Published: 05/02/2004, Volume II4, No. 5891 Page 4 5

Social action to improve health will follow investments in delivery and the expansion of choice as the third phase of the programme to reform the NHS, health secretary John Reid told chief executives on Tuesday.

Announcing the start of a 'broad' consultation on a white paper on improving the health of the nation, he called for a 'grown up' debate about the relative roles of government, individuals and industry in tackling public health.

Questions to be examined include regulation of advertising for food and drink. He described social action to improve public health as the third 'building block' of the NHS's core business, following investment in delivery, through increased capacity, and the 'personalisation' of the NHS via increased choice.

The announcement, weeks before government advisor Derek Wanless is due to deliver his report on public health, highlighted the need for action on smoking, obesity and sexual health. But Mr Reid suggested the government might take a cautious approach to regulation.

'Is it, as some suggest, the government's role to make rules and regulations? To ban things?

Should the government simply try to stop people doing what they enjoy? I can't speak for every one of my colleagues, but that was not what drove me to become a secretary of state.'

Faculty of Public Health president Sián Griffiths said: 'It was clear that public health is now up there with delivery and choice.

I am convinced It is a step forward in making it a mainstream part of the NHS agenda - I could not have wanted more.'

UK Public Health Association chair Geof Rayner said he hoped the consultation would test public attitudes to greater regulation, particularly in the field of child health: 'When you are talking about children, the issue of individual choice does not apply.

'I hope it gives the secretary of state an opportunity to rethink a policy of running scared of being branded a nanny state.'

However, Health Development Agency chief executive Paul Streets said the promise of a white paper did not necessarily mean an emphasis on regulation. 'That is a very polarised debate.

'Rather, I heard a focus on what the NHS can and should be doing to support individuals in making decisions about their health.'

King's Fund public health programme director Anna Coote welcomed the speech's emphasis on 'health rather than just a healthcare system, and the explicit link between good health and reducing long-term NHS expenditure that Wanless made; that has been lacking until now'.

However, she said she was 'slightly alarmed at the complete lack of any reference to the socio-economic causes of ill health'.