Defining the public in public health after Lalonde: the view from the United Kingdom, 1970s‒1990s.

Abstract

This article considers the impact of the Lalonde report on ideas about the public and public health in the United Kingdom from the 1970s to the 1990s. It begins by assessing how "the public" within the context of public health has been thought of. Three key modes are identified: the public as the whole population, as groups, and as individuals. An examination of the Lalonde report, and its British equivalent, Prevention and Health, Everybody's Business, points to the presence of these three ways of thinking about the public. Nonetheless, the role of the individual in disease prevention appeared to dominate both the Lalonde report and Prevention and Health. The influence of this approach is traced through an analysis of British health education campaigns around alcohol from the 1970s to the early 1990s. The target of such efforts changed over time, away from alcoholics and heavy drinkers and towards creating "sensible drinkers". Although alcohol health education campaigns were directed at getting individuals to change their drinking behaviour, they also took into account a population-level view of alcohol consumption. The current article concludes by suggesting that a reappraisal of Lalonde and Prevention and Health points to the existence of collective, as well as individual-based, ways of thinking about publics and doing public health.