Public health in hospitals: the missing link in health improvement.

Traditionally, public health professionals have scorned hospitals as the antithesis of community health. Secondary care remains notably distant from public health practice and policy. Yet hospitals consume over 50 per cent of the health budget and over a quarter of the population have contact with hospital services every year. There is an important public health agenda in hospitals for promoting health and an environment that encourages community partnership and a healthy place to work and be. Public health skills have a key role in ensuring high-quality, safe and evidence-based health care. Epidemiological support for hospitals can promote a much-needed culture of monitoring and evaluation of health services. A public health approach to planning of secondary care services can encourage a more objective and strategic assessment of health needs and how these are best met. We argue that public health hospitals should not be an oxymoron, but an essential component of public health strategy. Different approaches to putting public health into hospitals are discussed.