Failing to professionalise, struggling to specialise: the rise and fall of health promotion as a putative specialism in England, 1980-2000

Just say know: Drug education and its publics in 1980s Britain

Until the 1980s, anti-drug education campaigns in the UK were rare. This article examines the reasons behind a policy shift that led to the introduction of mass media drug education in the mid 1980s. It focuses on two campaigns. 'Heroin Screws You Up' ran in England, and 'Choose Life Not Drugs' ran in Scotland. The campaigns were different in tone, with 'Heroin Screws You Up' making use of fear and 'shock horror' tactics, whereas 'Choose Life Not Drugs' attempted to deliver a more positive health message. 'Heroin Screws You Up' was criticised by many experts for its stigmatising approach. 'Choose Life Not Drugs' was more favourably received, but both campaigns ran into difficulties with the wider public. The messages of these campaigns were appropriated and deliberately subverted by some audiences. This historical policy analysis points towards a complex and nuanced relationship between drug education campaigns and their audiences, which raises wider questions about health education and its 'publics'.

A Tale of Specialization in 2 Professions: Comparing the Development of Radiology in Chiropractic and Medicine

OBJECTIVE

The purpose of this article is to describe the development of radiology as a specialty in chiropractic with a comparison to the development of the specialty of radiology in medicine.

DISCUSSION

Specialization in medicine has been notably successful, with advanced training and enhanced capabilities in specialized skills leading to better outcomes for patients and increased prestige for practitioners. However, with chiropractic, as with other complementary and alternative medicine professions, no specialization has been recognized within it. Specialist radiology training in chiropractic bears a resemblance to that of medicine, with competitive entry for residencies, certification exams, and the creation of a journal and specialist professional organizations. To facilitate the comparison, I have divided the development of radiology into 4 phases from the chiropractic perspective. Phase 1 started with the discovery of x-rays in 1895, in which medicine adopted them but chiropractic did not. Phase 2 began in 1910 when B. J. Palmer introduced radiography to show chiropractic subluxations. Phase 3 started in 1942 when Waldo Poehner advocated for the mainstream diagnostic use of radiography in addition to subluxation analysis. Phase 4 started in 1957 when an examining board for certification in diagnostic radiology was assembled and many chiropractors began to embrace the mainstream medical use of radiography.

CONCLUSION

In this tale of 2 professions, radiology gained official specialty designation in the field of medicine. The medical profession had a monopoly on health care, and thus had few internal and external barriers to overcome. Chiropractic was oppressed by organized medicine, which helped to create the unofficial specialty of chiropractic radiology but which also later helped to limit the specialty. Chiropractic radiology has maintained its independence and autonomy, but also remains on the fringe of mainstream health care.

How important is public health practitioner registration to UK public health employers?

OBJECTIVES

The objective of this study was to understand the extent to which public health practitioner registration is encouraged by UK employers through recruitment, i.e. by including registration as an essential or desirable criterion in job descriptions and person specifications.

STUDY DESIGN

A repeated survey was conducted on two main UK public health job websites.

METHODS

Data were collected via a repeated structured search of all public health practitioner posts advertised in two specified weeks in March and September 2018 on two main UK public health jobs websites: local government jobs and National Health Service (NHS) jobs.

RESULTS

Fifty-six posts were identified for inclusion in the study. Only one post (2% of the total) required UK Public Health Register (UKPHR) registration or working towards registration. It was more common but still a minority (13% or 23%) of posts to require registration with any relevant register (e.g. UKPHR, Nursing and Midwifery Council or Health and Care Professions Council). Most employers demonstrated a desire for flexibility with none requiring an MSc Public Health and a majority requiring any relevant degree or equivalent experience (46% or 82%). Evidence of continuing professional development was also commonly required (34% or 61%).

CONCLUSION

There is currently a mismatch between UK national policy support for public health practitioner registration and the value that registered practitioners place on it and the recruitment polices of many UK public health employers.

China's National Health Guiding Principles: a perspective worthy of healthcare reform

For countries faced with much talk but little action on healthcare reform, China's National Health Guiding Principles (CNHGP), with its 60-year history, may provide a new perspective. There are four values of CNHGP for healthcare reform. First, these principles provide an innovative strategic framework for healthcare reform with three levels, from 'One priority population' to 'Four approaches' and then to 'Two aims.' The second is the importance of mass/grassroots participation, which runs through all three levels of CNHGP. The third value is that the CNHGP used nonspecific social approaches, an innovation in healthcare delivery that addressed the social determinants of health. The fourth value is the integration between Chinese traditional medicine and Western medicine.

Neither Physicians Nor Surgeons: Whither Neuropathological Skill in Post-war England?

Neuropathologists constituted a small field in post-war England, perched between neurology, psychiatry, neurosurgery and pathology, but recognised as a discrete field of expertise. Despite this recognition, the success of the neighbouring fields of neurosurgery, psychosurgery and neurobiology, and the consultant status granted to pathologists in the National Health Service, neuropathologists struggled to stabilise their field. A discourse of skills, acquired and acquirable, became central to their attempts to situate the field in relation to surgeons' handicraft, physicians' diagnostic acumen and the technologies of the biological sciences.