The health of the nation.

Seize the opportunity Will the government's white paper The Health of the Nation (p 135)'2 turn out to be the most important measure for improving the health of the English people since the birth of the NHS or just so much hot air? Following strong leads from the World Health Organisation,'4 it sets out an ambitious programme for shifting the focus of the health service from sickness to health. Target setting-as proposed by the white paper-is becoming an increasingly popular way of improving a population's health.5 '4 This remarkable turnaround is a huge step forward for Britain's health policy,'5 even though it is light on other accepted principles of the WHO's health for all movement-such as engaging the full participation of the community and reducing inequalities in health. Success will require great effort, resources, and cooperation among professionals unused to working together in the requisite alliances. 16 The conviction with which the government and the NHS Management Executive are planning to implement the white paper is therefore welcome. Despite the many obstacles on the long haul ahead it would be a tragedy if the initiative failed. One danger will be making the five key areas and their targets ends in themselves." Any choice of targets may be faulted, but this first list is as good as any other. Starting with only a few priorities means that there will be scope to add more locally. Other national priorities will be added later, benefiting from the experience of the first phase. Quibbling at this stage will be unhelpful; the targets are only a means to an end, and it is the process of implementing them that will count. Like most of its predecessors, the white paper emphasises the need for health promotion and health education, underlines the role of primary care, and calls for the close collaboration of the many agencies whose actions affect health. But there remains a disconcerting belief that much of the improvement will come about by exhorting individual people to live more healthily. It is crucial that social and economic policies are changed to allow people to choose the healthy options.'8 The whole endeavour has been jeopardised by playing down the effects on health of, for example, poverty, unemployment, and homelessness. The new ministerial committee to coordinate the strategy and the decision to appraise the government's policies for their impact on health are steps in the right direction, …