Ecological public health: the 21st century's big idea? An essay by Tim Lang and Geof Rayner

It seems to be the fate of public health as concept, movement, and reality to veer between political sensitivity and the obscure margins. Only occasionally does it gain what policy analysts often refer to as traction. Partly this is because public health tends to be about the big picture of society, and thus threatens vested interests. Also, public health proponents have allowed themselves to be corralled into the narrow policy language of individualism and choice. These notions have extensively framed public discussion about health, as though they are not tempered by other values in the real world. As a result, the public health field suffers from poor articulation, image, and understanding. The connection between evidence, policy, and practice is often hesitant, not helped by the fact that public health can often be a matter of political action—a willingness to risk societal change to create a better fit between human bodies and the conditions in which they live. We have reviewed how public health theory and practice have evolved over the last two or three centuries, and looked at the challenges present and ahead, and we conclude a rethink is in order. In difficult economic times, public health too easily falls down the political agenda. It is judged worthy but not a political priority. Yet there is strong evidence that health is societally determined, that public health is high in the public’s notion of what a good society is, and that health underpins economics