A new direction for public health in England: few devils, few details

Abstract

A quarter of a century ago, the Acheson Report 1 helped to address the challenges of a public health system perceived to be unsuitable in the wake of policy failures, concerns over communicable disease control, an imminent NHS reorganisation, a demoralised public health workforce, and uncertainty over how to meet the challenges of commissioning. Can Healthy Lives, Healthy People deal with many of the same challenges today?2 Public health professionals awaited the coalition government's public health White Paper with nervous apprehension. Their detachment from the White Paper's development was underlined by private sector involvement in shaping public health policy. Nevertheless, this government has not shelved the Marmot review ( Fair Society, Healthy Lives ) in the manner of their predecessor's response to the Black Report a generation earlier. Rather it has billed this White Paper as a response to Marmot's work and adopted its life course framework for tackling the wider social determinants of health.3 Can this government use such expertise to address health inequalities where the last government is widely perceived to have failed?4 Healthy Lives, Healthy People is a perplexing amalgam. Much of the document covers familiar ground describing health and wellbeing today and opportunities for major advances. GPs need no reminding of how unequally health-determining opportunities are distributed or how improvements to child public health and educational attainment could reduce later risks of physical and mental illness. The costs of many lost opportunities are …