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This book offers a unique multi-disciplinary perspective on tackling health inequalities in a rich country, examining the New Labour policy agenda for tackling health inequalities and its inherent challenges. The book presents an overview of progress since the publication of the seminal and ambitious 1998 Acheson Inquiry into health inequalities, and the theoretical and methodological issues underpinning health inequalities. The chapters consider the determinants of inequality — for example, early childhood experience and ethnicity — the factors that mediate the relationship between determinants and health — nutrition, housing and health behaviour — and the sectoral policy interventions in user involvement, local area partnership working and social work. This book offers a combination of broad analysis of progress from differing perspectives.

Involving citizens in policy-decision-making processes – deliberative democracy – has been a central goal of the Labour government since it came to power in 1997. But what happens when members of the public are drawn into unfamiliar debate, with unfamiliar others, in the unfamiliar world of policy making at national level? This book sets out to understand the contribution that citizens can realistically be expected to make. Drawing on the lessons from an ethnographic study of a public-involvement initiative in the health service – the Citizens Council of the National Institute for Clinical Excellence (NICE) – it explores the practical realities behind the much-quoted faith in ‘deliberation’ that underpins so many models of public involvement and presents the analysis of 64 hours of video and audiotape capturing a warts-and-all picture of deliberation in action. The book sets deliberative participatory initiatives within a broad inter-disciplinary context and challenges politicians, policy makers, and academics to develop more realistic approaches to democratic innovation.

Improving health in populations in which it is poor is a complex process. This book argues that the traditional government approach of exhorting individuals to live healthier lifestyles is not enough – action to promote public health needs to take place not just through public agencies, but also by engaging community assets and resources in their broadest sense. The book reports lessons from the experience of planning, establishing, and delivering such action by the five-year Sustainable Health Action Research Programme (SHARP) in Wales. It critically examines the experience of SHARP in relation to current literature on policy; community health and health inequalities; and action research. The authors make clear how this regional development has produced opportunities for developing general concepts and theory about community-based policy developments which are relevant across national boundaries and show that complex and sustained community action, and effective local partnership, are fundamental components of the mix of factors required to address health inequalities successfully. The book concludes by indicating the connections between SHARP and earlier traditions of community-based action, and by arguing that we need to be bolder in our approaches to community-based health improvement and more flexible in our understanding of the ways in which knowledge informs developments in health policy.

Does health promotion have a lasting and positive effect on people? With mounting pressure to reduce costs to the NHS and increasing scepticism of the so-called nanny state, health promotion initiatives are increasingly being criticised as costly and ineffective, with many arguing that health inequalities can only be reduced through radical political and economic change. This book examines the methods used to evaluate the value of health promotion projects and determines whether attempts to change people's lifestyles have proved successful. Taking into account the practical and ethical issues involved in deciding the appropriate approach to take in efforts to reduce health inequalities, the book assesses what might be the best path forward for health promotion.

Drawing on in-depth case studies across England, this book argues that governance and population health are inextricably linked. Using original research, it shows how these links can be illustrated at a local level through commissioning practice related to health and wellbeing. Exploring the impact of governance on decision-making, Governance, commissioning and public health analyses how principles, such as social justice, and governance arrangements, including standards and targets, influence local strategies and priorities for public health investment. In developing 'public health governance' as a critical concept, the study demonstrates the complexity of the governance landscape for public health and the leadership qualities required to negotiate it. This book is essential reading for students, academics, practitioners and policy-makers with an interest in governance and decision-making for public health.

This book critically explores the urban governance of healthy lifestyles and the contemporary problematisations of the obesity, sedentarism and alcohol ‘epidemics’. To do so, it uses US and UK case studies to shed light on the complex socio-spatial dynamics of responsibilities for health and argues for an engagement with the construct of ‘sensible’ behaviour at a time of its rising political salience.

Health care systems across the world are in a state of permanent revolution as they struggle to cope with multiple pressures arising from changing demography, new technologies and limited resources. Focusing on the British NHS, this book looks at how it has coped with such pressures over its 60-year history and considers what the future holds. It explores the complexity of health policy and health services, offering a critical perspective on their development. The book offers a reassessment of successive reforms of the NHS and their cyclical nature.

