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"Gifis'n hi Rao <.airishnrao20u2@yahoo.co.in>
'ComMedPGqrcup” <commedpeople@yahoogroups.com>
Thursdr’v Spnipmhpruzl 2003 *10:47 AM

oubjeci:

Two ciiiicai aiiiciea iui good leading

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20 naccs ). The
mans per:
of the onesity
°.r,,5. dr'w,‘i io earth too rn?.es.tir'ns
^^ofessionalism

<md the second one I siuinbied upon uno iliai makes good
readinQ esnecialtv if von have a nuhiic health
vaOkgxOuild oJud IS illakiilg it a CuiCOi. Though it iS TJIC.

centred it is more so applicable to the context or
1
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I msk ihis (inesiion on ihe nj-isis f'-» <? remark hv

fi lend - please do lei me know if I could foi waid
articles which I think I could sharci something which
1 ha\c done now. I would not like to trouble if it is
disturbing. So in this case 1 am blank marking the
mmr tn inniviHiio 1c mzliiip qnrirpccinn it tn
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couiedpeopic groups co-oidmaicd by Com ivied PGs from
Ranpalore Nfedicai College.
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1111 uicxiuv^ cijiv-i ivfc,cuU.i.

Jun. Girish

9/4/03

A Crisis? C'mon

Prob'em, Tint

bur smee i am recnmcaiiy ooese, i rind, it heartening that there‘s
rising concern about the "obesity coidcmic." Perhaps it will encourage
me tc lose more weight. Perhaos a better understanding of the causes of
r,ri 1 1

h^ln n-rnriTc: with

wnirrhr A'nd wninhr-rnl nrnH

Yet at the same time, the alarm over obesity causes me some alarm. I
like a hunted man. T’ra "wants'.']" for i ncreasi nci ths nation’s

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alltX

epi cienii c.
mare. ■ 5 often an epidemic or eiarniisr. sr.ories aoonr onesir.y ano
its costs m the past year (about 2,000 according to my Internet search)
that -an only son ths nolitir.ians on to mors foolishness and encouraas
■ nsii runcH comiw ri i hs arid t>«rlirir;s Hrnolovers Io

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responsibility has oeen r.ransrormeo inr.o a public crisis, wnippea up ny r.ne
uncritical news media, which sv.rallow and regurqicate the crudest statistics
abouc the most comolicated of oroblems — such as obesicv.

viie ”cxxsxs, -r dully pxodciue ovudle^ demonsLraulng how uiieix par clouxai

mmq is acruany me cause or ic ail. it's suburban sprawl forcing
people to drive everywhere. It's health insurers who won’t reimburse for
Weiaht Watchers. It's video aames. It's the lunches oarents send to
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ooesiry nave oeen arounci ror severax years, ic’s a iu_year crenci.
PAOfil P. who i\”(y c.rct r'WR • tj’> I

(- ! ;i i n 1 \/ known

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ordina to an April 9 studv in the Journal of the American

story ±5 a wiaeiy accepted ano. propagated slo.lisuc;
nd obesity cost society S90 billion to $117 billion a year.
s -- renresentino ’’economic cost” — are critical for publ i

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respond personally to those behind those ideas.

iworx. ana smiex irom worxpiace stressr inat’s Sou billion
tne international La.oor Organization. Hand it over.

get me starrea on occupational injuries, mental illness,
heaw drink-inn, bodv piercing and all the rest. All diseas
— anrl I hfi hv.hnv i c> r Hssocial nd will)

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r.o no sc,. /.nen risxy oenavior oecomes expensive oenavi or
our freedom shrinks. We get browbeaten. Or our behavior is
antisocial through a camoaian of negative publicity.

'.*7e determine wmen costiy oenaviors are crises re^uirmc
j mobilization and intervention and which arc not? Do wo
ith the highest cost and work our wav down?

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mid Can gdieiate

die iiiObu

nose costiy oenavior is aiso distasceiui to a majority or
immoral? We ail remember tne initial response to AIDS, a
is now viewed with appropriate compassion.

p.~, ev?.r bv ot.h=r far. paonl«. Tn addition to having econorn
nbp.s’iy

:s r.nn.s’derwd
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cue Bui>ii ca.uiiu.iixoGia uxun —

wining co overlook air ano. water pollution — nas joined me crusaae
against obesity. I accent that obesity is dangerously on the rise. I
favor nublic health measures to alert ns to its dangers and to heir, us
s'-m Hotjt:

Consider, for example, the statistics showing a great rise in obesity
among Americans. The definition of overweight and obesity is based on
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I am, of course, taking the body mass index too literally. It's a
range. The CDC savs that many factors, including muscle mass, bone
si r-ucl ii re and

family hisiorv musl

be. considered.

