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26.5.2016 "Better Health, Improving Health Care†is a strategic briefing document prepared by the Department for the incoming Minister for Health, in advance of the publication of the Programme for Government. It sets out some strategic considerations to inform the task of developing a clear and coherent agenda for action to improve the health service. Better Health, Improving Health Care

Much of our social and political effort, including a portion of the research in this university, is directed towards the promotion of one goal: health. But what is health? Or rather, how should we define health so that it is an identifiable goalpost for our social policies and technological developments? This lecture will discuss whether an appropriate goal for our health minded social policies and technological developments can be identified.

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

This action plan sets out to inform and provide support for dental practices as they focus more on preventative care under new contractual arrangements which will be in place from 1 April 2006. Designed to improve oral health both nationally and locally, this plan also sets out to assist and support Primary Care Trusts (PCTs) in meeting their new responsibilities for dental services under the Health and Social Care (Community Health and Standards) Act 2003. This legislation extends their remit to assessing local oral health needs and commissioning the appropriate services to tackle long standing oral health inequalities.

There is still a debate concerning the evidence base for community interventions. The randomised clinical trial design (RCT) is increasingly challenged as a gold standard for their evaluation. This thesis takes the Norsjö health programme in Västerbotten as the starting point for a discussion about the ethical platform of community interventions and for exploring the role of self-rated health. The specific objectives are: 1) to better understand barriers to community participation and to assess the role of ethical premises among decision-makers, 2) to explore how health related norms and attitudes interact with self-rated health and the risk factor outcome of an intervention and 3) to analyse the gender and socio-cultural interplay of self-rated health with biomedical risk factors for cardiovascular disease. The participation and views of different actors in the planning and implementation phases of the intervention were studied by contrasting information between official documents, interviews with decision makers and professionals and questionnaires to community members. The role of basic values in setting priorities and choosing intervention strategies utilised a questionnaire design with hypothetical scenarios sent to a representative sample of Swedish health care politicians. Qualitative research interviews were used to explore health related norms and attitudes. Health examination measurements and questionnaire data formed the basis for analysis of the development of self-rated health and risk factor load during a 10-year follow-up of the intervention. Access to a stroke registry enabled a case-referent approach for studying the interaction between bio-medical risk factors, socio-demographic factors and self-rated health. Data from the Västerbotten Intervention Programme (VIP) could be utilised for a cross-country comparison with a "sister project" in Otsego, U.S.A. The results point to both strengths and limitations of the efforts made to involve people in the intervention. The problem definition mainly remained with the professionals and participation as a goal in itself, strengthening local democracy was felt to be an exaggerated ambition. However, there was an overall agreement about the seriousness of the health problem, the need to intervene and about the implementation mode. Self-rated health and reported behavioural change were important indicators of participation and young men with bad health seemed to have been least involved. Among Swedish health care politicians there was an overall agreement to allocate resources for prevention directed towards communities when there are serious health problems. The majority preferred an intervention strategy that involved primary health care. The risk of harm by creating some degree of anxiety or stigma was for many considered an acceptable drawback of a successful intervention. The follow-up study revealed a positive risk factor reduction accompanied by a positive development of self-rated health, especially for men. Additional support for an intervention effect was given through a comparison with a reference area. The interaction pattern between risk reduction and self-rated health was more polarised for men than for women, with a corresponding pattern for the lower compared to the higher educated. These results could be linked to a transition in the health related norm system and to "ideal types" representing attitudinal sets towards the intervention. The case-referent analysis suggested an interaction effect between self-rated health and bio-medical risk factor load in predicting stroke that was greater for men than for women. The cross-country comparison revealed a stronger influence of education in the U.S.A. The lower educated, with a high risk load, had a greater risk of self-rated poor health than their Swedish counterparts. The thesis suggests that self-rated health is an unexplored indicator, potentially important for understanding the complexity of community interventions. Self-rated health may predict disease development as well as modify the impact of established risk factors.