The National Health Service (NHS) is undergoing a period of significant reform, with the reintroduction of the internal market, a focus on patient choice and the controversial introduction of ‘foundation hospitals’ — all central to New Labour's strategy for changing healthcare in the UK. This book contends that attempts to reform the NHS can only be understood by reference to both the wider social and political contexts, and to the organisational and ideational legacies present within the NHS itself. It aims to take students beyond a basic understanding of the historical development of health policy in the UK, to one that demonstrates an appreciation of the interactions between health policy, organisation and society. The book acts as a bridge between conventional textbooks on the NHS and contemporary health policy research, provides an account of the development of policy and organisational change not found elsewhere and provides recommendations for how the NHS can be better organised in the future.

It is vital for healthcare leaders to have a clear sense of which leadership ideas and practices are rooted in sound theory and convincing evidence, and which are more speculative. This book provides a coherent set of six lenses through which to scrutinise the leadership literature relevant to healthcare — leadership concepts, characteristics, contexts, challenges, capabilities and consequences. It offers a view of leadership beyond the traditional focus on the individual, and argues instead that leadership has to be understood and developed as a complex set of practices by many people within specific organisational and inter-organisational contexts and cultures.

This book critically examines the topics of medical fitness to practice tribunals and revalidation and how we as a society ensure doctors remain competent in their chosen speciality, through a critical socio-legal lens that draws on the disciplinary fields of medical sociology, criminology and law.

This book is a crucial contribution to debates about the rapid modernisation of health care systems and the dynamics of changing modes of governance and citizenship. Structured around the role of the professions as mediators between state and citizens, and set against a background of tighter resources and growing demands for citizenship rights, the book offers a much-needed comparative analysis, using the German health care system as a case study. The German system, with its strongly self-regulatory medical profession, exemplifies both the capacity of professionalism to re-make itself, and the role of the state in response, highlighting the benefits and dangers of medical self-regulation, while demonstrating the potential for change beyond marketisation and managerialism. The book critically reviews dominant models of provider control and user participation, and empirically investigates different sets of dynamics in health care, including tensions between global reform models and nation-specific conditions; inter-professional dynamics and changing gender arrangements; the role of the service-user as a new stakeholder in health care; and the rise of a new professionalism shaped by social inclusion. This book provides new approaches and a wealth of new empirical data.

The book is an important addition to the history of public health in England. Starting in the 1970s, with a brief overview of earlier periods, it charts the events leading to the unique achievement from 2003 of specialist status, equivalent to public health medical consultants, for those from non-medical backgrounds. Setting these changes in context, it discusses later implications, changes and developments for practitioners and for the wider UK public health workforce. A lively and comprehensive review of policy change, the book concludes with a reflection on the new public health system in England, making useful comparisons with the rest of the UK and internationally. In addition to factual and historical source material, the book makes extensive use of comments from individuals prominent in furthering the changes that took place from two Witness Seminars as well as a series of interviews specially conducted for this book. This is an invaluable resource for anyone with an interest in public health, the workforce and its current state of development. It will also be of interest to public health academics and relevant postgraduate students.

Over the past ten years partnership working has become a central feature of public services. This book analyses experience of partnerships in different policy fields, identifying the theoretical and practical impediments to making partnership work and critically evaluating the advantages and disadvantages for those involved. Its broad coverage goes beyond the confines of statutory partnerships, addressing other important forms of collaboration between voluntary, private and statutory sectors and service users and community and minority groups. Through a wide range of perspectives, the book aims to integrate theory and practice across a number of policy areas. Using a variety of models, it highlights both positive and negative aspects of partnership working at political, cultural and technical levels; shows how partnerships can empower people and groups through effective collaboration; suggests some of the principles on which good practice should be based and the resources required; and addresses key issues of accountability, representation and social exclusion.

The UK government’s reforms of the NHS and public health system require partnerships if they are to succeed. Those partnerships concerned with public health are especially important and are deemed to be a ‘good thing’ which add, rather than consume, value. Yet the significant emphasis on partnership working to secure effective policy and service delivery exists despite the evidence testifying to how difficult it is to make partnerships work or achieve results. Partnership working in public health presents the findings from a detailed study of public health partnerships in England. The lessons from the research are used to explore the government’s changes in public health now being implemented, most of which centre on new partnerships called Health and Wellbeing Boards that have been established to work differently from their predecessors. The book assesses their likely impact and the implications for the future of public health partnerships. Drawing on systems thinking, it argues that partnerships can only succeed if they work in quite different ways. The book will therefore appeal to the public health community and students of health policy.