Body mass

index

is ”onl v one

In other words, it's crude. Yet its crudeness does not prevent it
from being aonlied to the entire peculation. Nor does it prevent the CDC
pro othpr hpplbb nrof paa-? oti p 1 o

from dpr'prina fnpr

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no>*ranr of ha .= rp

C.n icu > an ng that increase is difficult because the data over time are
not reallv comparable. The definition of obesity keens changing. You
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sare orcressions and oolicymaicers. of course need these
rrior~ r.'ss, raise rr.onav for their research and.

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,nsasi tnm.< so. i can near tne conversations over tne dinner taoie at
: "You did great at math, dear. But. you flunked the fat test. Thin
” Wasn't it just s few years ago that we were so worried that kids
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Copyright © 2003 Elsevier Ltd. All rights reserved.

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Until recently. a medical quairiicaiion was required ror senior public lieaim posts m tiie UK. .National
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creation of a new senior professional role of specialist in public health equivalent to the consultant in
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tne policy and practice of multi-disciplinary public health in tne UK?1 me answer draws on recent
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1970: Professional Powers: a Study of the Institutionalization of Formal Knowledge. University of
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framework for The period 1972-1997. the concept of the professional project docs not easily explain the
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emails ail those procedures, techniques, mechanisms, institutions and knowledges that empower political
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without exnen knowledge. The concept of manipulated emergence helps explain why, having expressed a
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■___ lOpeciahst practice ami muiii-oiscipimary puoiic neaiin m ine ujs.

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.a noteworthy experiment in developing liiiilii-discipiinary public health is currently unfolding in foe

1 foiled k’im>dom- a new semm iirnfossional role f>f.wwfo>Z/s/ /« nuhUe. health onen to a ranne of
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process was a speech by foe Enghsh Secretary ci Stare tor Health, Alan Milburn, in March 2000. As parr
of hie argument for ?. wider process of 'modernising1 the bills. Milburn turned Lie attention to public
heaifo:
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label public health' has served to bundle together functions and occupations in a way that
actually marginalizes them... [2]y a series of definitional sleights of hand the argument
runs foai foe health of foe population should be mainly improved by populaiion-level
health oromotion and prevention which in turn is best delivered—-or at least overseen and
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lazv thinking and occupational protectionism. (I.Milburn (20001;
Milburn's condemnation of vested medical interests is not in itself surprising; such criticism of public
sector professionals lias been a recurrent theme in the modernisation project of the New l abour
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government ((Harrison |). What is new. however, is rhe application or this approach to the field of public
made to improve public health tn general, ami to tackle health inequalities in particular, These
commitments were formalised in the White Paper Saving lives: Our healthier nation ([Secretary of State
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m strengthen the ptmiic neaith Junction, with an explicit reference to the development of a muiti'^'SCmhimW OU’.tllC hCUltU. yi'OrVforC0

■■.Vilhm Ilin yAZIntr* Ponnr o Vr*v

tn ito ni-inr Try unnmvn

xti. atiu -mu reduce inequalities was a rurfoer specific commit mem to develop a new non-medical role of
specialist m rmbhc health This noltcv change nt the centre bias been reflected in related changes in the
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membership or foe faculty or Public Health Medicine (hPHM) to non-medical applicants, brom 2001),
C'^tirU’.Tant level mcoialtr.t in nutl’ie hctdtll noetc

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proiessional press, in zitov, direcior oi public health posts m the recently established English primary
care, trusts I'PCTsl were opened to non-medical applicants.
these developments might lead rhe casual observer to think that policy and practice were indeed taking
public b.caitii out or foe ghetto'. But reality is rarely so simple. Keith [Macdonald 1'1995]. p. xiii) reminds
us oi the key sociological question suggested by [Glaser and Strauss (19651 about the professions:' what
is going on here'?' Similarly this paper asks 'what is really going on with the. policy and practice of mnlti<U3CfolAUiXi j ptxvxiv AxCtuixl ixx ixxv vxV : x v culoWCx thio q'uCStxvix vVC ixvvd tv tCVtCVr what Wv alxCadV kilvW

oi the professions of public health, describe and analyse the new policy of multi-disciplinary public
health, and assess its implementation. Developments in public health need to be located within wider
SvCiviogicai debai.es about ibe changing toie oi medicine and oiiiei health pio fess ions. Tn doing this, mice

particular theoretical perspectives will be utilised- [Freidso (1970 and ^rejdspn Q986j and [Larson
vx w- prclc^mcmm |zfyjcct', [Fcucault (1979' nvlivti vl gvccmmcxtiality, mid {IlmriSyti

practice ot public health requires multt-disciplmarv and inter-

arion. healtn promotion. Housing, meoicme, nursing, social science ann

heme is iHarrison and Brace Wood
oniere-m guises . rrevemive meoicme
>ilv memf-jne' in the :960s anrl then hack i<>

