Suchergebnisse

This book identifies the key targets for intervention through a detailed exploration of the pathways and processes that give rise to health inequalities across the lifecourse. It sets this against an examination of both local practice and the national policy context, to establish what works in health inequalities policy, how and why. Authoritative yet accessible, the book provides a comprehensive account of theory, policy and practice

English
Tackling health inequalities has become a key policy objective in the UK in recent years, with inequalities in early life accorded strategic importance. The Sure Start programme has been central to this strategy. Over time, however, the early recognition given to the evidence base and the interconnected nature of social problems has given way to a more targeted approach, arguably marginalising those aspects that have been key to success. The aim of this article is to explore and explain this shift in focus and to assess the implications for the health inequalities agenda.

Systematic reviews have become an important methodology in the United Kingdom by which research informs health policy, and their use now extends beyond evidence-based medicine to evidence-based public health and, particularly, health inequalities policies. This article reviews the limitations of systematic reviews as stand-alone tools for this purpose and suggests a complementary approach to make better use of the evidence. That is, systematic reviews and other sources of evidence should be incorporated into a wider analytical framework, the public health regime (defined here as the specific legislative, social, political, and economic structures that have an impact on both public health and the appropriateness and effectiveness of public health interventions adopted). At the national level this approach would facilitate analysis at all levels of the policy framework, countering the current focus on individual interventions. It could also differentiate at the international level between those policies and interventions that are effective in different contexts and are therefore potentially generalizable and those that depend on particular conditions for success.

It is becoming increasingly important to understand the social and economic circumstances under which schools operate. Benchmarking school performance targets, contextualising performance outcomes, and Ofsted inspections all rely upon measures of the socioeconomic status of school populations. These tend to utilise administrative data—such as the percentage of pupils eligible for free school meals—or census data for the ward or neighbourhood of wards in which a school is located. This last approach brings to bear the remarkable wealth of information contained within the census, but it suffers from the fact that schools seldom draw their pupils exclusively, or even predominately, from their immediate hinterlands. The authors discuss a method of estimating the socioeconomic characteristics of school populations which, using a program called NCP Profiler to link individual pupil postcodes with census data at the enumeration district level, is sensitive to the manner in which schools actually recruit students—an increasingly important consideration as the quasi-market in education leads to the effective dismantling of geographically defined school catchment areas.

The process by which the UK government allocates resources for public sector services has rarely been scrutinised from the perspective of social exclusion or social justice. Yet, not only is a significant proportion of public expenditure targeted at just these issues but also the resulting per capita and areal allocations vary significantly with important implications for distributional equity. One product is an apparent urban/rural divide. This article draws on examples of both discretionary and mainstream funding mechanisms to explore the consequences for social exclusion and social justice in rural areas, finding concern for both vulnerable groups and universal welfare.

Partnership working has emerged as a key feature of New Labour's approach to social policy. However, although the theoretical benefits of partnership have been well rehearsed, agencies charged with fostering partnerships lack "evidence" about how best to proceed in bringing about organizational change. This paper describes the development and implementation of a practical approach to capturing the strategies that can be used to establish, strengthen and sustain local partnerships. To this end, it presents a conceptual framework for the evaluation of partnership working and demonstrates the application of the framework to an investigation of partnership working in Cornwall and Isles of Scilly, and Plymouth Health action zones.

Background: eHealth technologies are widely believed to contribute to improving health and patients' experience of care and reducing health system costs. While many studies explore barriers to and facilitators of eHealth innovation, we lack understanding of how this knowledge can be translated into workable, practicable and properly resourced knowledge mobilisation (KM) strategies.
Aims and objectives: This paper describes the aims, methods and outputs of a large European Union funded project (eHealth Productivity and Innovation in Cornwall and the Isles of Scilly (EPIC)) to support the development of a sustainable innovation ecosystem in Cornwall and the Isles of Scilly, in order to explore how knowledge mobilisation activities can help bridge the know-do gap in eHealth.
Conclusions: Preparatory knowledge sharing, linkage making and capacity building are necessary preliminaries to co-production, with an emphasis on capturing the uses to which patients, carers and health workers want to put new technologies rather than promoting new technology for its own sake. Financial support can play a key role in supply-side dynamics, although the contextual and organisational barriers to eHealth innovation in England should not be underestimated.

A key role of the Big Society is to bring about a transformation in public service provision through the greater involvement of voluntary and community groups. It is often assumed that, because rural areas have higher levels of volunteering, they are most likely to 'benefit' from the Big Society, while deprived urban areas will benefit the least. This article questions that assumption. Examining the scope and impact for promoting localism in the Fire and Rescue Service, a sector in which local involvement has played an important role in rural service provision, it finds that the 'Big Society' vision makes untested assumptions about the willingness and ability of citizens to perform public sector functions without the same employment rights as public sector employees; the extent to which the resource context shapes current and future capacity for community involvement; and the role of localism in driving forward improvements in service quality. Moreover, far from benefitting rural areas, higher rates of localism are not necessarily associated with higher performance, raising important questions about the implications of rolling out the Big Society agenda for rural and urban areas alike.

Partnerships are increasingly seeking tools that enable stakeholders to reflect on their own effectiveness, benchmark the status of their partnership and provide a framework for development. Drawing on the evaluation of two Health Action Zones, this article focuses on the use of one such formal assessment tool, adapted from the Nuffield Partnership Assessment Tool and the Verona Benchmark, to explore the contribution of formal tools to our understanding of partnership. It outlines some key methodological limitations and stresses the continued importance of an understanding of context alongside any measurement of partnership effectiveness. It is suggested that formal assessment tools can be extremely valuable in terms of the learning that can result both from the process itself and from the outcomes of the assessment. However, as a stand-alone device they are open to misinterpretation and unlikely to foster development other than in those partnerships prepared to invest the necessary resources in a broad-based evaluation.