Effective public health practice requires a combination of expertise and influence. Yet gaining expertise in the subject matter is only one element of practice: the ability to influence outcomes, policy, services and the people who make decisions is crucial. To deploy your expertise to have an impact, you must hone leadership and management skills to persuade, encourage and empower others. This chapter, therefore, aims to:

• offer a brief overview of different schools of thought in leadership;

• propose a simple framework of eight core domains for identifying skills and areas for professional development;

• introduce some popular theories for understanding others, which can enable you to work more effectively with individuals and influence within teams and organizations; and

• signpost to some key models of conceptualizing change and how to lead or manage change.

Public health cannot be understood or fully appreciated without some knowledge of its history, which this Introduction provides. Conventionally, this begins with the large body of work associated with Hippocrates (c. 460–370 BC). In these writings, health was viewed as resulting from a sound balance of the humours. Therapy included diet, exercise and other interventions tailored to the individual – akin to today’s emphasis on healthy living and lifestyle. The Hippocratics were, in addition, early exponents of environmentalism. In Airs, Waters, Places, the occurrence of disease was linked to such factors as climate, soil and water quality. Proposals for disease prevention were related to specific social and economic circumstances.

Health-care systems within most countries are resource-limited – budgets are finite and not every service one would like to provide can be funded. In publicly funded health systems, those responsible for procuring health-care need to be able to explain how taxpayers’ money has been spent. Decisions are made at both individual patient and population levels. At an individual level, the decision might be: which statin should this patient get a prescription for to lower her blood cholesterol? At a population level, the decision might be: will a health and social care commissioning organization purchase a heart-failure specialist nurse or an additional sexual health clinic?

This chapter focuses on how such decisions are made and considers a framework for priority setting, a discussion of what factors should be taken into account when comparing options, a consideration of basic health economic concepts, and an overview of ethical principles which influence decisions.

As we discussed with regard to leadership in Part 1, the context in which the public health tools are used has a bearing on the choice of tool and how it is implemented. In the second part of Essential Public Health: Theory and Practice, we consider a range of contemporary contexts in which public health is practised and illustrate how the tools we have described are applied.