Priorities in Public Health.

As scientists in public health, we are often asked to assist in the process of setting priorities in the area of public health. The task of public health scientists is often to help in establishing a sensible balance between, on the one hand, local needs, political priorities and availability of resources, and on the other hand, knowledge about causes and consequences of various public health problems as well as cost-effectiveness of different programmes. Many of the readers of this journal have experience of such work at local, regional or national level. In this issue, Weil and McKee present an interesting experience from a consultation on public health priorities at a European level. They have used the network of the European Association of Public Health (EPHA) to identify key public health issues perceived in different countries, based on criteria that emphasised European added value, and to agree on a list of ten priorities. The questions and criteria were formulated in a very general way. Thus, as could be expected, the boundaries of public health as well as the terminology and definitions used varied strongly between countries. Possible alternatives would have been to work with a more structured questionnaire, to formulate alternatives or to use a Delphi type of approach. The method used was probably more interesting as a first step in this procedure of starting to discuss priorities at a European level. Furthermore, the authors point out that more structured methods are difficult to use in a network of organisations with different backgrounds, cultures and national representativeness. Given the method used and the heterogeneous character of the organisations and respondents involved, many of the priorities given are remarkably similar. Inequality in health, alcohol and drug use and ageing were public health problems consistently mentioned by several countries, and a number of other problems in the final list were given high priority by several countries. It is not quite clear how the responses from the first round were brought together and synthesised to a final list. This was made during a meeting, in which staff from the European Commission also participated, but the format and procedure of this second phase is not described. The fact that the covering letter to the questionnaire specifically asked for five main priorities, but that the final list