It is not just the broad street pump

I congratulate Gillam and Maudsley on a wide-ranging review of the topic, and I appreciate being asked to provide a commentary as someone from outside the UK with a different experience and point of view on public health and training in public health for medical students. Let us start with the idea that medical students and tomorrows doctors are vital to the medical community and the health system, but they are also part of the educated population of a country. Today, everyone can see on television and on the Internet quite sophisticated programs on public health issues, globally and locally, such as on the BBC, and much of it of superb quality. This means that the public has access to information and attitudes about public health that the medical graduate needs to know about. Public health is now more than ever part of the general culture. It now seems important to recognize that public health is not only a medical field, it is broadly multi-professional and it is implemented through multi-dimensional sets of programs and activities staffed by professionals from backgrounds as varied as nursing, veterinary, laboratories, sociology, anthropology, economics, law and many other fields. Public health is part of the activities of governmental agencies but also many non-governmental organizations, advocacy groups and even the private sector, such as food, vaccine and pharmaceutical manufacturers. Clearly, medical students should have basic courses in public health as should all health professions. Indeed, there is good justification to have public health courses as part of undergraduate studies not only in the health sciences fields, but also in liberal arts studies such as sociology, anthropology, economics and especially as a requirement for many graduate studies programs in such fields. The great achievements of public health in the twentieth century were outlined by the US Centers for Disease Control showing that health and life expectancy in the USA improved dramatically, as it did in all industrialized countries. Since 1900, average lifespan lengthened by .30 years; 25 years of this gain were attributable to advances in public health. This includes: control of infectious diseases through water safety and sanitation, improved medical care and immunization; motor vehicle safety; safer workplaces; reduced mortality from coronary heart disease, strokes; safer and healthier foods; healthier mothers and babies; family planning; fluoridation of drinking water; and recognition of tobacco as a health hazard. The list included many topics in which the medical practitioner plays a key role and others where regulatory and legislative functions are the key to health promotion, such as in anti-tobacco legislation and in food fortification. The UK tradition in epidemiology is rich and goes back a long time before the Broad St pump, let us say to James Lind and his classic controlled trial of treatment of scurvy in 1747. More recently, the UK Science Council studies in 1991 established than folic acid taken by women before pregnancy reduces the incidence of neural tube defects. Yet, while mandatory fortification of flour has been implemented in more than 50 countries including Canada, the USA and many countries in Latin America, the Middle East since 1998, the Food Standards Agency recommendation in 2007 proposed mandatory fortification of British flour has not yet been adopted in the UK.