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s, lyy.i, p. 19/;. i_ewis recounts wnat sue sees as a senes 01 lanures—oi
beans of service,' fi e non-academici nnhlic health doctors in the 1940s o
t to make public health

i the NHS quasi-market m 1989-1991, the Acheson report on public health
.•ipimary puonc neaim. iviore recently, However, a numoer oi comment a tors nave ex arm neo me
iifmesNiorial landscape nt iiiibnr. health m the I TrC fScallv il 9961 himself a public health

udins me

iuoy or me puonc neaim junction <s jdcauy <,19901, p.
ntifv the location naradox* tacin? the profession: ’ public

iilty . WlilCi H1uie.S.SKiJiai Jj/ouph. ill pHJUCUiHJ ilUfSCh.

;eived as a narrow rneuical uefinition ot mibiic health’

pilunc iieaitn in me

health from the eariv 1970s t.c

ussion, particularly within the Society lor Social Medicine, the

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mcdical vroicssivnais from momborshm and training. .From the 1 j*7va structured training was availabic

oniv open io doctors, rtven those ivi.Sc. courses which were open io non-medicai applicants traditionally
MhrwHen few mirh Mhide.niM mm zherr yvmm rzn Gindina slrr.Mm or r.»reer nalhwuv for ihem ThiiM niiblir.

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the description non-medicai to describe other practitioners ot public health, a problematic term which is
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croups (e.g. nurses, social ccientiotey

ibe KHS ExeuUibe began expressing interest m developing miuti-di-scipiiiian- public health even before
liir 10Q7 rzf-rtAii blit ;he fn-AV : .ziho’Hi CmVrsnznrin deinOi'iNftamd A inildh StiVn'iPet nobr.V interest Far IV in
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puoiio neaitn nmcnoa. rhe interim rmaniss or this protect expressed a commitment to developing muln; ' -.-' ’ ;• xivM-t-««-»."»i .T;--nnrrmnnr y-sf TJr'obb rioosiv This commitment was developed and rc-stated m
’; v>..y. ibe V/liue Paper argued «ha« «lic. poteaual benefit of a more muhi-discipiinary approach was
hiir-’r' ;i aririuiinced a rati ot ooiicv ineasnres aimed at developing muiti-disciplmarv public health
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t i j

^ubiic Health iJevelopment rundand bianonai Public Health Workforce Development Plan. Hut the mosi
i-orijr'ol nrnnncnl u;oc 1v\r rb/'» pmolijAn z^Fn nnii’ czmtzAr rmblt/' ln/-»nirin nnot Tz-\r nr\r>. r1/>r‘fzArc

I I nr' lA/biTr* Uonzm

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<ij.su iiidiuHicd uini. hi liihelsHS diieuiiH ol public iieaiui pu.sus would be opened iu uuaidied Jivu-juc-diuai
specialists

1 he first practical result or the new pohev was ihe fsfHS Executive ■-u.dance on establishing PCz! s. a new
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.An appendix io ibis document outlined the qualifications and competencies required of

;hr i-.iibn;-. health nlr-inl-.e:' nftlir. PCT ftXftMWivf- cnmnlitte.fi This im'ifintfin that tiifi nnst fifillld hfi. tiilfiil

At tiifi snmfi timfi, thfi T .inn’T<>n Sfirntin fit rfvnifinfi .v. '!Toi>ii:nl Mfiihemfi miitlisiifirl n ffinsir'nlitv srndv cu thfi

; -Lessoi. liumeiow. i. ihe Ueparrm^2T then cnwimtsswned Heaitliwork UK, rhe national training

mere. r$ omv one. other specitilirv ot medicine ipathology) where non-meclicai health protessionais have
zs n .•'cortr’!’i'iTlv fir.r,i voiont

m/'ri tz'o 1 t», xncnltonto ntorl or/-» orlmtTtcrl t/A mz^mKnrcln ita Qt o j^OYal

C<»bege on an equal f‘.>o»ing ([Koya! College of Pathologisi^Qwl j). By contrast.., the Labour government
•\"is also created nurse consultant posts which ore more senior than previous nursing posts but are not
policy impiemeniauon. P.'eiiher

lives, nor the subsequent (and much delayed) final report oi the

1 the nianv complex and potcmiallv time-consumins issues
•i notably, the government nab not allocated any resource to support
JUU/. UUUCO I.ZAM/UU/

I he NHSplan section on public health contains no

public health function promise any additional resource. When in

96 English health were replaced by

■>GG PC’T^ ihr*. new Pi^T dirnHnr of nnhiir. hr.>»lih nosN were one-

■n and person specification.
b'b'3 a b b n"5.

