John's $12 tonic: press coverage of the government's selling of a private health insurance rebate

OBJECTIVE: To document representations of the 1998 introduction of a 30% rebate on private health insurance in the three most-read daily Sydney newspapers. METHODS: Thematic frame analysis of 131 newspaper articles. RESULTS: The rebate was opposed through two frames: that it was ineffective and unfair, and that it was politically motivated. Four supportive frames were more complex: the rebate was justified by claims that public health care was collapsing, that responsible citizens should pay for their own health care, and that individuals would benefit financially. There was also a focus on the political battle in the Senate. The newspaper with the readership least likely to benefit from the rebate supported it most strongly. CONCLUSIONS: Framing was strongly episodic (two dimensional, decontextualised and case-study based), limiting political accountability, and the anti-rebate case was presented less memorably. Community action around the issue was not encouraged, individual responsibility was emphasised and universal health care was not promoted as fair or necessary. Different readerships received different messages about the rebate. IMPLICATIONS: There is an urgent need to promote the value of the public health care system and make the future of Medicare compelling for news editors and the public.     

Reporting on violence: bringing a public health perspective into the newsroom.

The authors present a case study of a collaboration among the Berkeley Media Studies Group, the University of Missouri-Columbia School of Journalism, and journalist Jane Ellen Stevens to introduce to five metropolitan newspapers new violence-reporting techniques that include a public health perspective. A handbook was designed for journalists, and workshops were conducted to explore with editors and reporters how newspapers can report highly unusual crimes and yet avoid misrepresenting the patterns of violence in their communities and creating misguided fear in the public. This case study documents how journalists can be meaningfully engaged on this topic with people from public health despite typical barriers to access faced by public health practitioners and solid resistance from many editors and reporters. The authors describe goals, objectives, and activities across five daily newspapers along with journalists' reactions, concerns, and resistance to the issues that were raised.     

Health promotion in local government: a British experience.

Historically, the development of health promotion work in Britain centred largely upon the activities of elected local authorities. From the mid-nineteenth century onwards, these authorities were primarily responsible both for major interventions in the physical environment, such as improved housing and sanitation, and for the development of community-based preventive and primary care services, such as ante-natal care, health-visiting and district nursing. The importance attached to such work was underlined by the statutory requirement that local authorities should appoint a Medical Officer of Health who could not be dismissed without specific Ministerial approval. Yet in recent decades, this long-standing tradition has been undermined, with both public health doctors and the community health services being displaced from their historical local authority base and placed instead within the the National Health Service, where they are substantially outnumbered by their hospital-based colleagues. As a result, a major political and administrative focus for developing public health approaches has largely disappeared. This loss of a health focus has become a matter of concern to a growing number of local authorities in Britain; a concern which reflects their public health tradition and newer policy issues and approaches which began to affect British local authorities from the late 1970s onwards. This paper considers the example of one such authority, the London Borough of Greenwich, where the author was employed during the early 1980s. In particular, it examines the political and practical problems faced when attempting a systematic review of the authority's role and potential for promoting health through its policies on housing. In the light of this experience, some tentative suggestions are made about the kinds of structures which will be needed if local authorities are to revitalise their public health tradition in a political and economic climate hostile even to existing levels of State intervention.     

‘Radical blueprint for social change’? Media representations of New Labour's policies on public health

For almost two decades prior to the election of the New Labour government in 1997, inequalities in health were largely absent from the political debate in Britain. New Labour sought to bring inequalities, and the role of poverty as a 'root cause' of ill-health, back on to the public agenda. This paper analyses four key documents (Green and White Papers) laying out their proposals for public health. We explore the shifting emphasis on health inequalities between the four official documents, and between the documents and their associated press release. The paper also analyses how this translated into media coverage. It identifies common themes across the press coverage - such as criticisms about lack of targets - but also shows how coverage varied (e.g. between UK 'national' and 'Scottish' press). Finally, the study highlights the crucial issue of political context and news timing, illustrating how the English White Paper was overshadowed by other health stories which formed the basis for attacks on the Labour government in general and the Health Minister in particular.     

