Poverty, housing, environment, employment, family and heredity are all potentially more significant determinants of health than the local capacity of the NHS.

So, it is surprising, to say the least, that the principal policy response of the Government in recent years to continuing disparities in health outcomes has been to skew the distribution of NHS resources.

If spending on healthcare alone determined health outcomes, Glasgow would be the healthiest place in Britain and Wokingham the least healthy.

My purpose is to describe how we intend to improve the nation's health, and in doing so, also to improve the health of the poorest, fastest.

It is something of a cliché now to say that public health has become an issue less of public health and more of personal lifestyle. The big essential health gains have been made – clean water, Clean Air Acts, slum clearance. It is argued that we are confronting less the diseases of poverty and more the diseases of affluence.

But is the cliché right? Environmental health is still important. Banning smoking in public places is undoubtedly the most significant public health measure of the last decade and it is very much an issue of environment, not just lifestyle.

And how far is obesity, for example, a disease of affluence – hardly,
given that the rich are often thinner than the poor. It is perhaps more accurate to say that obesity is a disease of development.

The Government's Actuary Department currently predicts that life expectancy will rise over the next 50 years by around six years for men and five years for women.

Rising obesity, on average, would reduce this increase in average life expectancy across the population by only about a year.

The real risk, in addition to the major loss of life expectancy for the severely obese, is that people live longer with long-term ill-health.
The nature of this problem was rather well illustrated just last week in research published by the Peninsula Medical School.

It showed that although overweight people in younger and middle age
run a risk of premature mortality, among older people only the
severely obese have a higher risk of dying, but all older people who are overweight are at significantly increased risk of developing problems with mobility and carrying out everyday tasks.

If this happens, the £7bn current cost of overweight and obesity will
rise dramatically.

It is not just an issue about children today and in the future. Everyone who will be 65 or more in 2050 is already over the age of 23. If we are going to defuse the time-bomb of obesity-related ill-health, we must change the behaviour of adults today, as well as our children.

In a speech two years ago, Tony Blair accepted the proposition that "public health" had now really become about healthy living; that the traditional paternalistic state of the past must be replaced by an enabling state.

I agree with him, but Labour in government has not even delivered on the modest proposals he set out then.

He called it the "Small Change, Big Difference" campaign. But
nothing changed and there was no difference, a £13,000 PR campaign, a book of case-studies and that was it. Look at the "Small Change, Big Difference" website – last entry May 2007. In a Government obsessed
with top-down targets and initiatives, why has public health dropped off the agenda?

The targets for reducing health inequalities and reducing childhood obesity exist, but will be missed. The initiatives drift. Why? Because this is a Government even more obsessed with the short-term when what public health requires is a commitment to action now, and real follow-through, even if the benefits accrue over the longer term.

In our consultation on public health last year, we set out the structural and funding issues, to give us the necessary long-term framework. We consulted on three key proposals:

One: A Secretary of State for Public Health, leading a department no longer seeking to interfere in the day-to-day management of the NHS, with an enhanced Chief Medical Officer's department, leading a public health drive across Government.

Two: Separate public health budgets. They would be allocated separately from NHS service budgets. We want an evidence-based policy, and funding which supports success.

Three: Directors of Public Health, jointly appointed by Primary Care Trusts and local authorities, should not be within the PCT, but have a clear remit of their own.

I am pleased to confirm that our consultation secured overwhelming support for these proposals.

Recognising that some traditional public health tasks and threats remain, we will also lead a new public health strategy responding to new public health challenges caused by lifestyle and behaviour changes.

We will take action to ensure people have the opportunities, information and incentives towards healthy living. No excuses.

We will work with all age groups, but particularly recognise how vital it is that our young people are empowered with the self-esteem to make confident decisions for themselves.

They may be right or they may be the wrong decisions. But if we get it right, as parents and as a society, increasingly they will make the
right choices. And a healthier society will be the result.

Andrew Lansley is the Shadow Health Secretary. This is an edited extract of a speech that he delivered to the Reform think-tank yesterday.