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Public Health in PCTs has consistently punched below its weight ( a real value for money issue in management terms).This is partly due to its academic detachment and desire to not get its hands dirty. We can all recall countless repetitive mind-numbing presentations by public health consultants on SMR rates and awful health status gaps, going nowhere because of the lack of a resolving action plan: the culture is so inclusive and democatric, it has forgotten it needs to actually do something. What to do? Its obvious - funds need to be targetted to actions in the most deprived segments of urban populations, to raise the bottom 25% up to the local average, and then to raise the average to the upper quartile - only then is it worth thinking about narrowing the gap with a desirable England quartile or decile. This means planned diffential investment of interventional monies on a significant scale in deprived wards, over a 10 year period, and also by-passing the dead-hand of primary care contractors - policies which public health steadfastly refuses to take on board. It also means a more aggressive stance against manufacturers and purveyors of fast food, junk supermarket food and alcohol. What happened to the public health campaigning spirit? Come on, develop a spine, do a job!