The Health of the Nation programme launched by the former Conservative government has come under fire for the second time in two weeks, this time from right-wing think-tank the Social Market Foundation.
A new book by Conservative government adviser Tony Hockley and Professor Nick Bosanquet of London University's Imperial College, acknowledges that the programme was groundbreaking in its day.
But it says: 'If experience since the 1991 launch has taught us anything, it is that there are restricting limits on what the state alone can do to improve public health directly.'
The book, Back on Target , says a 'mixed economy of public health' is needed, in which non-governmental organisations - including pharmaceutical companies - have a bigger role and 'consumers have more power'.
'Many public health issues are not classic in the sense of involving the prevention of social cost and contagion, ' the authors argue. 'They are concerned with quality and risk in private consumption.'
Back on Target says 'consumers can reward high safety standards through their purchases'.
It suggests: 'We need to find ways of raising consumer power in product areas where problems have arisen, such as the sale of eggs and certain types of meat.'
The book argues that in such a 'mixed economy', the government would generally 'consult' with other interested parties and 'explore options other than government compulsion for reaching a goal'.
As a logical extension, the authors argue that another lesson to be learned from World Health Organisation and national public health programmes over the past decade is that education is more likely to change behaviour than fear.
'In pragmatic terms, the links between health and earning power will be much greater in the future than when the welfare state provided a guaranteed income, ' the authors add.
'There are opportunities to develop people's sense of their health being their most important asset and to stress simple steps for looking after it.'
In this 'mixed economy', the book adds, 'information will be a key resource and lever' in improving health and health improvement programmes.
Mr Hockley and Professor Bosanquet welcome the Labour government's approach to public health, set out in the Our Healthier Nation green paper.
It 'paves the way for a much more effective application of core national targets, and allows much greater scope for multidisciplinary work in pursuit of targets at local level', they conclude.
'It is an important new direction and the evidence we have suggests it should succeed.'
Looking at the Health of the Nation targets, however, the authors argue that the greatest progress was made in areas - such as breast cancer reduction - where work was already under way.
They argue that some targets may have been 'detrimental ' by 'providing a justification for focusing services on the target rather than the objective'.
Back on Target contends that this happened with family planning services.
The publication of Back on Target follows the publication last week of research for the Department of Health suggesting that The Health of the Nation was 'hampered by numerous flaws' and had little impact on the health service.
Back on Target . Social Market Foundation.
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See News Focus, page 14.