Quit smoking. Eat less of the unhealthy stuff. Switch off the TV and do something more active instead. Know your alcohol units and stop drinking so much. Choose life - by opting for a healthier lifestyle. None of the healthcare unions who will be involved in delivering good intentions framing the public health white paper, published today, are arguing with that.
The only resounding disappointment is the government's quasi approach to banning smoking, which will see the health killer tobacco continue to billow its smoke in about 20% of private clubs, as well as pubs that serve unheated food. The Trades Union Congress rightly points out that staff working in these surroundings will have none of the protection afforded to their counterparts in smoke-free pubs, short of quitting their job.
Health unions, from the British Medical Association, the Royal College of Nursing (RCN), Unison and the Royal College of General Practitioners, have been universal in their condemnation of the mixed message delivered by a government which claims - as if anyone was still in doubt - that smoking is the most important way of avoiding health problems in the future, while failing to follow Ireland and Scotland by banning the number one killer.
On a less contentious front, the document's measures to create a healthier nation are widely welcomed: curbs on the promotion of unhealthy foods to children; clear and unambiguous labelling of the nutritional content of food; NHS health trainers to provide advice to individuals on how to improve their lifestyle; and a wide range of measures to tackle social and geographical inequalities in health.
The recognition that the dearth of school nurses, following GP fundholding in the early 1990s, have created a vacuum for health promotion in schools - particularly around sexual health - is very much welcomed by the nursing unions.
But what is telling about this particular white paper, is that it offers a society-wide approach to society-wide problems. It involves industry, entertainment, health promotion and support and local government involvement, right through to individuals' responsibilities to safeguard their own health, ensuring that no one is left off the hook.
The NHS Confederation, which represents NHS trusts, laments the fact that this was not reflected in the creation of a specific cabinet position with responsibility for public health, to ensure "cross-governmental action", and ensure all eyes are not mysteriously turned to health. "The important point is that this white paper acknowledges that the NHS can only be a part of the programme to improve public health, and that the health service can't solve all problems on its own," said its policy director Nigel Edwards.
If truth be told, doctors and nurses are exactly the people patients will be looking to for help and delivery. Healthcare unions have been quiet on the implications for staff capacity and resources of delivering this ambitious agenda, hampered by the fact that the nature of a white paper is to give a policy outline, bereft of important detail.
Mark Jones, the head of the Community and Practice Nurses and Health Visitor Association, said health visitors are ideally equipped for the challenges laid out in the document. It would take two things: redeployment away from health screening children, which has recently been found to be of limited value, and more staff. Currently, there is a 1,000 shortfall in this highly trained workforce and this is a great opportunity to address the problem, he points out.
The Royal College of Nursing is more sanguine about nurses integrating the public health agenda into their given role, whether in the acute sector or primary care. Alison Kitson, the RCN executive director of nursing, said health promotion and supporting people in their lifestyle changes is a core component of nursing care. "They are up and ready for the challenge," she says. "It is fundamental to every nurse to impart health information and facilitate healthcare." This begs the question as to why nurses are not delivering on this essential aspect of their role already. Or maybe they are, but this simply proves that health promotion in itself is not enough to change behaviour.
But on the issue of resources, even Ms Kitson admitted that something will have to be done to find more school nurses to redeem their presence close to the youth frontline. Dave Prentis, the general secretary of Unison, said it's not just school nurses, but schools themselves that have a significant role to play. School dinners, for one, need to match up to the government messages about healthy eating, as well as being affordable for all. Junk food must be banned from all school vending machines, as well as fizzy drinks and sweets.
He also makes a point not picked up by many outside the mental health field, that poor lifestyle choices are often a reflection of mental distress. "It's not just obesity that causes health problems - many young people see stick-thin models in magazines and want to be like them, resulting in eating disorders that can have devastating long-term consequences on them and their families," said Mr Prentis.
What he doesn't say explicitly is that the obese child is just as likely to be a victim as the skinny one, and simple information alone cannot address that. Today, mental health charities have been loud in their insistence that to tackle surface health issues while leaving mental health untouched will be missing the point for many - whether they be excessive drinkers, heavy smokers, or comfort/poor/non-eaters.
Dr Hamish Meldrum, the chairman of the BMA GP committee, is concerned that the evidence base is not necessarily there to back up the government's plan of action. "GPs will all be aware of people who have no wish to give up smoking or drink too much and say they don't have a problem. The easy ones are the ones who have realised they have a problem. This idea that you can change people's behaviour by influencing their lifestyles . . . We may end up targeting the worried well, rather than people who need it."
Dr Meldrum said GPs should hold fire on what GP surgeries will be expected to deliver, until more detail is forthcoming. But he says that any delivery implications from the white paper for GPs and their nursing staff will have to be matched with extra resources. "If the government is prepared to put additional resources to that, GPs will look at that. What we are not prepared to go down is some plan appearing to address health which we have no evidence base for and little resources to deliver, because that will not be particularly effective." All eyes are now on the detail.
