In this paper we suggest that four significant periods of public health developments in the UK can usefully be thought of, in metaphorical terms, as ‘waves’. Each wave has risen rapidly and maximum impact has been experienced during this period, where the wave reaches its peak before breaking and declining in intensity. A trough of activity from each wave continues and remains important to population health, but no wave exerts the same impact as when it first emerged. Overall progress has been maintained by a new wave starting while the established wave is still rising.
When applied to current and emerging challenges this analysis helps us to envision the form of the ‘fifth wave’ which will be needed to confront these.
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