Health promotion in local government: A British experience

Historically, the development of health promotion work in Britaincentred largely upon the activities of elected local authorities.From the mid-nineteenth century onwards, these authorities wereprimarily responsible both for major interventions in the physicalenvironment, such as improved housing and sanitation, and forthe development of community-based preventive and primary careservices, such as ante-natal care, health-visiting and districtnursing. The importance attached to such work was underlinedby the statutory requirement that local authorities should appointa Medical Officer of Health who could not be dismissed withoutspecific Ministerial approval. Yet in recent decades, this long-standingtradition has been undermined, with both public health doctorsand the community health services being displaced from theirhistorical local authority base and placed instead within thethe National Health Service, where they are substantially outnumberedby their hospital-based colleagues. As a result, a major politicaland administrative focus for developing public health approacheshas largely disappeared. This loss of a health focus has become a matter of concern toa growing number of local authorities in Britain; a concernwhich reflects their public health tradition and newer policyissues and approaches which began to affect British local authoritiesfrom the late 1970s onwards. This paper considers the exampleof one such authority, the London Borough of Greenwich, wherethe author was employed during the early 1980s. In particular,it examines the political and practical problems faced whenattempting a systematic review of the authority's role and potentialfor promoting health through its policies on housing. In thelight of this experience, some tentative suggestions are madeabout the kinds of structures which will be needed if localauthorities are to revitalise their public health traditionin a political and economic climate hostile even to existinglevels of State intervention.     

Science,politics, and ideology in the campaign against environmental tobacco smoke

The issue of environmental tobacco smoke (ETS) and the harms it causes to nonsmoking bystanders has occupied a central place in the rhetoric and strategy of antismoking forces in the United States over the past 3 decades. Beginning in the 1970s, anti-tobacco activists drew on suggestive and incomplete evidence to push for far-reaching prohibitions on smoking in a variety of public settings. Public health professionals and other antismoking activists, although concerned about the potential illness and death that ETS might cause in nonsmokers, also used restrictions on public smoking as a way to erode the social acceptability of cigarettes and thereby reduce smoking prevalence. This strategy was necessitated by the context of American political culture, especially the hostility toward public health interventions that are overtly paternalistic.     

Overview of the health situation in Peru

This work presents a general view of the health situation in Peru in the last few decades by presenting a short historic development of health and pointing out the changes that have taken place as a consequence of the social, economic and political transformations and affected the population's health. The process of change in public and private health services, the influence of conceptions and sanitary policies of international organizations, the health system and the health situation are mentioned. Two problems of great impact are presented: the cholera epidemics and political violence.     

Alternative goals and policy mechanisms for radiation protection

For decades, radiation protection philosophy and practice have been the domain of professionals trained in the physical and medical sciences. Radiation protection policy was formulated and implemented largely without consultation with or participation by other professional disciplines or the general public. Although, from a public health standpoint, past radiation protection efforts have worked well, there are growing signs that the public has lost confidence in the radiation risk management system as currently configured. This paper draws on perspectives of political science, social psychology, economics, and decision analysis to analyze the limitations of the current radiation protection regime and to suggest alternatives for enhancing public trust and improving efficacy.     

Considerations for increasing the competences and capacities of the public health workforce: assessing the training needs of public health workers in Texas

Background  

Over the last two decades, concern has been expressed about the readiness of the public health workforce to adequately address the scientific, technological, social, political and economic challenges facing the field. A 1988 report from the Institute of Medicine (IOM) served as a catalyst for the re-examination of the public health workforce. The IOM's call to increase the relevance of public health education and training prompted a renewed effort to identify competences needed by public health personnel and the organizations that employ them.     

Theory and practice of the health systems reforms: the cases of Brazil and Mexico

This study focuses on the role of public health experts in the contemporary health sector reform process. The authors discuss the issue based on the case of Brazil and Mexico, where a group of public health specialists have oriented their participation to influence the conflict concerning health policy reform in the respective countries. One approach has been to develop a new cognitive framework for technical health sector reform projects viewed as policy proposals with technical content. The purpose is to demonstrate how these specialists have managed to influence the national debate over health sector reform when the technical and scientific discussion leaves the academic sphere and reaches the social and political realm. The authors contend that this occurs because such technical and scientific knowledge has been postulated (independently of its intrinsic value) as a political and ideological alternative platform for sustaining a health sector reform proposal which, once transformed into a policy project, has served to aggregate certain political and social forces.     

