From medical officers of health to multidisciplinary public health specialists: a history of the professional transformation of public health in Britain, 1970-2025.

Throughout the twentieth century, senior roles in UK public health were reserved for doctors. Local authority medical officers of health were replaced in 1974 by NHS community physicians and from 1989 by medical directors of public health. Over the last decade of the century, an increasingly vocal group of non-medical public health professionals sought to break the glass ceiling that restricted them from advancing to senior roles; although they received encouragement from some leaders within the Faculty of Public Health Medicine, there was also significant resistance from many members. A number of factors came together around the year 2000, which culminated in a ground-breaking decision by the English Department of Health to allow non-medical appointments as directors of public health and consultants in public health in the NHS, with the then Secretary of State memorably declaring it was time to 'take public health out of the ghetto'. At the same time, the leadership of the Faculty of Public Health Medicine overcame opposition from some of its members and opened its training, examinations, and membership to non-medical candidates. By the early 2020s, half of the renamed Faculty of Public Health members were from backgrounds other than medicine as well as 90% of directors of public health in England. This paper explores the complex history behind this unprecedented opening of a medical specialty to non-medical membership, the factors that enabled it, and the continuing legacy of tensions and inequalities within an occupation that is both a medical specialty and a multidisciplinary profession.