Nuffield Trust Series No 15: Dr John Bunker, Professor Emeritus at Stanford University and visiting Professor of Epidemiology and Public Health at University College London Medical School states in this monograph that medical practitioners of the past have, in general, assumed that medicine is the dominant determinant of health. Indeed, such has been the view of many scientists and of most members of the public.
Medicine’s role has been, however, shown to be relatively small in the first half of the twentieth century. The claim that medicine has little to contribute to health was widely accepted by public health analysts, who concluded that it is unhealthy personal habits that are largely responsible. Accordingly, large public programmes of community health promotion were set up to encourage adoption of a healthier lifestyle. When these programmes failed to achieve their objectives, attention was shifted to the poor health associated with social and economic deprivation.
In the resultant crusade to reverse the inequality in health associated with social position, it was again argued that medicine is relatively unimportant, perhaps even harmful. Medicine, lifestyle and socio-economic influences all, in fact, do have large and important effects on health. The contributions of each should be carefully weighed against those of the others, and each must be assessed in the broader context of the greater impact of public health measures achieved earlier in the twentieth century.
Drawing on a broad range of knowledge and understanding that extends from basic science through clinical practice to epidemiology, the author examines the relative contributions to improvement in mortality and morbidity played by a social policy initiative, a prevention strategy and medical care.