Some concepts universally regarded as A Good Thing mysteriously fail to attract the practical backing and financial support that everyone agrees they deserve. In the public sector, there is surely no better example - in a crowded field - than the longstanding chatter about an expanded role for local government in public health and the battle to reduce health inequalities.

This week sees the launch of the latest attempt to give some substance to the high-minded rhetoric. The local government service the Improvement and Development Agency (IDeA), working on contract to the Department of Health, will manage a two-year initiative called the Healthy Communities Programme (HCP). Andrew Cozens, the agency's strategic adviser for health, says the programme will "support and build the capacity of local authorities" as they tackle health inequalities in their communities. It is charged also with encouraging that New Labour holy grail: closer working between councils and the many existing local partnerships and NHS organisations.

Cozens says: "There is a widespread recognition in local government and the health service that many of the determinants of better health are areas that local government has strong connections with - while the health service does not."

But again, the overall aim of reducing health inequalities through local projects is hardly new: health action zones, anybody? And some are already making a contribution to healthier living for their communities. Take Dave Peacock, whose hard work in establishing a community garden for his neighbours in a socially deprived community in Gateshead highlights just how much some attitudes need to change (see 'Growing pains', below).

Peacock's eventual triumph, working closely with a Gateshead council community health team leader, Jayne Norwood, did not come without its trials. Peacock gives a fairly blunt assessment of public services' failure to back up fine words on community involvement, partnerships and public health.

"Every council screams about community needs and involvement, but we found that once we started this project, they closed up," he says. "The older ones at the council are set in their ways and they get frightened when people take the initiative from them. We had to upset them to get what we wanted and I used some very harsh words."

Norwood, a manager with the council's health team, is inevitably more circumspect in her assessment. But she agrees that the council could have done more to get the project off the ground.

"The biggest barrier they had to making progress initially was getting the regulatory services within the authority to be more flexible," she says. "It is about having to be flexible - not having to bend the rules, but instead applying the rules to suit the situation. We often find that when you come up against the core services local authorities provide ... they can be very rigid and sometimes community projects fall foul of that."

To be fair, Norwood insists that several other health-related projects in Gateshead have seen just such flexibility and cooperation. These include two community-led gym schemes - one for people with a disability and one for obese children and young people too self-conscious to use a mainstream gym.

So what do the Department of Health and the IDeA plan to do to make such smooth-running projects commonplace when other attempts have, to be generous, enjoyed only modest success?

Cozens says: "Health action zones were very much a Department of Health initiative; others were invited to join in, but they were managed and directed by the department. The IDeA is running this programme because the department recognises the subtleties of working with local government."

The work will very much reflect the IDeA's way of doing things as local government's improvement agency - rather than its performance manager or inspector. To a large extent, this means simply adapting tried-and-tested IDeA approaches such as peer reviews and combining them with a new health improvement module aimed at elected members within the existing leadership academy. Local authorities, and individual officers, seeking to join up council departments or councils and other community partners will have access to a mentoring network made up of "peer experts" or service advisers.

"This is linked to the specific experience of the agency," says Cozens. "We are not attempting to be as ambitious as the health action zones. We are charged with raising health on the agenda of local politicians and trying to connect examples of best practice in health back into what already exists, such as local service partnerships."

It is, he adds, about helping to "mainstream public health and develop programmes/initiatives as an essential corporate and strategic activity". He says: "The term 'golden thread' is often used to stress the fundamental link that should exist between health, housing, social services, leisure, planning and finance. This peer-led approach is focused on self-help."

The programme will build on recent policy and legal changes - notably the measures in the care services white paper, Our Health, Our Care, Our Say. Among those changes are:

· a requirement of councils to appoint a director of adult services to work with the director of public health to assess local health and care needs, support commissioning and assess the quality of services;

· the reorganisation of primary care trust boundaries to correspond with top-tier councils; and

· the provision of integrated personal health and social care plans by 2008.

