This document discusses the history and evolution of public health in local government in Birmingham, England. It examines key strategies from 1866 to the present, including housing work in the 19th century and the relationship between public health and the NHS in the 1970s. The document proposes an approach to public health that focuses on health improvement, health protection, commissioning priorities, and acting with or without full evidence. It provides examples of indirect impacts on public health through housing, education, and reducing worklessness. Finally, it outlines elements of an effective public health strategy, including addressing housing quality, the environment, and social factors that support independence and healthy living.