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The US is reframing its public health training so that it addresses the needs of a modern population ("US changes dose to treat public health malaise", 6 September). In the UK, the public health function involves a core of skills and learning that are expressed in varying organisations and roles. Ongoing reorganisations require UK training to be reviewed as a matter of urgency.

Practitioners have two key perspectives. They need to understand how to improve health and wellbeing at the population level while leading change in the organisations that serve the population. Particular leadership skills are needed to influence complex interconnected organisations. Individuals need to demonstrate new and creative ways of embedding public health wisdom in systems that are caught up in this public service revolution. Academic teachers in this area need to develop practical content that anticipates the radically altered environment in which their trainees will practice.

The UK's historic contribution to public health introduced clean water and safe sewers. Just as crumbling old sewers need replacing, old ideas need renewing.

Tim Moore, consultant in public health medicine

Woody Caan, fellow of the Royal Society for Public Health