Key points

• Sustainable development can be defined as development that meets the needs of the present without compromising the ability of future generations or people elsewhere to meet their own needs.

• Encouraging sustainability in general and tackling climate change specifically brings significant benefits for health in both the short and longer term.

• The National Health Service in England has developed an approach to sustainable development which can be used as an example of how policy and practice can be shaped within the health sector.

• Creating a sustainable future requires public health professionals to use their skills and the application of public health knowledge in a rapidly changing world.

The only thing we can be certain about the future is that our predictions will be wrong. It is easy to predict the future; it is just difficult to get it right. This last chapter is therefore not a ‘crystal-ball’ exercise into trying to guess exactly what the future holds. Instead, it aims to describe some of the most important transitions, challenges and opportunities that are already with us, and how we should be trying to shape them, for the benefit of all. Public health skills, knowledge and attitudes are essential elements of helping to shape a sustainable health system as part of a sustainable world. This public health approach has a crucial part to play in shaping a future-proof system, in the same way as other global challenges have been addressed: from cholera to tobacco to AIDS. Such challenges make public health frustrating, fascinating, challenging and rewarding.