Tony Blair made an interesting speech in Nottingham the other day, entitled 'Healthy Living: whose responsibility?'. It didn't get a lot of attention in the newspapers that I read, though Number 10 tells me that such discussions generate huge local attention as they affect real people's real lives.

Tony Blair made an interesting speech in Nottingham the other day, entitled 'Healthy Living: whose responsibility?'. It didn't get a lot of attention in the newspapers that I read, though Number 10 tells me that such discussions generate huge local attention as they affect real people's real lives.

Tory health spokesman Andrew Lansley issued a cheeky statement. It praised the prime minister for copying Conservative leader David Cameron's lead on the importance of public health, as if the New Labour crowd hadn't been banging on about it for years. Who could forget Mr Blair's apple-a-day appeal to launch the 'small change, big difference' campaign in April?

But sometimes initiatives get crowded out by other priorities, mostly Lebanon this month. For instance, David Nicholson's appointment as chief executive of the NHS surely warranted the sort of attention given to a major corporate appointment: Lord Browne's planned retirement from BP was page one news. But among the newspapers, only The Guardianand FTthought the health service appointment worth a mention.

Turning up the heat

Unison welcomed the choice of an NHS insider to the job. Elsewhere it was preparing a warmer welcome for Mr Nicholson: raising the temperature of their 'Heat is On' summer campaign to protect the service from the alleged privatisation which health minister Handy Andy Burnham denied in last week's HSJ.

Mr Blair's speech started by rejecting both the 19th century minimalist state and 20th century state socialism in favour of the enabling state, which 'empowers the individual to be able to make the choices and decisions about life that they want'.

He cited the Victorian assault on cholera and other mass killers and quoted a Timesleader of 1854 (before his weekend host Rupert Murdoch's ownership) saying the British nation would 'prefer to take our chances with cholera and the rest than be bullied into good health'.

Plus !a change?Blair thinks not. Epidemics have been virtually conquered here (fingers crossed for bird flu): what kills now are not public health questions at all, but lifestyle choices: fags, booze, drugs, sugar, plus a lethal lack of fruit, vegetables and exercise.

All of which cost the NHS billions. Alcohol, the nation's most dangerous drug (so medics again said this week), costs£1.7bn in direct treatment and a further£20bn to treat what he called 'alcohol-related harm'.

Informed change

I know this, you know this. But Mr Blair's argument is that outlawing something is not enough. Information is vital: on cigarettes 'the facts changed so people changed their minds'. Even Barbara Castle doubted if voters would ever accept seatbelts when she introduced them in the 1960s. The path to acceptance of the public smoking ban has been gentle, with individuals, companies and campaigns following science's lead, he pointed out. When he became PM in 1997 he would not have voted for the new ban.

All of which underlines Mr Blair's maddening optimism, the quality that keeps him going. His government, he says, is bearing down on school vending machines, under-age drinking, junk food, lax exercise regimes and sexual habits, even social exclusion - 'a public health policy in disguise'.

He has got Tesco, the Army - he has even attempted to get 1,200 new NHS health trainers on the case. Even Mr Blair knows the poor and ignorant suffer most.

I find such talk admirable, but also maddening. Every day we find the papers full of contradictory stories: the kids' cheese which is saltier than the Atlantic, the special needs teacher who resigns in disgust, 24/7 drinking laws. The day after Mr Blair spoke HSJrevealed that London primary care trusts are cutting hardest into funds allocated to tackle, yes, obesity and sexual health. Real life relentlessly intrudes and Israeli or Hezbollah rockets are not the only way to die unnecessarily.

As August looms the tireless Mr Lansley points out that NHS training budgets are also to lose£150m. His Lib Dem counterpart, Steve Webb, goes one better with a rigorous piece of research of 152 all-round English hospitals to show market forces now threaten 16 such trusts. I have trouble understanding his methodology. It is either my fault, his rigour or the heat.

Michael White is assistant editor (politics) ofThe Guardian.