.P.H. course do not stand or fall by the number of vacancies for a medical officer of health; they reach out towards a range of peaks – in industry, in general and hospital administration, and in any career involving administrative experience.

Sources: The Times, September 1948, and The Medical Officer, 25 September 1948, p. 132.

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