Major public health problems require major solutions. To be successful, solutions need to be delivered at a number of levels. The English white paper Saving lives: our healthier nation 1 stated “We want to see healthier people in a healthier country. People improving their own health supported by communities working through local organisations against a backdrop of action by the Government”.

To illustrate this backdrop of actions, we can look at nutrition, where the concern might be an insufficient or an inappropriate diet. To assess the need for action a number of questions must be asked. Do people understand the basis of a healthy diet, do they have access to it, can they afford it, are there the right incentives for the food industry and agriculture to produce the right food at the right price, are these linked to sustainable development? The responses to these questions indicate the many levels of potential action. For example, education and access might be tackled at the local level, but reducing poverty and providing incentives for agriculture require national action. While public health programmes must engage communities and individuals, to be successful they need effective underpinning policies. These should not be solely health policies, but must tackle cross government issues that affect both the individual and the wider environment.

Key elements of the national response must be an analysis of the problem, determination of …