Health has improved greatly in recent decades, both in the developed world and much of the developing world. Nevertheless, many health problems remain, and in particular, social inequalities in health are not diminishing. Recently there has been considerable concern about the rapid increase in obesity and related conditions such as adult onset diabetes, yet the debate remains largely phrased in terms of health education and individual behaviour. In addition, some grave health problems seldom even enter public debate, as they are not increasing—for example, we have become so accustomed to slaughter and maiming on the roads that road deaths are rarely even counted as newsworthy.

THE WANLESS REPORT

In the United Kingdom, a recent report from the Treasury (finance ministry), the “Wanless Report”,¹ explores the ways that population health can be improved and health inequalities reduced. This contribution to the health debate has a significance that goes beyond the British context, as it deals with issues that are relevant throughout the economically developed world. Arguably they are even more important in less well off regions, but the terms of the debate are considerably different in that context and will not be further considered here.

The report represents an important step forward—but also a step to the side. It builds on a previous report in 2002, also by Derek Wanless,² on the funding of the NHS, which considered that the recent substantial UK investment in health care would lead to large health gains only if population health also improved significantly through individuals’ involvement in their own health, “the fully engaged scenario”. The focus of the more recent report is on how to achieve this, the starting point being that prevention is more cost effective than …