The advent of the purchaser provider split has made the process of setting priorities much more explicit. It is against this basic background that we have considered "Scotland's Health: A Challenge to Us All". The priorities in that document appear to have been established on the basis of problem size and the existence of effective interventions and quantified targets. We suggest an alternative strategy for setting priorities, based upon the concept of efficiency such that benefits are maximised with whatever resources are available. To implement such a process fully is difficult largely because of the current lack of adequate measures of marginal benefits. But even lacking good measures outcome, we submit that the thinking underlying this approach will promote efficient resource use and, thereby, ensure that Scotland's health is promoted as fully as possible.