Introduction

The 1990s, building on the changes under way for public health in the 1980s, saw the start of a concerted effort for more formal recognition of the role of non-medical public health professionals within the public health workforce, as well as increased opportunities for development. The aim of the gathering multidisciplinary movement was to challenge the ‘glass ceiling’ and to break the mould of a permanent ‘support’ role for anyone working in public health who was not medically qualified. This ‘movement’ was the fortuitous combination of: the growing evidence of the contribution made by non-medical public health practitioners in tackling public health challenges; a recognised need for a range of skills to tackle new public health issues following on from renewed health protection concerns and the rise of the health promotion movement of the 1980s; a group of people with dogged persistence; and a new, Labour government whose policy favoured a multidisciplinary public health approach to delivering better health outcomes.

What was new about the approach in the 1990s from the 1980s, however, was that the clamour for recognition was no longer confined to senior public health academics from backgrounds other than medicine, that is, university research and teaching staff, but included service public health staff in substantial numbers for the first time, for example those involved in the delivery of public health programmes on the ground, such as health promotion and health intelligence officers. The environment was ripe for change.

Health service changes that had an impact on the public health workforce and the skills it needed

The National Health Service (NHS) and Community Care Act 1990 introduced an internal market with purchaser–provider contracts, general practice fund-holding and health service (hospital) trusts within the English health service from April 1991. This was a fundamental change in approach as District Health Authorities (DHAs), funded for the first time to support their residents wherever they were treated, changed into secondary care health service commissioners with accompanying population health responsibilities, playing to the strength of public health skills and methods.