With this being the 50th anniversary of the founding of the Faculty of Public Health, one of its earliest members - now a long retired Fellow, Paul Walker – reflects on his rather unusual approach to practising public health and its relevance to the future of the discipline.

"I did it my way ..... "

I qualified in 1965 and having sampled hospital clinical medicine in London and Cambridge for 3 years I decided that it was not for me – I neither enjoyed it nor found it particularly challenging (interestingly at Cambridge I was told that reading medicine was a waste of talent and that I should do something really scientific!).

With a wife and three children by this time I looked for a job that allowed more time with the family and which paid more than a junior hospital doctor's salary. It never occurred to me to become a GP which would have satisfied these two criteria and instead embarked on a public health career as a Medical Officer at the Birmingham Regional Hospital Board. This post which introduced me to health needs analysis and the planning of hospital services for a population of 5 million was not particularly interesting but it allowed me to embark on a formal training pathway to become a qualified public health practitioner. Although the London School of Hygiene and Tropical Medicine was then offering a brand new 2 year masters training programme, encouraged by my Scottish boss I applied instead for the Diploma in Social Medicine Course in Edinburgh which I obtained in 1971.

Then I very rapidly climbed the new career ladder in Community Medicine as it was then called and following posts in Wolverhampton, Stoke on Trent and Wakefield I was appointed Regional Medical Officer at the North East Thames Regional Health Authority in1978. Not only was a regional post as high as I could go in the profession at that time, the region I was appointed to was in a class of its own among the 14 regions in England - it had a uniquely large number of undergraduate and postgraduate teaching hospitals, a very diverse population and a talented team of officers led by a very experienced chairman.  It was in a very real sense the dream job.

After 7 years in this job I got itchy feet and fortunately another NHS reorganisation saved the day by introducing general management. So, having had a long term interest in management, and been sent to the US by the NHS for management training, I applied for and obtained one of the new District General Manager posts in Frenchay, Bristol where I stayed for three years. Falling out with my Chairman who was an import from industry who knew absolutely nothing about the NHS and healthcare – such wrong-headed appointments were all the rage with the Tory government of that time - I moved back to community medicine and obtained a post as DPH for the Norwich Health Authority which I held for 5 years before moving to Wales, initially as a Senior Lecturer in Applied Epidemiology and then as a locum consultant in public health with the Dyfed Powys, Swansea and Mid Glamorgan health boards and ending my career as the Public Health Director for Ceredigion and Powys Health Boards.

While working in Wales I joined the Labour party, became Chairman of the Socialist Health Association and for a period was a City Councillor in Bristol representing a deprived ward in the south of the City.

The only time I felt that I was practising real public health ie public wellbeing, as distinct from applied epidemiology, was when I was a Deputy Medical Officer of Health in Wolverhampton and later a Bristol City Councillor. In both posts I had a real sense that I was working in an organisation that could control at least some of the main levers of public health – or more correctly public wellbeing - for the benefit of the local population.

The main influences on my career were Gerry Morris, Bob Logan and later Julian Tudor Hart. I had little interaction with the Faculty which was a rather precious organisation in those days and generally unhelpful in my experience. In contrast I was very supportive of and active in the much more democratic and multidisciplinary Public Health Alliance and its successor the Public Health Association.

A major mistake made by the Faculty at its inception in my view was to limit membership to doctors only. To have omitted environmental health officers and community nurses, to name but two professions, was extraordinary but was a symptom of its founders having an obsession with gaining medical consultant status in the reorganised NHS. As a young Turk community physician I knew this as did many of my peers but was powerless to do anything about it. Regrettably it took a very long time for this mistake to be corrected but better late than never!

For me the key lessons I learned from my long and diverse career are that the concept of wellbeing is a much more useful and inclusive concept than health; that the public wellbeing function has to be based in local government - but with chief officer status, and incorporated into general practice. And that a genuine belief in and commitment to improving public wellbeing requires espousing a socialist political perspective.