There are not enough public health specialists to deliver the targets to tackle obesity, smoking and the health gap between the rich and poor outlined in Gordon Brown's spending review, experts have warned.
The Faculty of Public Health has called for a 40% increase in the number of public health specialists over the next three to seven years to make up the staffing shortfall.
In Monday's spending review, the chancellor set out new public spending agreement targets to cut smoking levels to 21% of the population - tougher than the current 24% target; to halt the rise in obesity among children under 11 and halve the pregnancy rate for under-18s.
Targets to tackle cancer and coronary heart disease announced last month by the health secretary, John Reid, have also been refined by the chancellor to include a narrowing of the gap between rich and poor.
A subsidiary smoking target has been set to reduce smoking among routine and manual workers to 26% in a bid to focus efforts on boosting the health of the poorest.
But the Faculty of Public Health, while welcoming the spending review's shift from hospital activity and waiting list targets to public health, has warned that there are "insufficient" specialists to carry out the work.
The faculty president, Professor Rod Griffiths, said: "The targets have definitely moved the focus to an upstream, preventive public health agenda. All the effort that went into the other targets needs to go into these."
But he added: "I'm not in any doubt that there are parts of the country where the workforce is simply insufficient to do the job that needs to be done."
In a March report on the state of the public health workforce, the faculty warned that a 40% increase in staff would be needed to deliver "a safe and effective" public health service, while public health skills were "in short supply" in many primary care trusts "with widespread reporting of staff shortages and significant numbers of vacant director of public health posts in England".
Professor Griffiths said that this was still the case. "Over the immediate planning period - the next three to seven years - those [a 40% increase in staff] are the kind of figures we need."
He added that "some of the percentages sound dramatic", but could be met with a relatively small number of extra staff.
"150 people extra - we're not asking for thousands of people," he said. Around half of England's 300 primary care trusts (PCTs) had just one public health specialist while a few had none. "So fill that gap and you've increased the capacity."
Professor Griffiths said it was a good thing that responsibility for targets, such as that to cut childhood obesity, would be shared among different organisations, including the Department for Education and Skills and the Department for Culture, Media and Sport, as well as health bodies.
But that needed skilled public health staff to "secure the connection" and manage coordinated activity by all those involved.
"If you're in a PCT with no director of public health at all, it's going to be more difficult. I don't think there's anywhere that you couldn't make an argument for more [specialists]," he said.
"In places you are talking about a single-handed director of public health with not a lot of staffing. The sheer complexity of the agenda needs bodies on the ground."
