Value based healthcare is the new paradigm enfolding the previous paradigms of quality improvement and efficiency as health services struggle to close the gap between need and demand on the one side and resources on the other. Value based healthcare requires those who pay for or manage health services to focus on populations as well as patients and use the population as the denominator in all their decisions about the allocation and use of resources. It also requires the development of population-based systems and networks and the need to create a culture of stewardship, so that every clinician becomes committed to preserving universal healthcare by minimising waste of time, money and carbon. The skills and experience of public health professionals are of vital importance in this paradigm shift. The development of population-based screening programmes provides a very good model for the development of systems for people with asthma or people with dementia to give two examples of the systems that are needed. The public health commitment to, and understanding of, equity can support health services as they make the shift their focus from providing care to the patients who manage to access services to using their resources to help all the people with a particular need in the population. Furthermore, the public health commitment to sustainability in the broadest sense of the term makes public health professionals ideal leaders in the development of a culture of stewardship. This is a tremendous opportunity for the profession, now recognised in a number of countries including Ireland, Wales, England and Saudi Arabia. A training programme has been developed to develop the skills of population healthcare and it is proposed that healthcare public health be regarded as a public health workstream alongside health promotion and health protections.