England may have missed an opportunity to improve public health

The resounding “no” vote for a regional assembly in the North East of England has firmly put the lid on the prospect of elected regional government for the foreseeable future. There is considerable debate in the North East as to the reasons for the rejection of the proposal, which may have come down to a distaste for having more politicians, a suspected higher council tax, intraregional rivalries, too few powers, or perhaps a mix of these. In the white paper announcing the regional referendums, assemblies would not have any direct responsibility for health care,1 although many would have liked to have seen such an outcome in the spirit of the government's devolution policy and commitment to localism.2 But the assemblies would have had a specific remit for public health.

The white paper announcing the regional referendums pointed out the high impact that housing, transport, and economic development have on public health and promoted the joining up of these policies to reduce health inequalities. Nevertheless, it remained a cautious document, produced against a background of little interest in the issue of elected regional assemblies.3

A public health presence already exists at regional level—a process that began with the NHS …