Like many countries, England has introduced a range of policies and strategies on public health since the early 1990s. Using concepts drawn from the policy success and failure literature, this article concludes that recent governments in England achieved only ‘precarious success’ in McConnell's typology. It demonstrates, with wider significance, that success or failure is not merely about policy achievement in programme terms, but that policy processes and the political dimensions of policy must be included in any evaluation. It also highlights the adversarial nature of public health policy, the subjectivity of judgments about effectiveness and the political problems this creates for government. The article pinpoints the relevance of public health policies for judgements about government competence, trustworthiness and accountability. It argues that failures of public health policy, including poor evaluation and failures to learn from experience, may be more comprehensible by adopting a political analysis of public policy making in this field.