Public health: a need to think outside the box

www.thelancet.com Vol 378 December 17/24/31, 2011 e26 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ health reform through the involvement of public actors and institutional mechanisms of accountability in Brazil, and HIV/AIDS activism in South Africa. The public health agenda should hence not be confi ned to a debate within the boundaries of academia, but widened to include stakeholders from civil society and operational public health agencies. This need for academia to think outside the traditional public health “box” will require a bold paradigm shift from medical interventionist approaches towards a new values-driven approach based on strong leadership and advocacy, which could draw from the experience of the contemporary art of health promotion. Health promotion seeks not only to improve overall population health through creating conditions that are conducive to personal, community, and organis ational empowerment, but also to reduce social health inequalities through both interdisciplinary and intersectoral cooperation. Although health promotion has struggled to identify and defi ne itself in terms of its professional status and accreditation, it delivers valuable lessons that could meaningfully inform the concept of a new multi disciplinary public health agenda. When doing so, public health could then, far from being on the verge of extinction as a marginal discipline in the medical sciences, not only be considered as an evidence-based approach towards implementing sustainable and eff ective public health interventions, but also as a values-driven approach for advocating healthy policies, including addressing the broader and global social inequalities in health.