Reducing social inequalities in health: public health, community health or health promotion?

While the Consortium on 'Community Health Promotion' is suggesting a definition of this new concept to qualify health practices, this article questions the relevance of introducing such a concept since no one has yet succeeded in really differentiating the three existing processes: public health, community health, and health promotion. Based on a literature review and an analysis of the range of practices, these three concepts can be distinguished in terms of their processes and their goals. Public health and community health share a common objective, to improve the health of the population. In order to achieve this objective, public health uses a technocratic process whereas community health uses a participatory one. Health promotion, on the other hand, aims to reduce social inequalities in health through an empowerment process. However, this is only a theoretical definition since, in practice, health promotion professionals tend to easily forget this objective. Three arguments should incite health promoters to become the leading voices in the fight against social inequalities in health. The first two arguments are based on the ineffectiveness of the approaches that characterize public health and community health, which focus on the health system and health education, to reduce social inequalities in health. The third argument in favour of health promotion is more political in nature because there is not sufficient evidence of its effectiveness since the work in this area is relatively recent. Those responsible for health promotion must engage in planning to reduce social inequalities in health and must ensure they have the means to assess the effectiveness of any actions taken.     

Public health genetics--potential for public health?

Although it is well understood that the disciplines of medicineand public health are different in their goals and practices,in the context of genomics this difference is even more pronounced.While medical genetics concerns the clinical decision made bya doctor to use genomic knowledge for the benefit of the patient,public health genetics may be defined as the systematic integrationof genomics into public health research, policy and practice.¹     

Managing for health: why health care?

Health and health care are increasingly big business. The challenge is to apply our knowledge and skills to meet people's needs, if not their demands as efficiently, effectively and beneficially as possible. Value for money is the slogan. For those who deliver the goods as required, the converse, money for value should equally apply, and not only in a market driven system. This paper offers a very personal view of these issues in the light of recent UK policy developments.     

Can children's health be predicted by perinatal health?

BACKGROUND: The purpose of this paper was to investigate how well children's health until age 7 years can be predicted by perinatal outcome using routine health registers. METHODS: Follow-up of one year cohort (N = 60192) was performed by record linkages with personal identification number. The data came from the 1987 Finnish Medical Birth Register, from six other national registers and from education registers of one county. RESULTS: All perinatal health indicators showed a strong correlation with subsequent health, and prediction of good health was satisfactory: 85% of children who were healthy in the perinatal period did not have any reported health problems in early childhood, and 91% of children healthy in early childhood had been healthy in the perinatal period. However, it was not possible to predict poor health outcome: 76% of the children with reported perinatal problems were healthy in early childhood, and 87% of the children with long-term morbidity in childhood did not have any perinatal problems. CONCLUSIONS: Our findings suggest that in assessing risk factors and health care technology, monitoring perinatal health is not enough and long-term follow-ups are needed.     

APHA policies on universal health care: health for a few or health for all?

The American Public Health Association (APHA) has long advocated the development of a system of universal health care for all US residents. APHA has adopted several policies on this topic that stress the financing of the system of universal health care under a single-payer mechanism. However, this approach has never been adopted by US policymakers. The need for universal health coverage in the United States is growing more acute, and failure to provide such coverage threatens the health status of the public. I propose an alternative approach to the single-payer system that is based on incremental extension of existing coverage mechanisms, accompanied by fundamental reform of the health care delivery system. This approach is in keeping with the traditional methods of policy development in the United States, and I urge APHA to assume leadership in advocating it.     

Can managed health care help manage health care-associated infections?

Managed-care organizations have a unique opportunity, still largely unrealized, to collaborate with health-care providers and epidemiologists to prevent health care-associated infections. Several attributes make these organizations logical collaborators for infection control programs: they have responsibility for defined populations of enrollees and for their overall health, including preventive care; they possess unique data resources about their members and their care; and they are able to make systemwide changes in care. Health care-associated infections merit the attention and effort of managed-care organizations because these infections are common, incur substantial illness and costs, and can be effectively prevented by using methods that are unevenly applied in different health-care settings. Both national and local discussions will be required to enable the most effective and efficient collaborations between managed care organizations and health-care epidemiologists. It will be important to articulate clear goals and standards that can be readily understood and widely adopted.     

Missed opportunities? Locating health promotion within multidisciplinary public health

This paper examines the complex interconnections between the development of health promotion and multidisciplinary public health, respectively. Health promotion takes a distinctive interdisciplinary and multiprofessional perspective on health. Historically, it has brought together practitioners from varied disciplinary backgrounds, education and training. It therefore brings real advantages to the public health enterprise, where the goal is to bridge organisations, professions and partners to collectively address key determinants of health in the most effective manner. This paper debates the contribution health promotion has made to the development of multidisciplinary public health over the past 30 years and explores the principles, values, professional bases and practices of both. It is argued that health promotion's contribution to the development of 'the new public health' was critical, while its status and role within multidisciplinary public health remain problematic and unresolved. The nature of these dilemmas is discussed, reflecting on missed opportunities and possible resolutions.