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Professionalization and Public Health: Historical Legacies, Continuing Dilemmas

Starr, Paul PhD

Journal of Public Health Management and Practice: November 2009 - Volume 15 - Issue 6 - p S26–S30
doi: 10.1097/PHH.0b013e3181af0a95

Professionalization in public health reflects wider institutional and political forces. Depending on the historical context in different countries, public health has developed as a medical specialty or as an independent field, entirely within the state or in mixed public-private institutions, closely or weakly tied to social movements, and in varying relations to fields such as engineering, nursing, environmental science, and the military. In early 20th-century America, the rise of the medical profession and the biomedical model of disease had a formative influence on public health, leading to a different institutional pattern from Britain. Public health in the United States emerged (1) largely outside the medical profession, but under the sway of the biomedical model; (2) without medicine's command of an exclusive jurisdiction and high status; and (3) with a limited role in healthcare organization and planning. Professionalism in public health continues to be subjected to contradictory pressures and uncertainties. Healthcare reform, bioterrorism, and environmental crises could expand its mandate and access to resources, but conflicts with other institutions are likely to result in limits on the capacity of public health professionals to assert an exclusive jurisdiction.

This article describes how professionalization in public health reflects wider institutional and political forces.

Professor of Sociology and Public Affairs at the Sociology Department, Woodrow Wilson School, Princeton University, where he holds the Stuart Chair in Communications and Public Affairs. His book The Social Transformation of American Medicine won the 1984 Pulitzer Prize for general nonfiction and the Bancroft Prize in American history. He also wrote The Logic of Health-Care Reform (1992) and served as a senior health policy advisor in the White House in 1993.

Corresponding Author: Paul Starr, PhD, Sociology Department, Woodrow Wilson School, Princeton University, Princeton, NJ 08544 (

© 2009 Lippincott Williams & Wilkins, Inc.