A review of UK housing policy: ideology and public health

OBJECTIVES: The aim of this paper is to review UK public health policy, with a specific reference to housing as a key health determinant, since its inception in the Victorian era to contemporary times. REVIEW: This paper reviews the role of social and private housing policy in the development of the UK public health movement, tracing its initial medical routes through to the current socio-economic model of public health. The paper establishes five distinct ideologically and philosophically driven eras, placing public health and housing within liberal (Victorian era), state interventionist (post World War 1; post World War 2), neoliberal (post 1979) and "Third Way" (post 1997) models, showing the political perspective of policy interventions and overviewing their impact on public health. The paper particularly focuses on the contemporary model of public health since the Acheson Report, and how its recommendations have found their way into policy, also the impact on housing practice. CONCLUSIONS: Public health is closely related to political ideology, whether driven by the State, individual or partnership arrangements. The current political system, the Third Way, seeks to promote a sustainable "social contract" between citizens and the State, public, private and voluntary organizations in delivering community-based change in areas where health inequalities can be most progressively and successfully addressed.     

Global Health Watch Canada? Mobilizing the Canadian public health community around a global health advocacy agenda

Growing poverty, collapsing health care systems, the AIDS pandemic and the widening of health and health care inequities within and between countries all point to the limited success of global public health interventions over the past few decades. Notwithstanding the efforts of multilateral agencies such as the World Health Organization and the many existing contributions from the Canadian community of health professionals, this commentary argues and appeals for further action particularly in relation to the social and political impediments to better health and justice. Specifically, it calls for the development of a robust instrument to assess the impact of Canada as a whole on the state of global health, and to monitor the performance of key Canadian institutions. It is suggested that such an instrument would result in a process that enhances global citizenship and public accountability, and buttresses the efforts of civil society to forge trans-national links in pursuit of a fairer and healthier world. Public health professionals, by virtue of their social standing as well as the nature and tools of their discipline, should be at the forefront of such civic efforts.     

Innovation and technology for global public health

Abstract Recent decades have been marked by the explosive development of innovative scientific, technological and business products and processes. Despite their immense impact on health globally, little has been accomplished in the field of global public health to incorporate, address and harness such innovations in practice. In order to meet the world's growing health needs, it is essential that global public health accepts and adapts to these innovations. Moreover, such innovations must be implemented equitably in ways that will best serve their intended recipients, without deepening health- and access-related disparities. This article will briefly discuss the wide array of technologies in the pipeline that will affect global public health practice, their impact on the field and on populations and the issues facing the field in adopting these innovations.     

Reinventing public health: a new perspective on the health of Canadians and its international impact

STUDY OBJECTIVE: To examine the Canadian origins of the Lalonde Report and its impact on British and American health promotion activities. DESIGN: A brief history of the development of key Canadian documents and their use by politicians and public health activists in the United Kingdom and United States. SETTING: This paper focuses on the impact of the Canadian model on Canada, the United Kingdom and United States. MAIN RESULTS: This paper argues that internal political and economic forces are as important as international trends in determining healthcare policy initiatives. CONCLUSIONS: In the 1970s all the English-speaking developed nations were facing deficits as curative costs rose. Adopting health promotion policies permitted them to shift responsibility back to local governments and individuals while limiting their expenditures. Health and community activists, however, used this concept to broaden their focus to include the social, economic and political determinants of health and thus reinvented public health discourse and practice for the 21st century.     

The Cuban experience in public health: does political will have a role?

