Public health and mental health experts have attacked the government's long-awaited public health green paper for not going far enough to tackle problems.
And while managers' groups welcomed Our Healthier Nation's 'radical agenda' they signalled there would have to be cuts in services if it was to be met without extra funding.
Institute of Health Services Management director Karen Caines accused the health secretary and public health minister of 'bottling out' of a commitment to cut the health gap between rich and poor. 'Frank Dobson and Tessa Jowell show all the signs of a personal conviction about reducing health inequalities,' she said. 'But the new consultative green paper... suggests that they have peered over the precipice and drawn back a step or two. Without measurable targets, even over a long timescale, there will be pressure for change and less scope to hold them to account.'
King's Fund chief executive Julia Neuberger said: 'We welcome the focus on disadvantaged groups at the local level but we do have to measure progress in reducing inequalities, otherwise there is a danger that no one will take responsibility and be held to account.'
The Public Health Alliance also criticised the government for ducking the key issue of setting targets to reduce inequalities.
PHA chair David Player said: 'This is the litmus test - if they fail on this, they fail entirely.'
He said that while the thinking behind the paper was right, there were 'outstanding omissions in the strategy'. The Treasury should set 'wealth index' targets, a policy to achieve maximum ratios between the highest and lowest paid.
Dr Player said: 'Studies show that societies with a lower wealth index, that is, where disposable income differences are smaller, have better overall health and are more productive.'
The Mental Health Foundation said after the launch of the green paper last week that it was hugely disappointed. Mental health is proposed as one of four national priority areas for action, but MHF thinks it is 'ludicrous' that only one target is proposed: to reduce the death rate from suicide and undetermined injury by at least a further one sixth by 2010.
MHF director June McKerrow said that while suicide was important and needed to be addressed, other areas needed to be tackled: 'Our Healthier Nation, like the previous government's Health of the Nation, has failed to identify any appropriate targets for the mental health of the country.'
The NHS Confederation thought the government's plans to enter into contract with the public would rightly raise expectations, particularly for those whose health is poorest.
But chief executive Stephen Thornton spelled out the implications for health authorities: 'If more time, energy and resources out of a cash- limited budget is to be devoted to improving health, then there is less money available to spend on health services.'
The green paper could open the way to joint health/local authority appointments of public health staff, social services managers said.
Welcoming the proposals, the Association of Directors of Social Services said it would see council chief executives playing a greater part in local health planning.
It regretted that no extra money had been set aside to fund health and local authorities' 'new responsibilities', ADSS president Roy Taylor said.
The British Medical Association said the document heralded a 'new start', but suggested that strong support across traditional ministerial boundaries would be needed to achieve progress.
Noel Olsen, chair of the UK public health consultative committee and a member of the BMA's board of science and education, said: 'Ultimately we would like to see the minister of public health having the same key role in government as the chief secretary to the Treasury.'
Large-scale cuts in community nursing threaten to jeopardise the government's public health agenda, nurses' representatives warned.
Royal College of Nursing general secretary Christine Hancock urged the government to strengthen the role of health visitors and school nurses.
Shadow health secretary John Maples said he would press the government to reintroduce the targets that Labour had dropped.