The reception given to the government's public health strategy green paper has, in marked contrast to The New NHS white paper, been rather muted. Perhaps things would have been different if, as originally intended, the green paper had preceded the white. As it is, the NHS agenda has assumed supremacy. Sadly, it was ever thus.

Possibly the most public display of support for the health strategy comes from an unexpected quarter - the food industry. The Kellogg company has large billboard posters with the words 'National Health Servings' on which it proclaims its support for the nation's health. Can this be what the government means by partnership with industry?

But it is churlish to carp. Our Healthier Nation is a welcome document - a serious attempt to shift the policy agenda away from healthcare towards health.

Although it is a consultative document, there are some 'givens' and they are likely to prove critical. First, ministers are unequivocal about their commitment to a long haul - they are not peddling 'quick fixes'. For politicians, programmed to think in the short term, this is a bold and welcome move. Ministers must be held to their resolve. The complex strategy being put in place, of which the green paper is only one component, will not produce early returns. It should not be expected to. What matters is that those implementing policy are rigorous about monitoring performance to ensure that the strategy remains on course.

The other major given is that ministers do not want to appear over-ambitious. They rightly intend to be focused - demonstrating their commitment to real progress as distinct from rhetorical flourishes. The challenge then becomes one of where that focus should lie and of how visionary it will be.

A key omission from the green paper is a European and wider international dimension. Its brief mention falls far short of its importance, and of its actual and potential influence on national health policy. EU directives and policy pronouncements already play a critical part in shaping and framing national policy. Food safety, for instance, is now largely determined at a European level.

More worrying, and not even hinted at in the green paper, is the move by the Organisation for Economic Co-operation and Development to introduce a new international accord, the Multilateral Agreement on Investment. If signed by member states, it would effectively grant multinational corporations the power to overrule democratically elected national and local governments where they believed their legitimate actions were being restricted. Thankfully, there are indications that this attempt to advance the interests of global capitalism at the expense of legitimate public policy goals may be thwarted. But where is the public debate about such matters, which surely go to the heart of a country's ability to put in place a sustainable health strategy?

The UK government rightly seeks partnership with business as one of the key stakeholder groups to be embraced in its vision of 'the third way'. This is, after all, prime minister Tony Blair's mantra, which ministers are obliged to chant at every opportunity. The government talks of a contract for health with the people. But this contract must also include, for example, those who profit not only from the food we eat, but from where and how we buy it since out-of-town shopping centres carry major environmental implications.

It is in these areas that the commitment to joined-up policy to address joined-up problems begins to look a little disjointed, especially when the government views regulation as a last resort if voluntary agreement fails. But, as is well documented in the case of the tobacco companies, the business sector will not change its ways unless required to.

An uncharitable interpretation of current government policy is that in its search for a third way between the discredited strategies of state social engineering and unfettered markets it leans too heavily towards markets, and a policy agenda the government would have us believe has been abandoned. But has it? Or is this product retention in new and more attractive packaging? A bit like Kellogg's conversion to serving the nation's health, perhaps.

This is not an indictment of this particular government. Its ministers are doing more than most to reconfigure the health policy agenda. The issues go deeper and certainly beyond the confines of individual nation states and their governments, particularly those occupying the political centre-ground. Though several have tried, no country anywhere has succeeded in doing what the UK government is attempting - that is, to close the health gap between rich and poor.

If we are not to be bitterly disappointed, we have to ask ourselves why others have failed. The green paper cites Finland and Sweden as having impressive health records to which we might aspire. But there is no mention that Finland and Sweden are in the grip of public sector expenditure squeezes which are likely to vitiate health gains made in recent years. Since our government, like its predecessor, is enthusiastically pursuing similar economic and social policies, is there a possible connection between the positive health profiles evident in Finland and Sweden and our dismal one?

Take flexible labour markets, which, the government proudly boasts, partly explain our strong economic performance. Research is beginning to show that the short-term contract culture is neither good for the health of the workforce nor that of the organisation.

Until we have an open and honest debate we will continue to fiddle at the margins and conveniently ignore the real policy drivers. We may even have to confront the unpalatable truth that within our existing political structures it will prove impossible to achieve desirable public policy goals. The third way, like compromise, may be a cruel illusion. Let's hope I'm proved wrong.

David Hunter is professor of health policy and management at the Nuffield Institute for Health, Leeds University.