In this Schumacher Briefing, Robin Stott proposes solutions to the key problems which beset our present health system. He argues that if we are to develop a true public health service rather than a 'disease service', we must make radical changes to its decision-making processes. We need to acknowledge the health impact of many factors including the distribution of wealth, the size of communities, lifestyle issues, local pollution, and the condition of the whole planet. The Briefing shows how enhanced interaction between people can contribute to health promotion, social justice and environmental improvements. It also sets out a blueprint for developing local organisations for the pursuit of health which could become units of local governance.