The Department of Health's new public conversation on health, This Is Our Health launched in April 2026, begins with an important insight: health is created in communities, not simply in hospitals. Yet its proposed solutions remain rooted in individual responsibility rather than structural change. The result is a public health vision that recognises the social causes of ill health but continues to individualise responsibility for addressing them. In effect, having identified the right problem, the Department offers the wrong solution.

The central question running through This Is Our Health is not, "Why are so many people becoming unwell?" but "What can people do to stay well and reduce pressure on the health service?" That shift may appear subtle, but it fundamentally changes where responsibility lies. The burden moves away from government and institutions and back onto individuals and communities.

This is not a new public health vision. It is an old political story wrapped in the language of empowerment. Professor Michael Marmot’s work over many decades has demonstrated that health inequalities are produced by unequal social conditions, not simply by unhealthy behaviours. People living in poverty do not experience worse health because they make poorer choices. They experience worse health because they have fewer choices. Homelessness, poverty, racism, zero-hour contracts, are not secondary influences on health—they are its foundations.

The Public Health Agency, an arms-length body of the Department of Health, has also reached the same conclusion. Its work on health inequalities identifies poverty, poor housing, unemployment, educational disadvantage, social exclusion, and inequality as the principal drivers of health outcomes across Northern Ireland. These are not so-called lifestyle issues. They are structural determinants of health. Yet these structural realities receive remarkably little attention in This Is Our Health. Instead, the emphasis falls overwhelmingly on what individuals can contribute through healthier choices, stronger communities, and greater self-reliance.

This is a profound contradiction. The Department acknowledges that health is socially produced while proposing solutions that remain individualised. This approach is not only confined to physical health but is also the dominant narrative in relation to mental health.

Former United Nations Special Rapporteur on the Right to Health, Dainius Pūras, has argued that we need "less chemical imbalance and more power imbalance" in our understanding of mental health. His critique is not simply of psychiatry but of political systems that locate distress within individuals while ignoring the unequal distribution of power, opportunity and human rights that produces it.

Power is entirely absent from This Is Our Health.

There is no serious discussion of poverty as a political choice. No meaningful analysis of homelessness and inadequate housing. No recognition that income inequality is a public health issue. No acknowledgement that punitive social welfare policy, immigration policy built on a ‘hostile environment’ ideology, rampant privatisation of public services, are all are significant health interventions that lead to worsening health outcomes.

Without confronting these realities, public health risks becoming little more than behaviour change.

Professor James Davies has similarly argued that contemporary mental health has become increasingly individualised and medicalised. Social suffering is reframed as personal vulnerability. Structural injustice becomes a problem of resilience. Citizens are encouraged to adapt to unhealthy social conditions rather than asking why those conditions persist.

That same logic runs through This Is Our Health. Rather than asking how government should reduce poverty, improve housing, tackle inequality, or dismantle the hostile immigration system, it asks how citizens can become more active participants in managing the health system's capacity crisis.

The language of "shared responsibility" sounds progressive. In practice, it risks becoming a subtle transfer of responsibility from the state to citizens without a corresponding transfer of power, resources, or accountability.

On the surface, this sounds empowering. Yet viewed through the work of Michael Marmot, Dainius Pūras, James Davies and New Script's own analysis, it risks becoming a neoliberal framing of health in which citizens are encouraged to help solve the state's capacity crisis without an equivalent commitment to addressing the structural drivers of ill health. It shifts the conversation from asking, "Why are so many people experiencing preventable distress?" to asking, "How can people reduce demand on services?" That is a profound reframing of public health—and one that must be firmly challenged. We need to flip this script, away from individuals to those with the real power to improve people’s health. To those with the power and resources to address the underlying drivers of poor physical and mental health.

In this respect, New Script’s Give 5 Framework, endorsed by all the main political parties, offers a road map for the Department of Health and its agencies. It is beyond time for those in power to listen to people with direct experience and to develop rights-based, workable solutions that create meaningful and sustainable change for communities everywhere.