Public health issues have become regular headline features in England, as elsewhere. The practice of public health is, and always has been, shaped by the political and cultural context. The three-domains approach, which focuses on public health as a system, provides a vehicle for delivery which recognises that public health is not just about specialists, and provides a formalised context within which skills at the other levels of practice can be developed. Choosing Health formally required hospital trusts to contribute to health improvement in the local community. To do this effectively, the trust will need support in recognising its role and learning to work across organisational and sectoral boundaries, which can and would be supported by the skills of public health specialists and practitioners. Public health specialists and practitioners have a key role in helping others to understand and respond to the challenges effectively.