For debate: A new wave in public health improvement

Sally C. Davies, Eleanor Winpenny, Sarah Ball, Tom Fowler, Jennifer Rubin, Ellen Nolte*

*Corresponding author for this work

Research output: Contribution to journalComment/debate

53 Citations (Scopus)


The rising burden of chronic disease poses a challenge for all public health systems and requires innovative approaches to effectively improve population health. Persisting inequalities in health are of particular concern. Disadvantage because of education, income, or social position is associated with a larger burden of disease and, in particular, multimorbidity. Although much has been achieved to enhance population health, challenges remain, and approaches need to be revisited. In this paper, we join the debate about how a new wave of public health improvement might look. We start from the premise that population health improvement is conditional on a health-promoting societal context. It is characterised by a culture in which healthy behaviours are the norm, and in which the institutional, social, and physical environment support this mindset. Achievement of this ambition will require a positive, holistic, eclectic, and collaborative effort, involving a broad range of stakeholders. We emphasise three mechanisms: maximisation of the value of health and incentives for healthy behaviour; promotion of healthy choices as default; and minimisation of factors that create a culture and environment which promote unhealthy behaviour. We give examples of how these mechanisms might be achieved.

Original languageEnglish
Pages (from-to)1889-1895
Number of pages7
JournalThe Lancet
Issue number9957
Publication statusPublished - 2014

Bibliographical note

Funding Information:
This paper is based on The St Andrews American Medical Alumni Lecture given by the Chief Medical Officer Prof Dame Sally C Davies, at St Andrews University, St Andrews, UK, on Nov 16, 2012. The contribution by EW, SB, JR, and EN to this work was supported, in part, by a grant funded by the Policy Research Programme of the Department of Health ( contract number 111/0001 ).


Dive into the research topics of 'For debate: A new wave in public health improvement'. Together they form a unique fingerprint.

Cite this