Transformational change: short-term gain for long-term pain?

Transformational change as envisioned by Millar and colleagues forecasts a closer relationship between public health and primary care. In this commentary, public health readiness and the fiscal feasibility of the suggested model are examined from a pragmatic perspective based upon past and current experience. In the face of finite resources and compelling evidence on the merits of public health retaining its traditional involvement with community partners, the utility of late-stage secondary prevention collaboration with primary care is queried. Pursuing partnerships motivated by alleviating pressures in the healthcare system may be superficially attractive but might have a long-term negative impact on the health of the overall population.