Thirty years of talking have failed to curb smoking, obesity and diabetes in Britain, problems which could eventually sink the NHS, Derek Wanless said yesterday when he issued his last report on the service.
Urgent and concerted action was needed at all levels to shift from "a national sickness service which treats disease to a national health service which focuses on preventing it", he said.
His call for a new approach coincided with an attack by the Consumers' Association on the government for apathy and half-baked ideas about the junk-laden British diet, which is the main factor in the obesity epidemic.
The CA gave 30 days' warning that it will name and shame individual junk food products and expose government inaction to protect consumers unless its demands for better labelling, advertising restrictions and a nutrition council are met.
"It is widely agreed we've reached a crisis point in nutrition, but so far, despite some PR tactics, the government has shown no policy, no vision and no joined-up thinking to address it," its head of campaigns, Nick Stace, said.
The Wanless report was "more of the same", and despite saying it was time to focus on delivery, it failed to make specific recommendations, the CA said.
The CA wants the advertising of food high in fat, sugars and salt, directed at children, to be restricted; labels developed with the supermarkets to identify food high in these substances; and a nutrition council to coordinate government action on diet.
The Wanless report says random target-setting in the past has failed to produce results.
It criticises the government's hopes for obesity as unrealistic and its goals for smoking as unambitious.
In 1992 the government set the targets of reducing obesity in men by 6% and women by 8% by 2010, but the obesity rate has soared ever since. In 1998 it aimed to reduce the proportion of adults smoking to 24% by 2010. In 2001 proportion still smoking was only 27%.
If it wants to maximise the cost-effectiveness of the NHS, the report says, it should aim for California's smoking targets: 17% by 2010 and 11% by 2020.
The report supports legislation to curb workplace smoking in the long term, saying it could cut smoking by up to four percentage points.
Mr Wanless draws comparisons with the seatbelt legislation, which was not introduced until there was a fairly widespread acceptance that it was needed. Higher taxes on cigarettes might also produce large gains, the report says.
It identifies reducing salt in the diet, increasing exercise, and screening those at high risk of diabetes as areas where action should be taken. It puts the onus on the individual to help him or herself, but says there is a need for much more information, including perhaps a dedicated website.
Mr Wanless wants to see more information collected on what works. And he wants a strategy which is led by the government but looks to the local authorities, primary care trusts and other local organisations for implementation.
The British Medical Association said in response that it was time for government to stop talking and tackle the issues.
"Government action to support people in improving their health is not just legitimate, it is urgently needed," its head of science and ethics, Vivienne Nathanson, said. "Rates of sexually transmitted infections are still rising. Obesity is contribut ing to soaring rates of diabetes.
"Young people are increasingly likely to indulge in binge drinking. At least a thousand people a year are dying as a result of passive smoking."
The Royal College of Physicians said it was "a brave report that outlines the shortcomings of successive governments' approaches to public health and offers a template for solutions".
The health secretary, John Reid, said he would publish a white paper on public health this year and build on the Wanless review: "After many years of discussion, the key challenge now is to draw up a plan of action and implement it."