People-centred public health examines how members of the public can be involved in delivering health improvement, primarily as volunteers or lay health workers. With a foreword by Professor Sir Michael Marmot and Dr Mike Grady, this book draws on a major study of lay engagement in public health, using case studies and real life examples to provide a comprehensive and accessible overview of policy, practice and research in this area. In an economic and political climate where there is renewed interest in the role of the citizen, the authors challenge old orthodoxies in public health and build a coherent argument for radical change in the way public agencies support lay action. The book provides contemporary insights into why, how and with what support people can move from being health consumers to active citizens who are able to make a valued contribution to health. The book is aimed at readers with an academic or professional interest in public health, health promotion, public sector management, social policy and community work.

Where people live matters to their health. Health-improvement strategies often target where people live, but do they work? This book tackles this question by exploring new theoretical, empirical, and practice perspectives on this issue, anchored by major studies of England's Neighbourhood Renewal Strategy and the Programme for Action on health inequalities. It uses complexity theory to understand the inter-relationships between neighbourhood change, the emergence of states of health, and policy interventions managed using performance indicators. This is complemented by reviews of the international evidence base on area effects and neighbourhood change, supplemented by new insights from the author's own research and experience as an advisor to local-neighbourhood-renewal strategies. The book is a wide-ranging study with many new examples of the impact of neighbourhood conditions from smoking to dementia.

Drawing on clinical experience dating from the birth of the NHS in 1948, the author, a politically active GP in a Welsh coal mining community, charts in this book the progress of the NHS from its nineteenth-century origins in workers' mutual aid societies, to its current forced return to the market. The book's starting point is a detailed analysis of how clinical decisions are made. It explores the changing social relationships in the NHS as a gift economy, how these may be affected by reducing care to commodity status, and the new directions they might take if the NHS resumed progress independently from the market. The essential principle in the book is that patients need to develop as active citizens and co-producers of health gain in a humanising society and the book's aim is to promote it wherever people recognise that pursuit of profit may be a brake on rational progress.

There are significant variations in how healthcare systems and health professionals are regulated globally. One feature that they increasingly have in common is an emphasis on the value of including members of the public in quality assurance processes. While many argue that this will help better serve the public interest, others question how far the changing regulatory reform agenda is still dominated by medical interests. Bringing together leading academics worldwide, this collection compares and critically examines the ways in which different countries are regulating healthcare in general, and health professions in particular, in the interest of users and the wider public. It is the first book in the Sociology of Health Professions series.

Ethical dilemmas are not new in the area of health care and policy making, but in recent years, their frequency and diversity have grown considerably. All health professionals now have to consider the ethical implications of an increasing array of treatments, interventions and health-promotion activities on an almost daily basis. This goes hand in hand with increasing medical knowledge, and the growth of new and innovative medical technologies and pharmaceuticals. In addition, the same technology and knowledge is increasing professional and public awareness of new potential public health threats (e.g. pandemic influenza). At the level of public policy, concerns over the rising costs of health care have led to a more explicit focus on ‘health promotion’, and the surveillance of both ‘patients’ and the so-called ‘worried well’. Health professionals and policy makers also have to consider the implications of managing these risks, for example restricting individual liberty through enforced quarantine (in the wake of SARS and more recently swine flu) and the more general distribution of harms and benefits. Balancing the rights and responsibilities of individuals and wider populations is becoming more complex and problematic. This book will play a key role in opening out a discussion of public health ethics. It examines the principles and values that support an ethical approach to public health practice and provides examples of some of the complex areas which those practising, analysing and planning the health of populations have to navigate.

Health systems everywhere are experiencing rapid change in response to new threats to health, including from lifestyle diseases, risks of pandemic flu, and the global effects of climate change, but health inequalities continue to widen. Such developments have profound implications for the future direction of public health policy and practice. This book offers a wide-ranging, provocative assessment of challenges confronting a public health system, exploring how its parameters have shifted and what the origins of dilemmas in public health practice are.