ABSTRACT
No one would dismiss out of hand the WHO 1948 ideal (health as 'a state of complete physical, mental and social well-being') or the Alma Ata call in 1978 ('health for all by the year 2000'), let alone the 1993 World Bank Report's advice on extending public health - but everyone knows they simply aren't realisable. Indeed matters are getting worse, if anything. So what is to be done? First, we need to re-state what is actually happening (and not just what should happen)- and then, as an integral part of a new realism, to take into account what the people whose health we worry about are themselves doing and thinking. We may not agree with it. Yet more may be achieved, in terms of their happiness if not always of physical health, by helping people use their own style of public health more effectively - in addition to the public health work as it is commonly understood. This is not mere populism, but an acceptance of how modest are both our abilities to fulfil our ideals and our willingness to spend the kind of sums required for them. Nor is this to dismiss the value of rhetoric in psyching up a team (or in getting good policies accepted by the otherwise reluctant), but rather to argue that a hard look at what the other players are really doing is just as necessary.
