EDITORIALS

understand the mechanisms through which health promotion is organised and managed in the public sector at national, state, area/region and local com- munity level. There seems to be a less than straight- forward delineation of role, responsibility and accountability which makes the development of strat- egy difficult and its implementation positively anarchic at times. This is no doubt the product of a healthy federal democracy which I have yet fully to understand-but it also gives messages to outsiders which indicate poor unity of purpose and a less than optimal sense of priority and direction. It may well be that the current (Macklin) inquiry into health services strategy provides an opportunity to achieve better role delineation, to identify mechanisms for better integration of health promotion into the health ser- vices, and to propose a better structure for del- egation of responsibility and accountability in health promotion. I look forward to the opportunity to par- ticipate in these discussions, and to the publication of the Issue Paper on ‘Preventive services and health promotion’.

So there you have it-observations from a partially informed observer. Others would no doubt have chosen different achievements to praise, and differ- ent problems to highlight. The editor will welcome correspondence! Substantial progress has been made in Australia and there is much to be pleased with in health promotion. Building on this start clearly remains a very substantial challenge for the 1990s.

Don Nutbeam Professor of Public Health (Health Promotion)

Department of Public Health University of Sydnqr

References 1.

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Better Health Commission. Looking f m a r d to better health. Vols 1-3. Canberra: Australian Government Publishing Ser- vice, 1986. Australian Health Targets and Implementation (Health for All) Committee. Health for all Australians. Canberra: Aus- tralian Government Publishing Service, 1988. United States Department of Health and Human Services. The 1990 health 4ectives for the nation: mid-course review. Washington, DC: Office of Disease Prevention and Health Promotion, 1986. For a useful discussion of alternatives to experimental design see: Green L, Lewis FM. Measurement and evaluation in health education and health promotion. Palo Alto, Cal.: Mayfield, 1986. Hawe P, Degeling D, Hall J . Evaluating health prumotion: a health worker’s guide. Sydney: MacLennan 8c Petty, 1990.

Not just a pretty new face A new title and layout reflect, to some extent, the coming of age of modern public health in Australia and also a switch in editorial control from Adelaide to Sydney. Without doubt, the new-look journal is a tribute to the Adelaide editorial team whose efforts made Community Health Studies a strong foundation. It was not an easy task-even the beginnings were difficult. As in Laurence Sterne’s classic, which went on for several desultory chapters before the hero, Tristram Shandy, was born, so it was with Community

Health Studies, which eventually appeared in October 1977 as the journal of the Australian and New Zea- land Society for Epidemiology and Research in Com- munity Health.

Thereafter the journal mirrored the renaissance of Australian public health, with its pages reflecting the progressive improvement and relevance of empirical studies. Appreciation of New Public Health prin- ciples was perhaps a little delayed, but especially after exhortations from Nancy Milio, the new movement’s Mother Theresa, the situation was rectified. Edi- torials maintained an admirably objective stance dur- ing the turbulence of public health reform in the 1980s. They neither contributed to the rise of demonologies nor, in the case of Kerr White, to hagi- olatry. As reform proceeded and the work of the Bet- ter Health Commission unfolded, so did the authority and confidence with which public health writers addressed policy issues.

The promising phase continues as the journal’s mantle falls on the Sydney editorial group which, originating from seven major academic or service units in that city, is itself a product of the new positive trends.

The Public Health Association has wisely laid down broad guidelines for this journal to suit a correspondingly broad readership. Given the diffi- culties of ascertaining the precise composition of that readership, possibly it is best to echo the official defi- nition of an Aborigine or Torres Strait Islander- those who identify with public health belong to it. One thing is clear: the journal is for a generalist clien- tele, something of an anachronism in this specialist age. It has to be interesting, informative, educational and reliable (and hopefully also entertaining and occasionally amusing). Arbitrary decisions are needed to avoid over-specialised content so that readers do not get tangled in logistically over- regressed thickets, terrorised by swarms of QALYs, lost on the dehumanised plains of grand social the- ory, stranded in the branches of a decision tree, sunk in a Frazerian bog of cultural symbolism or overcome by holistic fundamentalism. Specialised outlets abound elsewhere and doubtless will arise in Aus- tralia, with health promotion first off the rank.

This journal has no mandate to consider itself an exclusive mouthpiece for Australian public health- not for it the attitude expressed by the only hotels in Djoum, Cameroon, one called the Hotel Windsor, the other the Hotel Anti-Windsor. This journal’s task is to cover the entire range of public health interests. There is an additional incentive to maintain this role because of the danger, as Dan Nutbeam has noted above (p. 5 ) that institutional marginalisation may occur if certain strategies are left off the main agenda. It goes without saying that, if thejournal is to prosper, it must continue to attract and communi- cate excellent material. The new Sydney editorial group has enthusiastically committed itself to finding the means to achieve this goal.

Charles Kerr Editor

Department of Public Health University of Sydney

6 AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1 9 9 1 VOL. 15 NO. 1