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We are concerned that providing insurance for the previously uninsured will be seen as a panacea for resolving health disparities, for the social environment makes a tremendous difference in health outcomes. A careful examination of the factors involved in the social determinants of health shows that health insurance plays only a small role in alleviating health disparities. In this commentary, we highlight the complexity of the problem of the social determinants of health and health disparities in the United States by comparing two neighborhoods in Baltimore City and by examining hypertension and mental health disorders.

In 2003, the Swedish Parliament adopted a national public health policy that included the domain - "A more health-promoting health service". Strategies and tools are needed in the work to reorient health services. Personal health documents are documents concerning a person's health, and are owned by the individual. Several studies that have evaluated such documents indicate that they could be of interest in health-promotion work. However, there is insufficient knowledge concerning personal health documents that target adolescents, and little is known about the feasibility of such documents in a Swedish cultural context. The concept of empowerment is gaining increased interest for health services, but the associations between empowerment, self-rated health and health behaviour are sparsely studied. The overall aim of the thesis is to explore a strategy - empowerment - and a tool - personal health documents - that might facilitate the work of the public health goal of a health-promoting health service. Specific aims are to examine the feasibility of using personal health documents in health promotion; to examine professionals' experiences of working with health promotion and personal health documents; to examine the association between personal health documents and self-reported health behaviour change; and to examine the perception of empowerment in relation to self-rated health and health behaviour among adolescents. Two personal health documents that targeted adults and adolescents were developed and evaluated. Distribution to adults in different settings was compared in a cross-sectional study (n = 1 306). Adolescents received the document in school, and surveys were performed at baseline and after one year (n = 339). Practical use and attitudes by document owners were studied by questionnaires. Teachers (n = 69) answered a questionnaire, and community health nurses were interviewed (n = 12). The interviews also explored nurses' experiences of working with health promotion in general, and were analysed by qualitative methodology. Adolescents' empowerment was examined by a questionnaire (n = 1 046). Most participants reported reading in the documents; writing in the documents varied between 16% (distribution in occupational health) and 87% (adolescents). The health document was perceived as useful by 35% of the adolescents. Factors significantly related to personal usefulness were being born outside Sweden, experiencing fair treatment by teachers, being a non-smoker and having a positive school experience. Community health nurses were striving for a balance of being a doer of practical, disease-oriented tasks and a health-promotion communicator. The structural organisation in health care centres was important for their work with health promotion and the health document. Teachers were generally in favour of continued work with the document. In different settings, between 10% and 26% of adults reported changes in their health situations as a result of reading the booklet. Self-reported changes in health situations were less likely using postal distribution, and there were no significant differences between the other types of distribution. Adolescents with low empowerment scores reported poorer self-rated health and more risk-taking behaviours such as smoking and binge drinking. To conclude, personal health documents are feasible to use in different settings. Health promotion in health services needs active support from leaders as well as adequate support systems. Findings suggest that personal health documents can be tools for promoting self-reported lifestyle changes among adults in different settings. There is a close relation among adolescents between low empowerment in the domain of health, low self-rated health and health behaviours such as binge drinking and smoking.

Reforming a public health service is a difficult proposition under the best circumstances. Attitudes of health workers and the expectant public have become entrenched over the years and major change is bound to produce reaction and resistance. The public has come to expect an unlimited service for free. What is not available in Malta is expected to be made available by referral to other centres abroad. In this article the author illustrates the lack of communication the Maltese Government has with the Maltese Medical Association with regards to the health reform. ; peer-reviewed

"Healthy behaviors, at the individual and community levels, are imperative to improving and sustaining better public health. With a strong focus on prevention, health promotion strategies are crucial to improving quality of life, while taking into account the various determinants of health. This book provides a global perspective, with an emphasis on contextual issues with health promotion in South Asia for understanding challenges and related strategies. Readers will be comprehensively introduced to healthy behaviors through case studies, covering theories, interventions, and approaches to promote healthy behavior, the impact of policy and how behavior change can be sustained. Key features: Covers existing and emerging issues in health promotion. Inputs from globally renowned public health experts with a multi-disciplinary approach in content and audience. Connects with health systems and relevant sustainable development goals. Provides case studies for enabling readers to understand and apply evidence-based solutions to key public health issues"--