Beyond the Golden Era of public health: charting a path from sanitarianism to ecological public health.

The paper considers the long-term trajectory of public health and whether a 'Golden Era' in Public Health might be coming to an end. While successful elements of the 20th century policy approach need still to be applied in the developing world, two significant flaws are now apparent within its core thinking. It assumes that continuing economic growth will generate sufficient wealth to pay for the public health infrastructure and improvement needed in the 21st century when, in reality, externalised costs are spiralling. Secondly, there is evidence of growing mismatch between ecosystems and human progress. While 20th century development has undeniably improved public health, it has also undermined the capacity to maintain life on a sustainable basis and has generated other more negative health consequences. For these and other reasons a rethink about the role, purpose and direction of public health is needed. While health has to be at the heart of any viable notion of progress the dominant policy path offers new versions of the 'health follows wealth' position. The paper posits ecological public health as a radical project to reshape the conditions of existence. Both of these broad paths require different functions and purposes from their institutions, professions and politicians. The paper suggests that eco-systems pressures, including climate change, are already adding to pressure for a change of course.

Why are we fat? Discussions on the socioeconomic dimensions and responses to obesity.

This paper draws together contributions to a scientific table discussion on obesity at the European Science Open Forum 2008 which took place in Barcelona, Spain. Socioeconomic dimensions of global obesity, including those factors promoting it, those surrounding the social perceptions of obesity and those related to integral public health solutions, are discussed. It argues that although scientific accounts of obesity point to large-scale changes in dietary and physical environments, media representations of obesity, which context public policy, pre-eminently follow individualistic models of explanation. While the debate at the forum brought together a diversity of views, all the contributors agreed that this was a global issue requiring an equally global response. Furthermore, an integrated ecological model of obesity proposes that to be effective, policy will need to address not only human health but also planetary health, and that therefore, public health and environmental policies coincide.

Multidisciplinary public health: leading from the front?

This article argues that public health historically evolved in Britain as a multidisciplinary project. The return to its multidisciplinary roots remains an essential but insufficient condition for its future success. Despite its part-emergence from the 'new public health', institutional public health is hampered by short-term strategies and a preoccupation with evidence when it requires a more powerful analysis of contemporary society, a more imaginative engagement with political structures culture and communications, and an embrace of ecological approaches in place of national public health strategies of surrogate consumerism.

Trade liberalization and the diet transition: a public health response.

Trade liberalization remains at the forefront of debates around globalization, particularly around the impact on agriculture and food. These debates, which often focus on how poorer countries can 'trade their way' out of poverty, pay limited attention to dietary health, especially in the light of the WHO's Global Strategy for Diet, Physical Activity and Health (2004), which warned that future health burdens will be increasingly determined by diet-related chronic diseases. This article examines the diet transition as the absent factor within debates on liberalizing trade and commerce. We describe the evolution of trade agreements, noting those relevant to food. We review the association between trade liberalization and changes in the global dietary and disease profile. We illustrate some of the complex linkages between trade liberalization and the 'diet transition', illustrated by factors such as foreign direct investment, supermarketization and cultural change. Finally, we offer three scenarios for change, suggesting the need for more effective 'food governance' and engagement by public health advocates in policy making in the food and agriculture arena.

Policy councils on food, nutrition and physical activity: the UK as a case study.

International experience of Policy Councils on food and nutrition has developed over recent decades but they have not received the attention that is due to them. The 1992 International Conference on Nutrition recommended that governments create Food Policy Councils but few have been created. There has been more experience in local and sub-national policy councils, particularly in North America. Developing country experience of attempting to improve food policy integration stems from the 1970s. The UK's House of Commons' (Parliamentary) Health Committee, in its 2004 report on obesity, reviewed current policy determinants of the rise in obesity, concluding that national food and health policy lacked coherence, integration and effectiveness. To address this vacuum, it proposed the creation of a new 'Council of Nutrition and Physical Activity to improve co-ordination and inject independent thinking into strategy'. The case for creating such a Council in the UK is reviewed, as are possible organisational options, functions and remit. A Council could be created under the forthcoming Public Health Act. The purpose of the new Council would be to provide independent advice and strategic advice as well as monitor the linkages between policies on food, nutrition and physical activity, noting their environmental implications.