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The biggest 'lifestyle factor' for major disease & reduced life expectancy is poverty, closely followed by ignorance.

I can't quite remember the last time I saw a public health person speaking about health inequalities and their effects on their populations. They only seem to emerge from seclusion when there's an interesting outbreak of something virulent. The rest of the time they seem to spend office bound, counting stiffs and sickies from on high.

To command respect, public health services have to take effective action locally - and no, I'm not talking about more 'Stop Smoking' leaflets. They were never as effective as a simple ban.

I think the old MoH model had much to offer, but they had teams of health visitors, tuberculosis visitors, specialist family planning and a full school health & dental service to work with. Where are they now...?