Never mind the rhetoric, Labour must do something about health inequalities, the Public Health Alliance conference was told.
Health secretary Frank Dobson already has his slogan for the next general election. It will be 'Vote Labour - live longer' he told public health activists last week. Wisely, he added the rider, 'provided we can demonstrate that is what we are doing'.
Clear evidence of longer life, specifically for Britain's worst off, is precisely the goal public health campaigners will be counting on Mr Dobson and his health team to deliver. Closing the gap in health inequalities is seen as the litmus test of New Labour's commitment to public health. After all, the stalwarts who came to hear Mr Dobson speak to the Public Health Alliance conference in Sheffield did not campaign for 10 years under a government which attempted to ban the word 'poverty' to give up quietly now.
Mr Dobson made all the right noises about his determination to tackle poverty and bridge the health divide. There would be a 'break with the past'. Labour acknowledged health inequalities and rejected the 'blame culture' of the previous government. 'We now say right out loud there are inequalities and we are going to do something to improve them,' he said. And he twice remarked - perhaps as much as a reminder to the Labour leader as anyone else - that when appointing him health secretary, prime minister Tony Blair had given Mr Dobson the twin tasks of restoring the NHS and improving the public health.
Mr Dobson promised that action resulting from his public health green paper would be across government. The drive had already begun - with last week's announcement of a Food Standards Agency and plans for a national minimum wage, the welfare to work programme and more home building. Such projects were all targeted at the worst off, Mr Dobson stressed, with possibly a glance towards the idea of future tests - whether on 'means' or 'affluence' - for benefits.
He made clear that national targets in the green paper should be translated into local goals within health improvement programmes. He also expected that health impact assessments - testing government policy for its effect on public health - would be mirrored locally by studies demonstrating the effect on health of measures as diverse as traffic calming, crime reduction and housing improvements.
Officials from the English, Scottish and Northern Ireland health departments reinforced the themes - although rumour has it that the Scottish green paper, due out the same day as the English, will contain more radical proposals.
So far so good. While New Labour generally has hit some uncomfortable rocks recently, its health team is still enjoying a honeymoon, at least with public health. Public health minister Tessa Jowell escaped criticism over the tobacco advertising row because it is well known she faced the door if she failed to back Downing Street's decision to exempt Formula One racing. And there is strong support for the public health moves already launched, like the food agency, the social exclusion unit and the very fact England has its first public health minister. But it is just a start. Expectations are high.
'The rhetoric is terrific,' says Geof Rayner, secretary and one of the original founders of PHA. Many of the demands made by PHA when it was launched in 1987 - not long after the Black report was blocked, the first AIDS case identified and BSE in cows detected - are now government policy. The PHA first proposed a public health minister in 1988, in response to the then Acheson inquiry into public health. Labour consulted PHA officers before firming up Ms Jowell's post. 'When we were launched, some die-hards wrote us off as a radical fringe group,' Mr Rayner recalls. 'Now we find our ideas are mainstream.'
Shirley Goodwin, another PHA founder who is now a commissioning officer with Hillingdon health authority, believes the previous government's Health of the Nation strategy was the first major advance in the past 10 years. 'Many of us will judge how much difference New Labour will make by what the next one says,' she comments. But she is likely to be disappointed - judging from the Journal's leaked green paper - by the lack of targets on inequalities.
'I would want to see not just targets and outcomes set, but quite a bit to do with what people are supposed to do now,' she says. The document should ensure every HA carries out an 'equity audit', including checks on basic standards like GP list sizes in deprived areas, she suggests. If it is to work, the paper must set HAs a 'difficult and uncomfortable agenda'. She adds: 'A public health minister is not an end. It is just a beginning.'
David Player, another PHA founder, felt the wrath of the last government when he was effectively sacked from his post as director-general of the former Health Education Council over another embarrassing report on inequalities. Now PHA chair, he may yet provoke the wrath of this government. He applauds New Labour's commitment to reduce inequalities.
'If they don't do that they will have failed completely. That is the touchstone. That is the litmus test.'
But he is already alarmed by Labour's failure to promise tax rises and the benefit cuts to lone parents - which he compares to Britain's attitude to the Irish famine when officials preferred that people died rather than become dependent.
In his keynote speech, Kevin Watkins, senior policy adviser to Oxfam, also hammered home the message that Labour must redistribute wealth if it is serious about public health. Inequalities in the UK are widening more rapidly than almost any other country in the world, due partly to poor nutrition related to low income. So cutting lone parents' income was a 'very curious starting point for a government committed to public health', he said.
Few in public health doubt New Labour has the will to tackle health inequalities. Whether they produce the means to achieve that end remains to be seen.