There was a moment in 2021, at the point the Office for Health Improvement and Disparities (OHID) was being launched, when focus was finally given to improving the nation’s health and reducing inequalities. The then Secretary of State for Health and Social Care, Sajid Javid, said: ‘By focusing on preventing and not just treating poor health, [OHID] will tackle health disparities to break the link between people’s background and their prospects for a healthy life.’ This was to be the moment the building blocks for good health would finally be considered across the whole of government; OHID would coordinate activity across Whitehall ‘to address the wider drivers of good health, from employment to housing, education and the environment’.

Fast forward 2 years and this ambition is barely recognisable. A commitment to produce a standalone, cross-government health disparities white paper has been diluted beyond recognition. The agenda is now a minor feature in the major conditions strategy, a document rooted firmly in the Department of Health and Social Care and more specifically the NHS. While the document lists primary prevention – tackling the root causes of ill health – as a priority, there are no substantive commitments likely to reverse stalling life expectancy trends or the gap that exists between different areas.

There is only one new policy announcement in the prevention space: government consulting on adding pack inserts to tobacco products to encourage smokers to quit. This new policy is not enough to address the impact of risk factors such as smoking, alcohol and obesity on people’s health. The report is anchored in the role of clinical services and places too much focus on individual behavior change and personalized prevention. This ignores broader evidence on the state’s crucial role in taking population-level action on risk factors and the wider determinants.