A new dawn for public health – with nanny to wake us up

We all knew prevention was better than cure – for many, listening to experts repeating this mantra was just annoying. So what's changed?

A new reality is dawning. The latest department of health production makes for sober reading. The government may have begun to master NHS waiting lists but one in five children does not eat any fruit in a week. A man born in Manchester is likely to die eight and half years before a man in Rutland. One in 10 sexually active young women is infected with chlamydia, which threatens their fertility; there are three times as many obese people in Britain now than in the early 1980s and we are confronting a massive increase in alcohol abuse and binge drinking among the young – and whatever we are meant to be doing to control drug abuse is failing.

Until now, the debate has been constrained by the perception that there is little that can or should be done and that it is simply a matter of individual lifestyle choices and has little to do with the state. Now, the scale and immediacy of the problem may at last allow that defeatist talk to be challenged. Of course, individual responsibility is central to this debate but it is a complex issue affected by a host of wider determinants.

If we are to make a difference, it will require a radical response, not only from the healthcare system, but also from schools, from employers, from the industries that feed and water us and from local authorities and voluntary organisations. In part, this is about finding very different ways of interacting with individuals and communities, adapting advice and services while opening opportunities that empower individuals to make healthier choices about their lifestyle.

To make a difference to health will require a radical response from schools, employers, industry, local authorities and voluntary organisations

If you don't feel good about yourself you are less likely to look after yourself.

But it is also about ensuring that institutions face up to their responsibilities. That means confronting schools that earn money by leasing soft drink machines and who are content to see pupils consume a diet of fried food. It means moving towards a smoke-free environment. It means challenging employers to ensure they are enabling their staff to take exercise; it means demanding that the food industry reduce the excessive use of salt and sugar in the processed food that now forms so much of our diet.

The immediate difficulty is the one that has thwarted previous attempts to make a difference: everyone know the nature of the problem, everyone knows that certain behaviours are more likely to lead to ill health, but knowing something and knowing what to do about it are a two different things.

The other challenge is that the rewards for effective public health action are seldom in this world. The electoral clock and the public health clock have never been synchronised. Much of tomorrow's heart disease is already beating in the chests of the middle-aged and nothing the government or anyone else can do will make much difference between now and the next general election.