The role of political will in public health has been largely ignored. In Cuba, however, for the past 50 years, political will has been the ultimate, encompassing intersectoral action in public health. The excellent achievements in population health in Cuba during these 50 years have been widely recognized. Researchers have sought to explain this "Cuban paradox" by focusing on a large array of public health factors, including health promotion, primary care activities, and intersectoral action on health determinants. These factors constitute necessary but not sufficient conditions to achieve good health outcomes. This article defines political will and uses the experience of Cuba to illustrate the potential role of political will in public health. The authors suggest a framework for the evaluation of political will aimed at achieving good health, examining the "Five R's of political will," five observable features that may provide systematic information on the direction and realization of political will: (1) renewal of commitment, (2) reform of the system, (3) resource development, (4) review of performance, and (5) responsible management. These five features focus the spotlight on the consistency between health goals and public discourse and action.     

Skirting the issue: women and international health in historical perspective

Over the last decades women have become central to international health efforts, but most international health agencies continue to focus narrowly on the maternal and reproductive aspects of women's health. This article explores the origins of this paradigm as demonstrated in the emergence of women's health in the Rockefeller Foundation's public health programs in Mexico in the 1920s and 1930s. These efforts bore a significant reproductive imprint; women dispensed and received services oriented to maternal and childbearing roles. Women's health and social advocacy movements in Mexico and the United States partially shaped this interest. Even more important, the emphasis on women in the Rockefeller programs proved an expedient approach to the Foundation's underlying goals: promoting bacteriologically based public health to the government, medical personnel, business interests, and peasants; helping legitimize the Mexican state; and transforming Mexico into a good political and commercial neighbor. The article concludes by showing the limits to the maternal and reproductive health model currently advocated by most donor agencies, which continue to skirt--or sidestep--major concerns that are integral to the health of women.     

Women's health and the mass media: The reporting of risk

News about women's health risks is prevalent in the mass media, and how that news is presented is important for the women who uses it to make decisions about her health. Conferees at a Jacobs Institute symposium reviewed the presentation and discussion of risk factors in scientific articles and the subsequent translation of this information by the media to their consumers. The symposium participants made four major recommendations to improve the reporting of risk: 1) as information sources, the scientific community, institutions, and media organizations should share the responsibility of clearly presenting information on risk factors affecting women's health, 2) institutional public affairs officers, journal public affairs officers, and mass media editors should require that reports on single studies be placed within the context of current scientific knowledge, with limitations prominently described, 3) measures of absolute and relative risk should be interpretable by a general audience, and 4) news makers (the scientific community) and news writers (reporters and editors) should have more training opportunities to achieve a clearer understanding of the constraints on the news media and the limitations of science.     

Globalisation and global health governance: Implications for public health

Abstract Globalisation is a defining economic and social trend of the past several decades. Globalisation affects health directly and indirectly and creates economic and health disparities within and across countries. The political response to address these disparities, exemplified by the Millennium Development Goals, has put pressure on the global community to redress massive inequities in health and other determinants of human capability across countries. This, in turn, has accelerated a transformation in the architecture of global health governance. The entrance of new actors, such as private foundations and multi-stakeholder initiatives, contributed to a doubling of funds for global health between 2000 and 2010. Today the governance of public health is in flux, with diminished leadership from multilateral institutions, such as the WHO, and poor coherence in policy and programming that undermines the potential for sustainable health gains. These trends pose new challenges and opportunities for global public health, which is centrally concerned with identifying and addressing threats to the health of vulnerable populations worldwide.     

A critical examination of the health promoting prison two decades on

Two decades since the WHO Regional Office for Europe outlined and published a report on health promotion in prison, which stimulated further debate on the concept of the ‘health promoting prison’, this paper discusses the extent to which the concept has translated into practice and the extent to which success has been achieved. This paper primarily focuses on why there has been a gap between the strategic philosophy of health promotion in prison and practical implementation, suggesting that factors such as ‘lifestyle drift’ and public and political opinion have played a part. A further argument is made in relation to the overall commitment of European countries and more broadly WHO in their support of settings-based health promotion in this context. It is proposed that there has been a weakening of commitment over time with a worrying ‘negative trajectory’ of support for health promoting prisons. The paper argues that despite these challenges, the opportunities and potential to address the needs of those who are often most vulnerable and excluded is colossal and acting to tackle this should be a greater priority.