Health inputs are critical in attaining a healthy nation and improving health outcomes. Kenya, like other developing countries, grapples with limited health expenditures and poor population health indicators. Specifically, Kenya is yet to achieve the allocation of least 15% of the government's annual budget to improve the health sector as enshrined in the Abuja Declaration. Though there is an improvement with regards to infant mortality rate decreasing from 96.6 per 1, 000 live birth in 1970 to 30.6 per 1, 000 live birth in 2018. This indicator of population health outcome is currently far below the Sustainable Development Goals (SDGs) target of reducing the under five mortality rate to as low as 12 deaths per 1,000 live births by 2030. The literature suggests that increase in government's budgetary allocation to the health sector can improve country's health outcomes. Evidence on the impact of health expenditures on health outcomes is mixed and limited in developing countries. This study aims to analyze the impact of public health expenditures on health outcomes, among other control variables in Kenya. The study uses time series data from 1970 to 2018. The variables are found to be integrated of different orders suggesting the choice of Autoregressive Distributed Lag (ARDL) model. ARDL provides a useful link between long run equilibrium relationships and short run disequilibrium dynamics is estimated. The ARDL bounds test suggests presence of cointegration thus leading to the estimation of Error Correction Model (ECM). The findings suggest that improvements in public health expenditures enhance health outcomes in Kenya. The control variablesthat are found to be important determinants of infant mortality rate in Kenya include the national income and number of hospital beds per 100, 000. The study recommends that Kenyan government should increase annual budgetary allocation to health sector. Such increase is likely to lead to investments in physical and human capital in the health sector thus translating to improved health outcomes in Kenya.

This new cardiovascular policy, Changing Cardiovascular Health covering the period 2010-2019, comes a decade after the first national cardiovascular health strategy, entitled Building Healthier Hearts, was published by the Department of Health in 1999. The new policy is timely given the pace of scientific discovery and related changes in medical practice, changes in health service structures, and patterns and influences on population health behaviours in Ireland over the decade. Cardiovascular health and its maintenance is a microcosm of health more generally. A policy that can improve cardiovascular health and cardiovascular disease management will have beneficial effects for the whole healthcare system and population.Download this document

BACKGROUND: Starting from 90'th, the Government of Georgia (GoG) made several attempts to transform Georgian health care system into one with improved efficiency, accessibility, and quality services. Mandatory social health insurance which was introduced in the 1990s was abolished and private health insurance has been promoted as its replacement. The main principle of health care reform since 2006 was the transition towards complete marketization of the health care sector: private provision, private purchasing, liberal regulation, and minimum supervision. This paper aims to analyze an impact of ongoing reforms on public health and population health status. MATERIALS AND METHODS: A systematic review of the available literature was conducted through national and international organization reports; key informant interviews were conducted with major stakeholders. RESULTS: The country has attained critical achievements in relation to improved maternal and child health, national responses to HIV, TB and Malaria. Life expectancy has increased from 70.3 years in 1995 to 75.1 years in 2010. Under-5 mortality indicator has improved from 45.3 to 16.4 per 1000 live birth in 2005-2010 meaning a 64% decrease. However, Georgia is still facing a number of critical challenges securing better health for the population. Cardiovascular diseases are by far the largest cause of mortality, respiratory diseases are the leading cause of morbidity and have doubled during last decade. Georgia has one of the highest rates of male smoking in the world (over 50%). CONCLUSION: Governmental efforts in health promotion and disease prevention can have significant impact on health status by preventing chronic diseases and detecting health problems at a treatable stage. Government should consider increasing funding for public health and prevention programmes with the focus on prevention of the main risk factors affecting the population's health: tobacco and drug use and unsafe sexual behaviour.

Over the last decade Belfast has experienced significant political, economic and social change. As a consequence, the population of greater Belfast has increased substantially over the past decade. This has been as a result of both natural change and net migration gain. This report covers the following issues legislation on immigration, work, health & social services and social security entitlements; health issues; migrant health priorities identified at the Stakeholder Workshop held in April 2010.

BACKGROUND: Our aim, as part of the collaborative study SPHERE (Strengthening Public Health Research in Europe), was to describe public health publications in the French language according to health needs and public health functions. METHOD: All articles published in six French public health journals, and one French/English language Canadian journal, over the period 1995-2004, were retrieved from three electronic databases. Original research articles were indexed by hand according to one main domain of health need, based on Global Burden of Disease categories, and into one of four public health functions. RESULTS: After removing duplicates, 3984 original research articles were identified. Only 51% could be allocated to a health needs code. Of these, 71% were about non-communicable diseases, 25% communicable, maternal and perinatal conditions and 5% injuries. This compared only moderately with the global burden of disease for France (84, 5 and 11%, respectively). The other articles addressed health determinants, such as behavioural or environmental exposures, or a methodological issue. Ninety-two percent of the articles could be assigned a public health function code. Health monitoring and health services research accounted for 80% of references from French journals. Only 9% of articles from French journals were related to prevention, which was lower than that in the Canadian journal (17%). Only 1% of articles dealt with legislation. CONCLUSION: The distribution of articles in French public health journals broadly follows the distribution of health needs. History and data availability may explain the extra research focus on communicable diseases and maternal and child health research. Injuries, and prevention, are topics which appear to be under-represented in French language journals.

