Published: 04/03/2004, Volume II4, No. 5895 Page 23

I was sniffing around Derek Wanless's second report ahead of publication, hoping to get a sense of what it was going to say about Securing Good Health for the Whole Population, when I met with a less than an enthusiastic official response.

Not for me, but for Wanless. A banker I met over dinner that night snapped: 'He was no good at NatWest either.'

'Wanless II is a bit of a damp squib compared with Wanless I, ' confided one well-placed Whitehall policymaker.He complained that 'Mr Wanless' - I fear the peerage will have been delayed - had been too methodological and not sufficiently prescriptive about what we can do to improve Britain's spotty public health record. Too much 'motherhood and apple pie' about things we already know, he opined.

Hence the decision several weeks earlier, when it became clear there was not going to be a substantive package from Wanless, to announce that health secretary John Reid will produce a public health white paper in July.

It will build on Wanless and on those aspects of the Big Conversation which address key issues like smoking, obesity and diabetes.My friend made one useful point which I had not seen elsewhere, namely a deliberate attempt to harness reform to the 'new localism' to obtain wider public consensus.

The local fluoridisation campaigns are a template.

So councils will be empowered to enforce smoking bans in the workplace and restaurants, thereby provoking useful democratic debate.

'As more and more councils come on board you get critical mass, making it easier for government to come along as a sweeper and legislate later on, ' I am told.

This column has an irrational dislike of total bans of legal products enjoyed by 28 per cent of the population. Though a lifelong non-smoker I voted this week against a total ban in the press gallery at Westminster where a persecuted minority of smokers survives like early Christians.

Reading Wanless II when I finally got my copy, it is hard to justify my conduct except on libertarian grounds, although I suppose you could say that Americans are freer, and healthier, than Russians, despite the exercise-free and fat-sodden lifestyle of so many Yanks.

The EU does things better.

I do not know about you, but I did not find Wanless an easy or illuminating read. To the annoyance of bodies like the Consumers'Association ('more of the same') it falls into the same trap as the very government strategies it criticises - unclear targets and unrealistic goals.

As a thin and exerciseconscious non-smoker in no danger of picking up a sexuallytransmitted disease, I looked up 'salt' in the cardio-vascular section, which heredity has made my number one threat. Not much use, Derek, I am afraid. Salt intake is up 9 per cent for blokes in the past 15 years, but 75 per cent of it comes from manufactured food. Not much I can do about that except avoid it as best I can.


In search of optimism, I rang Dartford's Labour MP and GP, Dr Howard Stoate. A natural optimist, he is the chap who contradicted fellow Labour MP medic, Lewis Moonie, on BBC2 last week for saying Tony Blair's heart scare was serious.

Dr Stoate was out training for the London marathon on a snowy Sunday night. Twelve miles later, I caught up with him.

He was very keen on Wanless - 'quite a radical' contribution.

'We have to teach kids, educate parents and force food makers to improve their products.

'If companies are not responsible, there must be a tougher approach - legislation even.'

But he is against a special tax on the bad ingredients in food - one of the ideas Wanless toys with before leaving it on the side of his plate.

'It is not just impractical; it targets families who are already struggling. By and large obesity is a disease of poverty; people get a bigger bang for their buck with fats and sugar when they're feeding hungry kids, ' says Dr Stoate.

What people need is education about achieving a balanced diet.

They need knowledge, not coercion, access to affordable shops, and the kind of community and buildings where walking is encouraged.

'Stairs in the front, lifts round the side, ' he says.

A stern reproach, too, for Dr Moonie who, he says, has not practised for so long that he does not know Mr Blair's supraventricular tachycardia incident is easily treated by the electric shock option these days.

The alternative is beta-blockers, says Dr Stoate. No good for a busy PM.