mmeniai neaitn omcers, neau.n visiiors) ana puouc neaim
■ ar senior mana**

>>[■:•< ana neaiin auinoruy <cv
hr

e requirea iq pc
s in communicable

being medical trainees

icraiiy arc cmp-

support rotes. • acre
ziU.ll V

heaiiii aurhonrii
practice usually miea o_y meuieaiiy quantica candidates, n wasnotaoie mai graaes ana salary scales v^ere
much higher for posts advertised as consnltpmt/snecinhsr m public health than tor those advertised simnlv

mosi oi ine jha; rv_ is aavenisea lor aireciors oi puouc- neaitn. joo aescnpHons ana person speciucauons
hraadiv fallowed the national specimen developed coilabornfivelv between the Department of Health and
id tacjdmg the wider
evidence of ieaininy and

ine’ ffDenartm:

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; hr*

dlkt. luCulvCrSiuD Of uiC .bl< jHV8uS !). SluCC 19/2 tllC J/PilNl hcS CuSailiSCkt the SDCCialist 172.111 iFi.Q
*' * •

-■ x

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.xx-»zl

recommended mein for inclusion on the omc specialise register. in the eariy *yyus a pressure group, the
;vHsih-nn;r?nhnan P;:hs-r T-T?-*:-; 3:'r. Pnrnrn
x-’u-Cvix^Uj’.c. UUJ oUtivCi >

Hyrrnp.n io permitj-uih lhe FPT-Tivf in inriinij-* non-mer
* oUv-vCCKUUA. V» iLU tUC IcivUit-V o UCviOAvUd Ail A

iLi 'iroiessiona! cx-inrinnaOKS !•' 7:0:1-171 edseai candiCiates and in

LU OUCAi Petit I

to open Part li anti tui]

reinuonsnips. : his leans i .arson io an exploration or issues around professional training ( jLarson (197 / j,
•n
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She aigues uiai uieie is an h:>j»whcu cu tn valence between the Liuahiy anti length oi naming. Ti. is oiten

emphasiScu that professional training must be nrolonneu. specialised and have a theoretical base—but
professional practitioners are rvpieaiiv over trained; the entrant to the profession will r/picahy le.am far

•..>
-

..nrolcssionals live within ideologies ol their own creation. which thev oresent to the outside
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public Health medicine between 19/2 and the mid-1990s can be well described and analysed usins the

At me same ume. uiiier occiipauonai groups iuuiiiomg epidemiologists, inibrmaiion analysis and nurses,
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d> *w t,<ry fr^r.-ie.vvi>rk for .he period 19 f2~l^y / (and mdeed lor earlier in die

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state as an external calcniadng subject, a state that provides ' shelter , exerts control over the socioi-f-oitorrnf- tf-fijis ot rwotevsij'Hinl w<h k Ir-fiviiio iruittci s ot tcchrnoal r.vahiation in fhr. harids of
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rouoauir's conception 01 eovemmentaiir/ allows us ro overcome.

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profession. in the case or public health medicine. wider socio-political processes challenge its technical
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the growing assertiveness of lay explanations of health and illness, and the locus on inequalities and the
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profession to shining poiiucai boundaries.

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it

specialists, ino maionrv or nubJic health doctors and their professional organisations nave not abandoned

-,55ir.ntr.rr. niciir.riion r.erwerr; inner* wiTh ar.A irwver* wiir.nni ovnorr niirihr r.mlih trnrvwinrlnf*

me new Labour govern mem's policy initiatives (e.g. primary care groups and irusis).

heahh field ihis would sugges' <ha« once mere are nigh-quality iraining scneines csiaonsned, or new
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ge vemmenr has done m setting high aspirations ior new non-medicai posts, and then giving little detailed

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.A:.:?.•, ome: j'.'uj?.: i_> ■•c.u. L'DiiC'-i .Mates) nave ueveiooed multi-discipiinary public iieaitn worklorces
n.irr.<'i

even tiie

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meoreticai unuerstaiiuiiiu oi me evidence. Anumoer oi omer theoretical or conceptual.

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interests. Ii^ctnsreiv. i-crlie snei xvlci?..cc <

* coiiccDts of rcccotive cuio non-rcccDtivc contexts tor

neiwerKs of heaim care professioiiaib «v j west, Barron, ijowseti, ]). ihe real lest of the theoretical
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which couid then ha tested empirically m further research, and conclusions drawn about their utility.

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nave been established: one centres on the continued role of public health medicine, the other on the

±ii iliai ir includes bfoiessionals if om a raiige of oroiessions. but by practice and implication it is not
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racmrv of me three UK Rovai Colleges or ^vsicians.

iii'js me puoiie neaitii medicine professional project continues. Weakened !?y a long-term anti

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