BACKGROUND: Our aim, as part of the collaborative study SPHERE (Strengthening Public Health Research in Europe), was to describe public health publications in the French language according to health needs and public health functions. METHOD: All articles published in six French public health journals, and one French/English language Canadian journal, over the period 1995-2004, were retrieved from three electronic databases. Original research articles were indexed by hand according to one main domain of health need, based on Global Burden of Disease categories, and into one of four public health functions. RESULTS: After removing duplicates, 3984 original research articles were identified. Only 51% could be allocated to a health needs code. Of these, 71% were about non-communicable diseases, 25% communicable, maternal and perinatal conditions and 5% injuries. This compared only moderately with the global burden of disease for France (84, 5 and 11%, respectively). The other articles addressed health determinants, such as behavioural or environmental exposures, or a methodological issue. Ninety-two percent of the articles could be assigned a public health function code. Health monitoring and health services research accounted for 80% of references from French journals. Only 9% of articles from French journals were related to prevention, which was lower than that in the Canadian journal (17%). Only 1% of articles dealt with legislation. CONCLUSION: The distribution of articles in French public health journals broadly follows the distribution of health needs. History and data availability may explain the extra research focus on communicable diseases and maternal and child health research. Injuries, and prevention, are topics which appear to be under-represented in French language journals.

Demographic change, new health threats and inequalities in health and healthcare provision in and between European Union (EU) member states pose a great challenge to European health care systems. Not only for these reasons does it make sense to collect comparable European health data. Such information provides insights on the distribution of risk and protection factors, the prevalence of chronic diseases and the levels of care provided in the member states and supports the planning and implementation of (health) policy measures. Since 2013, in the context of the European Health Interview Survey (EHIS), all EU member states are obliged to collect data on the health status, the provision of healthcare, health determinants and socio-economic conditions of their populations. In Germany, the EHIS is integrated into health monitoring at the Robert Koch Institute (RKI). The RKI is thus Germany's interface to the European health monitoring presented here. European health monitoring relies on different indicator systems such as the European Core Health Indicators (ECHI), EU social indicators and the health indicators of the European Sustainable Development Strategy. These are based on administrative and survey data, which stem for example from the EHIS or the European Union Statistics on Income and Living Conditions (EU-SILC) survey. Comparative data analyses must take into account the differences between health care systems, socioeconomic conditions and the age structures of societies. Variances in the prevalence of allergies for example are also due to differences in the available diagnostic tools. Significant differences in the prevalence of hypertension in Europe (with a range of 20% for women and 17% for men) are also related to different levels of awareness of hypertension. Comparative analyses can support the planning of and provide information for policy measures, and enhance the sharing of experiences between EU member states. A forthcoming EU regulation aims to harmonise the content of and intervals between ...

Together, men, masculinities and health comprise an emerging area of research, activism and policy debate. International research on men's health demonstrates how men's enactment of masculinity may be linked to their sexual health risk. However, little research to date has explored men's enactment of different forms of masculinity and men's sexual health from a social generational perspective. To address this gap, insights from Mannheim's work on social generations, Connell's theory of masculinity, Butler's theory of gender performativity, and Alldred and Fox's work on the sexuality-assemblage, were utilised to offer a better understanding of the implications of masculinities for men's sexual health. A multi-site cross-sectional qualitative study was conducted in three cities in Bangladesh. Semi-structured interviews were used to capture narratives from 34 men representing three contrasting social generations: an older social generation (growing up pre-1971), a middle social generation (growing up in the 1980s and 1990s), and a younger social generation (growing up post-2010). A thematic approach was applied to analysis to identify the key issues focused upon in men's accounts. The analysis revealed generational differences and similarities in the construction of masculinity, in sexual practices and in help and health-seeking practices. Findings show that certain ideals of masculinity were common across all social generations. However, social, cultural, economic and political transformations in Bangladesh have produced significant cross-generational differences and discontinuities. Study findings point to the importance of understanding how the production and enactment of specific forms of masculinity are shaped by education, urbanisation, and globalisation, as well as by the cultural dynamics of religion (especially Islam), work, homosociality, patriarchy and heteronormativity, and how these in turn affect sexual health and health-seeking practices. This thesis contributes to a socially located understanding of masculinities, gender and men's sexual health from a social generational perspective. It argues for the need to move beyond stereotypical, reductionist, essentialist and binary understandings of men, masculinity, gender and health in the South Asian contexts, highlighting opportunities for new forms of intervention and action to promote men's sexual health.

Many practical issues in medical ethics depend on an understanding of the concept of health. The main question is whether it is a purely descriptive or a partly evaluative or normative concept. After posing some puzzles about the concept, the views of C Boorse, who thinks it is descriptive, are discussed and difficulties are found for them. An evaluative treatment is then suggested, and used to shed light on some problems about mental illness and to compare and contrast it with physical illness and with political and other deviancies which are not illnesses.