Cozens insists that the Gateshead gardeners will be able to judge the programme's effectiveness - eventually. "This is a two-year shot in the arm and we need to ensure that [the improvements and projects that result] continue beyond that. We will be measured by what we deliver: expectations are built into the Department of Health contract. Although our real success will only be measured when we see how we do against the government's health inequality targets, there will be monitoring by a project board in terms of how many councils have taken up the project and the extent to which we have been able to identify and promote best practice."

In Gateshead, Peacock might be forgiven for suspecting that the IDeA's "golden thread" could unravel. But this latest attempt to bridge the great divide between local government and health is particularly timely. With the NHS focused on structural change, and parts of it financially stricken, local authorities have the chance to reassert their historic interest in health and keep the public health flame burning.

Case study: Growing pains

The man behind the restoration of an 18th century Gateshead garden has probably paid a higher emotional price than the wealthy brewer who oversaw the original design and planting. While the brewer was doubtless able to spit orders at cringing workmen and petty officials, Dave Peacock admits to having regularly directed swear words at Gateshead council officials when they voiced "quite ridiculous" objections to his proposals.

It should be quickly noted that Peacock has nothing but praise for the council's Jayne Norwood and her line manager, Trevor Hopkins. "[They] have been absolute bricks ever since she came to the first public meeting to see if there was public support for my idea," Peacock says. "They even came and helped out some weekends."

The project has secured almost £50,000 of funding from a range of sources, including Gateshead primary care trust, since first securing £1,000 from the council. "They were very clever at seeking lots of small grants rather than one big one," Norwood observes.

Peacock suggested restoring the long-derelict Hermitage Garden, on council land in the village of Whickham, in 2001, after his wife's sudden illness forced him to abandon two allotments some distance from home. He remembered the garden from his childhood. "It was a rich man's folly with a lake, a bridge and a watch tower," he says. "I thought, why was no one doing anything with this land? And I expected them to tell me to mind my own business, but they didn't."

Nearly five years later, the garden provides exercise, education and enjoyment for people ranging from a few volunteers, mainly retired, to young offenders. Children from the local primary school are currently reaping the first crops of vegetables, the product of their own enthusiastic planting labours.

Peacock says: "They are fascinated because they have never seen what grows in a garden: they thought potatoes came from the Co-op. It is great for them to get out of the classroom."

For Norwood, it is about helping local people implement their own plans: "Everything my team and I do very much uses ideas from the community rather than seeking to impose lifestyles."

Case study: Fit for life in the city

There must be times when Erlinda Zapata's family and friends curse the Fit for Life project. Five months into her course, she has become an evangelist for fitness and is good-naturedly berating all those she knows with messages about diet and exercise.

Zapata is a living embodiment of Fit for Life's key aim: training local people in Camden, north London, so they can spread the message of healthy living in the community. Teresa Sewell, who is running the programme for the Camden Central Community Umbrella, a healthy living centre, says the fitness certificate that students should gain when the course ends next month provides an entry into a field in which training can be very expensive. "The aim was to give them sufficient skills to go into the workplace if that is what they want."

Health needs assessments carried out jointly by Camden primary care trust, Camden council and Community Umbrella had identified low levels of physical activity, high levels of health inequalities and few opportunities for employment and training in fitness and exercise. While Sewell and her colleagues at Community Umbrella have designed and manage the programme, it has been funded by government money under the Communities for Health programme.

The 14 students on the course, who range in age from 18 to 61, attend classes one evening a week to learn about basic anatomy, health and safety in the fitness workplace and exercise programming. Eager to work in the industry, Zapata for one is hoping to enrol for the level-two programme, which the centre hopes to offer later in the year. She says: "I am just starting to find out about jobs in this area, maybe working with older people. I am a very energetic person."

On top of the general fitness and exercise course, the programme has trained 35 local people as walking leaders, many of whom are now encouraging and leading energetic walks around the inner-London borough's streets and green spots, including Regent's Park.