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I am ex public health, now doing something completely different, but a lot more target/ outcome focused, and very hands on. I despaired of the culture and attitudes and found the lack of action immensely frustrating. I realised I could never progress my career or feel I fitted in a job until I left. I have some sympathy for dull reports because I've written my share of them in order to tick some corporate box. But equally, yes, every disease has a social gradient. There are still things that can be done to address inequalities and deprivation but while I don't know enough to go as far as Cassander and tackle big business, I don't think the skill set lies in public health. I've met some very driven, passionate health promotion managers who've had an impact and take pride in achievements for hard to reach groups, but I have to say that most of them were in LAs or the NST. In the NHS it felt like a career cul-de-sac because it was mostly about contracting. Yes, we could've made better use of people, e.g. by building the evidence for change and looking at clinical/ cost effectiveness but maybe the horse has bolted. Many good people have left. But that's just my personal experience.