Health authorities. Raising the stakes

A survey of 25 health authorities found user groups, professional forums, newsletters, complaint scheme, roadshows and focus groups the most extensive means of consultations. The majority of health authorities had identified the parties to be consulted over strategic planning. The results suggested that consultation is being used more for service planning than strategic purposes. Many health authorities plan to include police and fire services, the media, unions and the private sector and schools in consultations.     

Health authorities: obsessed by structures

Last January, Brian Watkin suggested (Journal, January 25) that the constitution of health authorities as essentially lay bodies required further consideration. He concluded that it would be far better for an authority to consist of a chairman, a group of executive directors (the area management team or area team of officers) and a group of nonexecutive directors who might be appointed or elected in a variety of different ways. Frank Pethybridge, regional administrator, North Western RHA, begs to differ     

Health underachievement and overachievement in English local authorities

OBJECTIVE: To identify English local authorities that "overachieve" and "underachieve" in health terms, given their level of deprivation, sociodemographic context, and region. DESIGN: Cross sectional study using data from the 1991 UK census and mortality data from 2000-2. SETTING: England. PARTICIPANTS: 354 local authorities (total population 49 558 000). MAIN OUTCOME MEASURES: Life expectancy. Residual life expectancy after regression analysis. RESULTS: In general, the more materially deprived the population of a local authority was in 1991, the lower its life expectancy a decade later, with men being more sensitive to the effects of deprivation than women. Many local authorities, however, did not follow this general trend, and these shared common characteristics. Mining, Manufacturing and Industry, and Urban Fringe authorities collectively had lower life expectancies than predicted by their level of deprivation, as did authorities located in the north west. Outer London and Education Centres and Inner London authorities had much higher life expectancies than predicted, as did authorities located in the east, south east, and south west. Given their level of deprivation, sociodemographic context, and region, 11 local authorities significantly overachieved for male life expectancy and 10 underachieved, while 12 overachieved for female life expectancy and three underachieved. CONCLUSIONS: Life expectancy in English local authorities is strongly associated not only with material deprivation, but with the local sociodemographic context and the region where the authority is located. Some authorities defy their contexts, however, and overachieve in health terms, while others, including some in affluent areas, underachieve.     

Health for all through research.

John F. Kennedy's vision of man on the moon by the year 1970 set a goal for technological research and development. The World Health Organization's vision of health for all by the year 2000 set a similar goal not only for health policy but also for health research. Drawing on the analogy between these goals, this paper first explores what health for all means as a policy goal. It calls for changes in most aspects of the health care system. In the European Region of the World Health Organization, 38 specific targets show how approaches to health problems, lifestyles, environment, health care and various support measures (e.g., planning, management and training) should be changed to reach the over-all goal. These changes should be based on sound scientific knowledge. Health for all therefore also calls for a health research policy and reorientation of research. The second part of the paper looks at the research implications of health for all. Assisted by the Regional Office of the World Health Organization, the European Advisory Committee for Health Research analysed the 38 targets to see what kind of research would help to achieve them. The result of this analysis were two publications: "Research Policies for Health for All" and "Priority Research for Health for All". The first volume explains why a country needs a health research policy. The second one identifies, target by target, research necessary to reach them. Translated into several languages, they have begun to influence national research policies. The third section of the paper describes the research priorities identified in the two research for health for all volumes. It also aims at showing their relevance for the European health research community. It finally discusses the prerequisites that the countries have to set up to make research for health for all possible. They include changes in the incentives for and financing of research, personnel development, research organization and communication between the researchers and decision-makers.     

Health of children looked after by the local authorities

Objectives. To assess the healthcare needs of looked-after children in East Surrey. Methods. Epidemiological, comparative and corporate approaches were used to study the healthcare needs of looked-after children. Information was obtained from published and unpublished sources, case note review, cross-referencing with records from specialist services, and interviews with stakeholders. Results. Of the 136 children whose case notes were reviewed, only 64% had undergone statutory medical examinations. Several physical health problems were identified, emotional and behavioural problems were present in 34% of children, 25% of school-aged children had a statement of special educational need, and 36% had ever used child and adolescent mental health services. Immunization coverage was lower than that of children who were not in care. Several unmet needs and gaps in service provision were identified. Conclusions. Children in care have a higher degree of physical and mental health needs than their not-in-care counterparts. The local service for children in care needs to be improved to meet these health needs and lead to better health and health-related outcomes for the children.     

Health in all policies

The main principle behind the slogan ‘Health in All Policies’is really very simple: Health is greatly influenced by lifestylesand environments, e.g. how people live, work, eat and drink,move, spend their leisure time etc. These are not only individualchoices, but they often have strong social, cultural, economical,environmental etc. determinants.¹ Accordingly, decisions influencingpeople's health do not concern     

Health Policy. Fair shares for all

Where services are resource-limited, they will be targeted at those in poverty. The HA will invest in programmes that provide the maximum health gain and the greatest reduction in health inequality. The HA will map and audit the distribution of poverty and of service provision and redirect services to reflect identifiable need. The HA will adopt an 'anti-poverty effect' measure as an indicator of service quality.     

Health for all in Nicaragua

The state of health care in Nicaragua can be attributed in part to the interaction between 'revolutionary' and 'counter revolutionary' forces. Since 1979 development of primary health care has been rapid and ambitious. Nicaragua's early successes in the pursuit of 'Health for all by the year 2000' have been widely reported and rightly acclaimed. Since 1983, however, these advances have been difficult to maintain, leading to stasis and deterioration in the health system. The contribution of various factors to the current health status of Nicaragua is examined.     

Health authorities: the time is ripe for a new model

Health authorities are charged with the management of the NHS on behalf of the Secretary of State. They are expected to provide leadership and guidance to their chief officers. How realistic is this expectation? Brian Watkin suggests Patrick Jenkin should think again about the constitution of health authorities as essentially lay bodies.     

人人享有健康保障

本文回顾了中国卫生服务与医疗保障体系的改革与发展过程，分析了现存的主要问题，提出了人人享有健康保障的理念，并分析了实现这一目标的必要性、目标与途径，并提出相关政策建议。     

Health planning: a vital role for district health authorities

Next April the planning function of DHAs will change. However, planning will still be vitally important if they are to perform their purchasing role effectively. Douglas Scott discusses the implication of this and describes the approach to planning being developed in Leeds.