Whenever the former United States surgeon general, Dr David Satcher, was faced with a particularly complex public health issue he would ask the question: "Where is the handle on this Broad St pump?"

The question, of course, he was asking is where is the epidemiological evidence, the science that shows the source of this particular public health threat? When Dr Snow persuaded the guardians of the parish of St James to remove the handle from the Broad St pump in September 1854, to stem one of the worst cholera outbreaks London had seen, a marriage between science and disease prevention was formed. That single event did more to shape modern day epidemiology than any other. Our story on page 305 looks at the man, seen as a crank by his contemporaries, who did so much to drag us out of a world informed by superstition and ignorance about health.

If you fast forward 150 years to the present day, it does not take a great leap of imagination to start drawing comparisons between society's attitude to public health then, and our attitude to mental health as a public health issue now. Mental health is one of the last great taboos beset by widespread fear and ignorance. Our story, on page 302, shows us what little research exists looking at the link between our environment and our mental wellbeing, even in the more obvious areas of noise and hoarding.

It is widely accepted that we need a combination of legislation, education and policies to promote physical wellbeing in our communities in order to create health equality. What we lack, and is only now starting to be discussed in the field of workplace stress, is a similar approach to address our own mental wellbeing. Using the physical health model, we need to start looking at how we can reduce inequalities in the distribution of mental distress and improve the mental health of the whole population. We all have mental health needs regardless of whether we have been diagnosed with a mental illness, in the same way as we all have physical health needs.

The argument for forming a public health strategy addressing mental health, much in the same way as Derek Wanless showed us, can, in part, be based on cost. Poor emotional health in childhood leads to troubled behaviour, lack of confidence, feeling of alienation and poor academic achievement. The cost to public services of adults who exhibited "troubled behaviour" as children is ten times higher than for adults with more stable backgrounds. Stress-related illness is also creating a financial headache for employers.

The argument for integrating public mental health into the broader public health agenda is gaining currency. Unfortunately, what is missing in this debate, as Dr Satcher would put it, is the handle to this particular Broad St pump.

Stuart Spear
Editor