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Failure to address avoidable ill health will put huge pressures on the future NHS while deepening health inequalities. This discussion paper asks why, until recently, helping people to stay healthy has had so little emphasis, and what mechanisms and incentives are needed to put wider population health at the heart of attitudes, policy and behaviour. It marks the start of the programme 'Putting Health First' which: analyses how the media influence public attitudes and policy; explores the structures, mechanisms and levers needed for change; highlights the need for clear evidence, and argues for stronger leadership at all levels.  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It is now widely acknowledged that improving health involves a range of different activities by many players on many fronts.  Government policy, set out in the White Paper, 'Saving Lives: Our Healthier Nation', identifies specific targets for reducing avoidable deaths from cancer, coronary heart disease and stroke, accidents and suicides. It sets broader objectives for improving health and reducing health inequalities. It also stresses the importance of individuals, local communities and national government working together to achieve these goals. The government has emphasised its commitment to 'evidence-based policy-making' and wants to link public investment to knowledge of 'what works'. However, it is notoriously difficult to assess the effectiveness of many forms of public health activity, especially those relating to the underlying causes of health and ill health. Conventional approaches to evidence are insufficient and unhelpful. There is not enough evidence of the types required, and what does exist is too narrowly defined and biased towards a medical model of public health. A common approach, which all parties can endorse, is needed. a new shared framework is proposed, within which a more inclusive and appropriate evidence base can be built up over time.  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It addresses four central issues: the need for change (how adequate is the existing public health evidence base?, what issues need to be addressed?, what are the consequences of leaving these unresolved?); the scope of the public health evidence base (how wide should the net be cast?, what information should the public health evidence base contain?, what gaps need to be filled - and what are the implications of leaving them unplugged?); values and hierarchies (how should the new public health evidence base be conceived?, are existing frameworks suitable for application to the field of public health?); and towards a new shared framework (can a conceptually sound framework for evidence be developed and applied to the field of public health?, what might the elements of such a framework be?). The paper comments on specific points raised by the Health Education Authority's consultation paper 'Evidence Base 2000 : evidence into practice'. An open response to their proposals is set out in Section 1, and central issues raised in the reponse are explored in more detail in the discussion that follows in Section 2.  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