It was in the 'ninth year of austerity' - with the end of full rationing still six years away - that the NHS came into existence on 5 July 1948. The chief medical officer, reporting on the state of the public's health, declared the NHS had begun 'its colossal task' amid 'economic adversity' - though he said the British people were coping with 'their usual good-tempered grumbling'.

The report begins, typically, with the weather: a key determinant of health which in "complete contrast with 1947 [was] very favourable both as regards the incidence and the fatality of the more prevalent diseases, thus forming".

It was so good that flour, bread and potatoes were removed from the ration book in 1948, though other foods, including tea, sweets, butter, cream, cheese and cooking fats were still restricted. Reports of the time note the success of rationing in ensuring "nutrients which might be in short supply were not consumed solely by those with the longest purse". In fact, ration and higher incomes among the working classes made the nation's diet better than ever.

The 1948 report announced new research into "diet and industrial output". In 1949, the chief medical officer reported on a study that had graded "the energy requirements of adult men in six grades of activity, from sedentary at 2,274 calories to 'extremely heavy work' at 4,926 calories daily".

Of course no one could predict how much incomes would rise and lifestyles become less physically active in the next 60 years and what this would mean for people's health. The result was a decline in calorific consumption but an increase in average weight.

One lifestyle-related illness does begin to emerge in this period: a 1950 chief medical officer's report discusses for the first time a possible link between smoking and cancer: "Heavy taxation of tobacco may in time lessen its enormous consumption and the ever-increasing habit of smoking, which [is suspected] of being a factor in the aetiology of lung cancer, the standardised death rate of which has increased many times since 1920."

That report also heralded the first intimation of the "fully engaged" Wanless scenario. The point, it argued, had been reached "where further improvement in the physical environment is likely to show diminishing returns [and the time had arrived] when the citizen must actively participate in the campaign for better health if further substantial progress is to be made".

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