The post of chief medical officer for England has a broad range of responsibilities for health and health care at national level accounting to health ministers with an additional role as the United Kingdom's chief medical adviser. The present appointment was 15th in a line of succession dating back to the middle of the 19th century. Taking up post on the threshold of a new millennium made it a propitious moment when the past and future of health and health services were the subject of reflection and debate.

Strategically and day to day most of the work of the chief medical officer falls into four broad categories: improving the health of the population of England, ensuring high standards of care for patients in the National Health Service, protecting the public health, and addressing a wide range of clinical and scientific developments relevant to health and medicine. In addition, there is a major role in troubleshooting across a broad front that is unplanned and unpredictable as problems and crises arise.

Over the past two years all these areas have been characterised by fresh thinking, new developments, increased public and media interest and greater exchange of ideas internationally. The chief medical officer role has been at the centre of much of the change.

On the population health front, an important new white paper1 set out a new and forceful commitment to improving health, reducing inequalities and tackling the major causes of mortality and premature death in England. The strengths of this new policy were its unambiguous pledge to reducing inequalities (which followed a special review of the subject2), the recognition that action would only be successful if it involved many other government departments (not just the health department), and the underlying philosophy of public health practice as multiprofessional, multiagency and …