The recent Faculty of Public Health Medicine Manifesto of 12 Actions to improve the nation's health contains some interesting ideas for the next generation of Public Health measures after the 'success' of the smoking 'ban'.  To me just as interesting were the assumptions in the discussion about it on BBC Radio 4's Today programme with Prof Maryon-Davis and Geoff Mulgan of the Young Foundation  (18^th January 2010 http://news.bbc.co.uk/today/hi/today/newsid_8464000/8464789.stm ).

There was much reverence for the smoking ban and talk of learning the lessons.  But do we know what the lessons are?  The smoking ban came at the end of decades of gradual chipping away at the core message, and as was pointed out, came in the context of an absence of opposition because of the 'doing harm to others' argument.  So for Geoff Mulgan to declare "If you really want a big impact on health you have to change whole environments in which people live" (co-incidentally damning 'Nudge' as 'so last year'), was surely to miss the point - that such change requires the active co-operation of or acquiescence of large parts of our society. 

Mulgan's appeared to be a 'done to' model of change (perhaps not what you'd expect?), not a done with, through or by model.  Why does this matter?  Because if we are to get a new relationship between public and public services we need to see greater ownership of the decisions that most affect us - none of the Manifesto for Public Health changes can happen without Public Service action and primary legislative change would be required in at least seven of the twelve.  Crucially it also matters because, conversely, we wont get such important and practical changes unless we do have public support for such measures, which wont come from a 'done to' model of change in our society -  because that really is 'so last year'.

See the Manifesto at http://www.fphm.org.uk/advocacy/press/archive/2010/jan/18_manifesto.asp