Sir Liam Donaldson - Chief medical officer

Question: Smoking has been identified as the key public health risk. With bans on the agenda and the emphasis on health so high in people's minds, how do you envisage Britons will relax or spend their free time in years to come?

Sir Liam Donaldson: The whole issue of public health has come right up the agenda in the last few years. People are much more conscious than they were about the things that cause illness: smoking, poor diet and lack of exercise.

People are increasingly recognising that their leisure time is not always spent in the most appropriate way for maintaining good health. They realise that long sessions on the couch, watching TV or staring at a computer screen and eating heavily have lead to the high levels of obesity that we are currently experiencing.

Looking to the future, we hope to see people who are much more conscious about what they eat.

We would also like to see many, many fewer smokers and people using their leisure time to put in some regular physical activity.

Question: Does the government's focus on public health mean that it risks creating an interfering, nanny state?

Sir Liam Donaldson: I don't think so. The government is offering advice to people and they don't have to take it up.

We mustn't forget that a large section of the community maybe doesn't have the opportunity to pursue healthy choices.

If you are a single mum living on an inner city estate that has no access to shops that sell fresh fruit, frightened of letting your children go out and play to burn off excess calories, then good advice alone will not suffice.

While government advice is definitely important, it is also essential that government creates healthier opportunities in schools and neighbourhoods so that it is easier to take up healthier options.

Question: Is economic redistribution the only way to beat the geographical and social inequality that you refer to?

Sir Liam Donaldson: Government policy over the last seven years or so has involved some economic redistribution.

I think the key is to regenerate neighbourhoods. I have visited some very run-down neighbourhoods in parts of the country, and they have been turned around by investment and the help of local authorities.

The most constructive way forward is definitely to look at the neighbourhood level and focus on putting expertise and resources into them to turn them around.

We must work together with the people who live in these communities so that we can involve and engage them.

Question: There has not been such a wide gap in health equality since Victorian times. Is the government winning the fight against health inequality?

Sir Liam Donaldson: I think it is important to recognise that health for everybody has improved enormously since Victorian times. People now live to a ripe old age and babies that would have died at childbirth are surviving.

While everybody's health is improving, the health of the best off continues to run ahead of that of the least affluent in society.

In some areas the gap hasn't narrowed and this remains a very important challenge but in other areas of disease the gap has narrowed. I think it is a partial success at the moment but this is really a long term project.

When you are trying to reduce health inequalities, you are looking a 10 or 20 year target. All the right ingredients are in place and the policies are very strong.

There is work going on right across government on this issue: in the Treasury and the Department for Culture, Media and Sport and it is also one of the themes of the European presidency.

We are definitely giving it a very high profile but it is a subject that takes a long time to turn around.

Question: In the government's November white paper there was talk of doctors 'prescribing' visits to the gym instead of drugs. Do you think that is a good idea?

Sir Liam Donaldson: It does help, but people like to have a variety or choice of the sort of physical activity they can do.

For some people the gym is too expensive or inconvenient and for others exercising alone is no fun.

I think getting a range of physical activities is essential; we need to offer people a menu of sports and gym attendance is only part of that.

There needs to be a general push on sport. Whether or not we had won the Olympic bid I think sport and health are going to be a big theme for the future.

Question: Have we seen a sea-change in people's attitudes to their health?

Sir Liam Donaldson: There is much more concern about health now. When you see the interest generated by Jamie Oliver and the school meals that becomes evident.

Whether this interest is translated into people taking more responsibility for improving their own health remains to be seen.

There is some evidence of people's lives now starting to change, but they still need to change a lot.

You only have to consider the fact that 23-24 per cent of people smoke, compared to 19 percent in California.

Between those two figures, there are thousands and thousands of deaths. Tobacco remains the leading cause of premature death.

Question: Does tobacco represent the greatest threat to public health in the future?

Sir Liam Donaldson: If you look forward 20 or 30 years people will look back with astonishment at the grip that the smoking epidemic has had on such large parts of the world for so long.

It still kills over 100,000 people in this country every year. If we reduce the percentage of people smoking, the lives saved could be counted in the thousands and then the hundreds of thousands.

Smoking definitely remains the major public health challenge, and that has been the case for the last 30 years.