Societal doctors already exist: author's reply
Authors: Anand Bhopal
Journal: The Lancet Global Health (2015)

While I broadly agree with the points raised by Kate Mandeville and colleagues, I will take this opportunity to better clarify the thrust of my argument. In any society, the transfer of public health research, advocacy, and policy into clinical practice involves several intervening steps and must engage multiple stakeholders. Particularly in the final stages, health-care professionals, and especially clinical doctors, have a crucial role in ensuring policy ambitions are successfully implemented.1Glasziou P Chambers I Altman DG et al.Taking healthcare interventions from trial to practice.BMJ. 2010; 341: c3852Crossref PubMed Scopus (161) Google Scholar Today more than ever, curbing the multicausal problems we face—such as childhood obesity, diabetes, and antibiotic resistance—requires an approach that transcends the increasingly antiquated public health, primary care, and secondary care divide.2Atun R Jaffar S Nishtar S et al.Improving responsiveness of health systems to non-communicable diseases.Lancet. 2013; 381: 690-697Summary Full Text Full Text PDF PubMed Scopus (188) Google Scholar In this regard, I believe efforts of public health physicians (and non-medically trained public health consultants) should be reinforced by greater cooperation across the medical profession, guided from within by a shift in medical education. This shift requires a subtle, but substantial, change in curricula, which not only increases public health education but radically shifts the emphasis and importance of public health to medical training.3Bhopal A Baker PA Meldrum JL Chan JKM Gopfert APN Embed a public health ethos in the medical workforce.Lancet. 2015; 385: 853-854Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar We need greater recognition within the whole medical profession, and indeed across entire societies, that health is more than health care, and especially in the new era of chronic disease, the role of a clinician includes prevention as well as cure. I agree that public health physicians are already the “societal doctors” and welcome a greater number of training places and consultant posts. However, my intention here was to argue that all doctors should take greater responsibility for population health concerns and work to support colleagues in public health. Balancing the benefits of hyperspecialisation with the often incalculable returns of generalism is one of the great challenges facing us in the decades ahead. I declare no competing interests. Improving responsiveness of health systems to non-communicable diseasesIn almost all countries, development of health systems that are responsive to the challenge of prevention and treatment of non-communicable diseases (NCDs) is a priority. NCDs consist of a vast group of conditions, but in terms of premature mortality, emphasis has been on cardiovascular disease, cancer, diabetes, and chronic respiratory diseases—diseases that were also the focus of the UN high-level meeting on NCDs, held in 2011.1 Full-Text PDF Embed a public health ethos in the medical workforceSally Davies and colleagues1 raise several important issues for the reshaping of public health and the addressing of the cultural context of health. Engagement of several stakeholders is essential; however, we believe that doctors are ill-equipped to fully address today's major health challenges, including obesity, smoking, and social injustice.2 Confinement of the population health remit to public health specialists runs against the needs of the population; all doctors have a duty extending far beyond the clinic. Full-Text PDF Societal doctors already existIn Anand Bhopal's discussion (March, 2015)1 of health inequalities, social determinants of health, and advocacy for social change in health care in the 21st century, we were disappointed to see little recognition of the branch of medicine that epitomises “societal doctors”1: public health. Full-Text PDF Open Access