The paragraph which leapt from the pages of the public health green paper, Our Healthier Nation, was the one which proclaimed 'a third way between the old extremes of individual victim-blaming on the one hand and nanny-state social engineering on the other. Good health is no longer about blame, but about opportunity and responsibility.'

Pure Blairism and, sure enough, as it emerged in London, so the PM was talking ideological 'thirds ways' with Bill Clinton in Washington. But one's reaction to the green paper must depend on where exactly in our soon-to-be-healthier nation you're starting from.

If I was an unskilled man of my age living on the dole in Newcastle I'd be fairly depressed, despite the splendid new 'healthy living centre' set up in the city's impoverished west end. Even so, being a pampered middle-class Londoner may not save me from the strokes which felled both my middle-class parents at an average age of 53, ie next year in my case. Otherwise those statistically impoverished Greek males would not emerge from Frank Dobson's many statistical tables as second longest livers in Europe.

At 75.2 they're just behind the Swedes at 76.3, wealthier but lacking all that olive oil, red wine and sunshine - what Tessa Jowell would call the 'Mediterranean diet factor' which makes up for a lot of filthy Greek tobacco. Our own blokes are number six in the Euro-table at 74.3, by the way, whereas our womenfolk (79.5) are way out of line at number 13. No explanation is offered.

So John Maples, the Tory spokesman, had a point when he warned Dobbo that the link between poverty and ill-health is 'not as simple as he makes out'. But only a modest point: everyone knows the score, and the government's holistic approach - which seeks to look at work, housing, education and the environment - is surely right and proper. Three cheers for good intentions.

But how to make a real difference, that's the thing. When I caught up with Ms Jowell, she was still smarting from Tory-led jibes that Labour is reducing Mrs Bottomley's 27 health targets to just four and lowering them as well. 'There will be targets and reaching them will require tough action,' she insisted. 'Our goals can only be achieved as a result of government strategy.'

When she asked chief medical officer Ken Calman which targets would be hardest to meet, he told her it would be cutting strokes and coronaries by one third by 2010. That's the year I'm supposed to retire, if I make it, so I wish them well. Meanwhile, ex-CMO Sir Donald Acheson is busy working out how best government action can close the health inequality gap between social groups, even though he knows how hard such inequalities are to measure. Just look at those Greeks.

Ms Jowell herself has already visited Birmingham to start her 'public health roadshows', the first of eight Blairish public meetings with experts and voters to preach the word. It's being done in conjunction with other departmental ministers from education, housing etc, all aimed at creating effective local strategies for making - and enforcing - that real difference.

I hope she stops in Wakefield where she will find a fretting David Hinchliffe, chair of the Commons health select committee and a former social worker. From where he starts, in a town which has lost 20,000 industrial jobs, the local MP doubts whether the government as a whole grasps the scale of Britain's deeper pockets of deprivation.

Mr Hinchliffe places much trust in an enlarged role for local authorities. Frank Dobson plans to enhance their statutory obligations to public health, but he goes much further, suggesting the restoration of a specific public health function and a local medical officer of health.

Why do this in 1998? Because health, social services and local government were much more integrated and effective when Mr Hinchliffe was a young social worker pre-1974 and later a councillor, when 'we had vigorous debates about public health. It's all gone, all been marginalised.' And may be further marginalised, I might add, if councillors do not respond to the modernising challenges set out by Mr Blair in yet another green paper last Monday. It's not enlargement, but emasculation, they'll be facing.