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The Public Health Act 1848 was a major landmark in the history of health in England and Wales.1 It is 175 years old on 31 August 2023. Testament to the vision of the act, life expectancy in England and Wales has nearly doubled between 1841 to 2011.2 The largest increases have been through improved drinking water and sanitation, better housing, and better nutrition.3 Life expectancy continued to improve through the first 65 years of the NHS and the welfare state. But austerity policies since 2010 have seen life expectancy stall and inequalities widen. The life expectancy of women in England and Wales has declined since 2010.45 Life expectancy worsened through the covid-19 pandemic, with inequalities in death rates widening, particularly for people from ethnic minorities and for men.6 Five years ago, The BMJ marked public health’s 170th birthday and asked for a big birthday present to go alongside the NHS’s 70th birthday investment.7 Since then we have had the covid-19 pandemic, Bre

United kingdomJohn middletonMedea middletonGlobal network for academic public healthUnited kingdom faculty of public healthPublic healthHonorary professor of public healthProfessor of public healthCovenant for healthRoyal commissionAssociation of schools public healthChester universityUniversity of wolverhamptonAssociation of schoolsA royal commissionPublic health act