The UK public health system has a good international reputation for the surveillance and epidemiological analysis of population-based data, which has its roots with the public health pioneers of the 19th century. This chapter describes the current arrangements in place in England as an example of how monitoring performance can be used for development and active management of public health programmes and the public health system. Since public health policy and practice is as complex as the determinants of health, one useful framework which assists the performance development and performance management of public health is the identification of three distinct and inter-related domains of practice – health improvement, health protection, and health and social care services. Constructing frameworks at each level to scope public health responsibilities and accountabilities usefully holds together the complexities of the public health system.