Traditionally, the goals of public health have been to curb the spread of infectious diseases and to protect the well-being of the general population. The strategies used to achieve these goals have included surveillance, regulation, diagnostics, research and, more recently, reducing inequalities in health. The first three papers provide evidence of the need for an effective public health system that can deliver services to prevent the potential for risks to health. De Costa et al. discuss the risks associated with an unsuitable provider mix based on their study in Madhya Pradesh province, India. The study concludes that the available public health professionals were unsuited to the needs of the population, particularly in the rural areas and given the priorities in regard to maternal and child health. This may even have contributed to some of the high maternal mortality in the province. The paper by Elmanama and Al-Hindi emphasizes the need for good surveillance in determining the occurrence of drug resistance, in this case of vancomycin-resistant enterococci in Gaza City, Palestine. The authors were able to isolate, from both hospitalized and non-hospitalized subjects, enterococci that had high rates of antibiotic resistance. Burapadaja et al. discuss a cross-sectional study to determine the factors associated with the number of trade names and products of systemic anti-infective medicines available in Thailand. The study concludes that regulation would be a better way to control the market availability of this type of product.

Top-down styles of public health programming, as Laverack argues later in this issue, have been necessary to protect us from and to curb the spread of infectious diseases. However, they have had relatively modest success in promoting the health of the general population. The findings of the study by Sarrafzadegan et al. in Iran support this; they report on the impact of an intervention designed to reduce modifiable risk factors for cardiovascular disease. The study typically showed 'modest degrees of improvement,' especially in more marginalized population groups such as women. Promoting health and changing behavior are complex processes, and the study by Bergh, Starrin and Hagquist highlights this in regard to the link between psychosocial factors in neighborhood and workplace environments and psychosomatic health problems. The worst health effects were seen in people who had the lowest degree of inclusion and social solidarity. The study points to the importance of simultaneously considering social relations in different areas as a part of public health programs.

An important part of being included in a program or an environment is having access to knowledge. One role of public health is to enable people to use knowledge to make the right decisions for health and to take greater control over their lives. The paper by Kolip and Buchter reports on a cross-sectional study of first-time mothers in Germany who had planned a cesarean section. Most women felt that they did not receive enough information about the consequences of having a cesarean section, an issue that could have been easily resolved by the adequate involvement of a practitioner, such as a midwife, in their care. Kolip and Buchter present evidence from other studies also showing that those women who receive adequate information, especially first-time mothers, are happier about having a cesarean section.

The purpose of engaging with the recipients of public health programs is to build a sense of ownership, to meet their needs and to allow them to become involved in a meaningful way. In return the program has a greater chance of success and sustainability. The final paper by Laverack brings together many of the ideas of the previous authors in this issue by firstly discussing the present state of public health and why it has had only modest success in achieving some of its goals. The paper goes on to ask what public health programs will have to take into consideration in the future to be more effective and concludes with a rational way forward.