Published: 04/03/2004, Volume II4, No. 5895 Page 24

Ultimately, Derek Wanless's latest report, Securing Good Health for the Whole Population, falls short of the consistency and clarity of message evident in his first.

Perhaps the complexity and opacity of the public health function overwhelmed him.Or perhaps he calculated that an essentially technocratic, managerial report would carry more weight with a government obsessed with improving performance and delivery.

The report risks being quietly consigned to the archives, leaving the government to produce yet another worthy policy statement, in the form of the promised white paper, of precisely the type of which Wanless is so critical.

Wanless is strong on what has gone wrong and why, but less convincing on the way forward.

He is good on the weak public health focus in primary care trusts and the poor state of public health research and development. But on the big political issues, notably the relationship between government and individual, he pulls his punches, setting out the issues but reluctant to offer a steer on how they might be tackled. It is left to government and the public to debate. But, as he so eloquently argues, for all their promises and alleged commitment, successive governments have failed to deliver over the past 30 years. Is the present one really so different?

High hopes, maybe unreasonably high, were riding on Wanless II to chart a clear way forward for public health from which ministers could not shy away. As things stand, the future for public health remains equivocal and at the mercy of political power plays.

David Hunter Professor of health policy and management Durham University Chair designate UK Public Health Association