Presents the results of a survey of directors of public health in England, looking at the public health aspects of the sustainability and transformation plans (STPs) in England and the level of involvement of key local public health staff. The report identifies the key public health challenges and influences in the effectiveness of the public health and preventative elements of the STP. STPs are critical in delivering the widely welcomed public health and radical prevention aspirations of the NHS England Five Year Forward View. The survey however suggests STPs are falling some way short of translating aspirations into achievable targets and commitments. The level of strategic public health input is reported as very high but the impact of this on the STPs appears variable and, in some geographical and service areas, to be disappointingly poor eg. the level of evidence of effectiveness for proposed interventions, the extent and depth of collaborative working and integration and stakeholder support, and a lack of confidence that the interventions are realistic. The survey has also found a failure to tackle the wider determinants of health, highlighting some of the more concerning signals about several specific determinants including quality of housing, employment, and access to education and training. The report argues that the ambition to strengthen intervention has been limited by the year-on-year budget cuts to the public health budget. This, coupled with reducing numbers of public health trained staff, particularly specialists, who are perceived as an expensive resource, is compromising the ability of the system to deliver prevention. The report calls for additional resources to be invested in prevention and protected from a diversion to reduce deficits.