Aspirations to ‘move upstream’ and invest for health are of long-standing – as are criticisms of national governments and local commissioners for failing to meet these aspirations. Investing for health involves action to prevent the causes of illness, shifting the focus from immediate, or proximate, causes of ill health (such as lifestyle factors) to the wider social, economic and environmental causes of ill health and health inequity, sometimes referred to as the ‘the causes of the causes’ (Rose, 1992). It also implies public health-informed policy, a longer-term perspective and a shift in investment priorities so that avoidable causes of morbidity and premature mortality can be addressed and health and wellbeing can be maximised. Given the nature of many public health challenges, success also depends on engagement of the public, building on community assets and strengths rather than focusing on deficits (Harrison et al., 2004; Foot and Hopkins, 2010), and encouraging wider policy and structural support for community activities that increase social capital and social cohesion (Putland et al., 2013).

These aspirations are reflected in national and international initiatives to reorient health and social care systems towards prevention and to encourage policy makers to address the social determinants of health and health equity. At an international level, efforts to prioritise prevention have gained prominence over the last forty years through a series of influential reports including the Canadian ‘Lalonde’ report (Lalonde, 1974) with its concept of the ‘health field’; the Declaration of Alma Ata (WHO, 1978), which described health as a social goal; Health for All by the year 2000 (WHO, 1981); and the Ottawa charter for health promotion (WHO, 1986). The latter reflected the breadth of public health action, spanning healthy public policy, community action and the reorientation of health care services towards the prevention of illness and the promotion of health. It also recognised the social determinants of health, emphasising that: ‘the fundamental conditions and resources for health are peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity’. This tradition continues through Health 2020 (WHO 2012a), a European policy framework developed by the World Health Organization (WHO), and its associated European action plan for strengthening public health capacities and services (WHO, 2012b).