A politics of health glossary

This glossary reflects a (re-)emerging awareness within public health of the political dimension of health and health inequalities, and it also attempts to define some of the key concepts from the political science literature in a way that will be of use in future public health analyses. Examples from different domains (healthcare and population health) are provided to highlight how political concepts pervade health.

Developing public health nursing: barriers perceived by community nurses

OBJECTIVES

To understand the key issues for field nursing in developing their public health role within five primary care trusts (PCTs) in Merseyside, in the North West of England.

DESIGN

Qualitative study.

METHODS

Fourteen school nurses and 30 health visitors participated in 11 focus groups consisting of others from their profession working within the same PCT, and 24 practitioners responded to a questionnaire.

RESULTS

The findings suggest that there are a number of shared obstacles that need to be overcome before the public health approach can be fully developed within community nursing. These include: the need for facilitation to deal with organisational change, lack of clarity around the public health role, inadequate administrative support, general practitioner attachment problems, poor interprofessional partnerships, competing priorities and resistance to change.

CONCLUSIONS

The development of public health nursing in England envisaged in current government policy will not occur in full unless the kind of issues identified in this study are adequately addressed. This will require participative, interprofessional approaches to redesigning services by all relevant public health practitioners.

Attitudes of community optometrists to smoking cessation: an untapped opportunity overlooked?

AIM

To assess community optometrists' attitudes and current behaviour regarding provision of smoking cessation advice in their practice.

METHODS

A self-completion postal questionnaire was sent to community optometrists in north-west England identified from the General Optical Council's practice lists.

RESULTS

Of 709 optometrists identified, 71.8% (509/709) returned the completed questionnaire. Few community optometrists routinely asked about smoking habits: only 6.2% (95% CI: 4.1-8.3) (n = 31) at new patient consultations, and 2.2% (95% CI: 0.9-3.5) (n=11) at follow-up visits. Reasons for optometrists not routinely providing smoking cessation advice included: not their role (35.4%, n=180), lack of time (22.0%, n=112) and forgetting to ask (21.4%, n=109). Overall 67.6% (95% CI: 63.5-71.7) (n=344) of community optometrists wanted to improve their knowledge of smoking and visual impairment with 56.2% (95% CI: 51.9-60.5) (n=286) requesting further training.

CONCLUSION

Despite low levels of current involvement, many optometrists were keen to receive training on smoking cessation topics. We suggest that there are untapped opportunities to develop brief interventions to promote smoking cessation services in community optometry settings.

Is patriarchy the source of men's higher mortality?

OBJECTIVE

To examine the relation between levels of patriarchy and male health by comparing female homicide rates with male mortality within countries.

HYPOTHESIS

High levels of patriarchy in a society are associated with increased mortality among men.

DESIGN

Cross sectional ecological study design.

SETTING

51 countries from four continents were represented in the data-America, Europe, Australasia, and Asia. No data were available for Africa.

RESULTS

A multivariate stepwise linear regression model was used. Main outcome measure was age standardised male mortality rates for 51 countries for the year 1995. Age standardised female homicide rates and GDP per capita ranking were the explanatory variables in the model. Results were also adjusted for the effects of general rates of homicide. Age standardised female homicide rates and ranking of GDP were strongly correlated with age standardised male mortality rates (Pearson's r=0.699 and Spearman's 0.744 respectively) and both correlations achieved significance (p<0.005). Both factors were subsequently included in the stepwise regression model. Female homicide rates explained 48.8% of the variance in male mortality, and GDP a further 13.6% showing that the higher the rate of female homicide, and hence the greater the indicator of patriarchy, the higher is the rate of mortality among men.

CONCLUSION

These data suggest that oppression and exploitation harm the oppressors as well as those they oppress, and that men's higher mortality is a preventable social condition, which could be tackled through global social policy measures.

A prospective health impact assessment of the Merseyside Integrated Transport Strategy (MerITS)

BACKGROUND

Prospective health impact assessment is a new approach to predicting potential health impacts of policies, programmes or projects. It has been widely recognized that public policies have important impacts on health. In 1997, the Liverpool Public Health Observatory was commissioned to carry out a health impact assessment of the Merseyside Integrated Transport Strategy (MerITS). A secondary aim was to pilot a method for health impact assessment at the strategic level.

METHODS

The methods used drew on previous health impact assessments of projects, on strategic environmental assessment, and on policy research. They included policy analysis, semi-structured interviews with key informants and literature searches.

RESULTS

Four priority impact areas of MerITS were identified: establishing road hierarchies, economic viability, air quality, and public transport. Potential health impacts in each of these areas were estimated, and recommendations were made to minimize the effects of negative impacts and to enhance positive ones.

CONCLUSION

This health impact assessment prospectively identified the key health impacts of a strategy on a defined population and made recommendations to maximize potential positive and minimize potential negative health impacts. The methods employed are generally applicable to prospective health impact assessments of public policies and strategies.

Income inequality and mortality in England

BACKGROUND

Despite the increasing evidence that income inequality causes reductions in life expectancy in developed countries, this relationship has not been explored in the United Kingdom, where local income data are not routinely available. We have surmounted this problem by employing an ecological design which applies national income data to local mortality and occupational data.

METHODS

This ecological, cross-sectional study used 1991 mortality and Census data on the 366 English local government districts, and 1991 New Earnings Survey data for England, to determine the independent effect of income inequalities within English local authorities on the variation in all cause mortality between them. The subjects were all men and women recorded as economically active in the 1991 Census. We carried out linear regression analyses between all cause, all ages standardized mortality ratios, income inequality indexes and mean income levels of the local government districts. Results Both income inequality and mean income were independently associated with mortality.

CONCLUSIONS

It is likely that income inequality makes an independent contribution to life expectancy in English local authorities. This finding adds further to the international evidence supporting the potentially positive health impact of increasing the scale of redistributive fiscal policies.

Health gain versus equity

A new organisation, the Association for Public Health, has just been formed 'to help deliver real health gain for the population'. Alex Scott-Samuel suggests that the concept of 'health gain' is counter to health equality and needs wider debate.

The WHO strategy and community nutrition in the UK

The World Health Organisation (WHO), in its global and European strategies for health for all, has provided an excellent framework for the promotion of community nutrition. Sadly, the UK government has not responded adequately in terms of health-promoting public policy. However, regional and local initiatives in the public sector give much cause for hope. Major areas for action include the creation of political commitment and the development of a new social epidemiology of food and nutrition.

Need for primary health care: an objective indicator

The allocation of resources for primary health care should be based on the community's needs and not only on the workload of general practitioners. I therefore present an objective indicator that may be used to assess the need for primary health care.