Health Action Zones Research Articles

Interprofessional working in Health Action Zones: how can this be fostered and sustained?

This view from the 'frontline' examines what is needed to underpin interprofessional collaboration in the new Health Action Zones (HAZ). Successful joint working in the Luton HAZ has required continuing commitment at all levels, time and other resources. The agencies involved need to create an environment of low-competition and high involvement, one that rewards innovation where risk-taking is supported by senior management. They seek measurable outcomes without being obsessed with attribution.

Health promotion in the medical curriculum: enhancing its potential

The medical profession has a central role in contributing to public health. An expanding role for doctors in terms of health is clearly indicated by their anticipated contributions to health improvement programmes, primary care groups, healthy living centres and health-action zones. These initiatives all require doctors to contribute to planning health promotion activities for local populations. It is timely with the recent publication of the Government's public health strategy Saving Lives-Our Healthier Nation to consider how best to integrate health promotion into medical education. This paper outlines key issues that underpin sound health promotion practice. These areas are equity, effectiveness and collaborative working. Evidence from the literature, research, policy and practice is used to demonstrate how these areas could be integrated appropriately into the medical curriculum. A series of vignettes is presented for teachers to use to enhance the effective delivery of health promotion for medical students.

Health action zones: improving the health of older people

On 25 June 1997 at the NHS Confederation Annual Conference, the Secretary of State for Health announced his intention to establish a number of Health Action Zones (HAZs). These would be pilot projects whose aim would be ‘to explore mechanisms for breaking through current organisational boundaries to tackle inequalities, and deliver better services and better health care, building upon and encouraging co-operation across the NHS’ (DH 1997/145). Health action zones are expected to be ‘trailblazers’; pioneering innovative approaches to improving health. They are part of a family of area-based initiatives introduced by the Labour government. The three broad strategic objectives of HAZs are: to identify and address the public health needs of the local area; to increase the effectiveness, efficiency and responsiveness of services; to develop partnerships for improving people’s health and relevant services, adding value through creating synergy between the work of different agencies. In October 1997, health authorities in England were invited in conjunction with local authorities and other agencies to submit bids to become Health Action Zones. Forty-one bids were received by the Department of Health. From these, Health Action Zone status was granted to 11 areas from April 1998. Of those areas not selected in the 1st wave, a number were asked to submit further applications, and 15 more areas were granted HAZ status from April 1999. HAZs have a mandate to develop programmes to improve the health of their general populations. Within this mandate however, they have considerable flexibility concerning the areas, services or population groups they target. It is thus worth posing the question: To what extent have Health Action Zones chosen to focus on improving the health of older people? We begin to address this question in three ways, by: Detailing some of the diversity of HAZs by describing their characteristics. Outlining to what extent HAZ programmes and activities focus on older people. Providing two examples of HAZs who are developing programmes specifically aimed at improving the health of older people.

EMB3/389: Information Systems for Evidence-based Healthcare: status, issues and perspectives

IntroductionIn the United Kingdom, the National Health Service (NHS) has embarked on the formation of health action zones for the delivery of good quality community-centric healthcare. It is recognised that the evidence-based healthcare practice is critical in this venture, and the optimistic projection is that community-centric healthcare encompassing medical, dental, nursing, health visiting, optical and pharmaceutical services will be brought under the evidence-based healthcare practice framework. The evidence-based medicine and its practice in its 'first wave' with its six steps provided a paradigm shift in the clinical practice by integrating experiential and external evidence with clinical practice to arrive at clinical decisions and establish disease management framework. The internet was rightly considered as the key player in the evidence-based healthcare practice. The shortcomings of this global system has constrained the wide-spread application of the evidence-based practice.MethodsWe will first take an in-depth look at the relevance, quality and accessibility issues, by presenting examples from respiratory and metabolic disease domains, particularly from the classes of paediatric metabolic disorders. While analysing the information presented, we will also assess to what degree the information needs of clinicians as well as patient/home-carers are met. We will examine what is required in terms of structure, protocols, information storage and access to meet the two often disparate needs.ResultsWe will argue that the information should be in a form that enables their effective assimilation thereby enhancing the usage of the evidence-based practice. Concepts of componentware, model-based information- bayesian causal graphs will presented with examples. Examples of emerging database implementations will be referred to in these examples. Our on-going research work on MEDINFONET, and models of domain-specific software agents for knowledge management will be presented.DiscussionThe service-centric model of the next generation internet presents a bright perspective. From the evidence-based healthcare practice point-of-view, its differential service (diff-serv) facility with emphasis on classes of services will largely meet the speed of access requirement. The 'object web' with data integration facility, digital libraries, domain-specific search agents etc.. will provide a better information quality. We argue that models and metrics for information systems and its environment are needed, and in this connection present a five-layer maturity model for evidence-based healthcare practice.

Joining up care in London—establishing the North Southwark Primary Care Group

This is the second of four articles showing how primary care groups have been set up in various areas in Britain The shadow board of the North Southwark Primary Care...

Managing the future in Bradford

This is the first of four articles showing how primary care groups have been set up in various areas in Britain This paper describes the processes and experiences of key...

Primary care groups will have to be good at this, and that and the other.

Functions of primary care groups (PCG) should be considered ahead of structures and those forming PCGs need to see the links between the key health and social policy initiatives. Early influence by PCGs will shape the design and local implementation of health action zones, health improvement programmes and performance frameworks. The Green Paper "Our Healthier Nation" and its successor are central to the emerging role of PCGs. Partnership work between GPs, practice staff, trusts, local authorities and health authorities needs emphasis. Recognition of what people and existing organisations can contribute needs to be given. Leadership themes of good primary care operations, health development and clinical leadership or their equivalents need time and space to emerge.

Magnetic resonance imaging to assess familial risk in relatives of women with endometriosis

In places where the population has shrunk, the average mortality is high compared with places in which the population has grown. The correlation between population change and all-cause standardised mortality ratios was –0·62 (p<0·001); for standardised mortality ratios for the male population, the correlation was –0·68 (p<0·001); and for the female population was –0·50 (p<0·001). All correlations were weighted by population size in 1991, but weighting made little difference to the findings. Analysis of male and female cause-specific mortality showed strong correlations between population change and most broad cause-of-death groups (accidental deaths excepted). To investigate whether the relation between population change and mortality merely reflects differences in degree of deprivation, we calculated partial correlations between allcause standardised mortality ratios in men and women together and population changes between 1971 and 1991, controlling for the proportion of the population in social classes IV and V or with unclassified social class in 1991. The correlation was weakened but remained substantial at –0·49 (p<0·001). Finally, we found the correlations between population change between 1971 and 1991 and change in standardised mortality ratio during 1969–73 and 1990–92 to be –0·37 (p<0·001), which suggests that change in population size and change in mortality accompany each other. Although most studies have tended to focus on economic factors (work and wages), people also move to improve their physical and social environment. The quality of life factors include issues such as cost of living, the image and ambience of a place, available amenities and services, notions of community, crime, pace of life, degrees of pollution, healthcare provision, and quality of housing. 2–4 These factors are thought to underlie differences in health statuses between areas, but they are not adequately indexed by conventional measures of deprivation. The people who remain in shrinking areas need environmental improvement and health services. At present, resources are allocated largely according to population size, and local and health authority budgets have therefore fallen most in these shrinking areas over time. New funding arrangements, such as health action zones 5 will not reverse this trend.

The Government's New Employment Agenda: Implications for Mental Health Service Managers

This article proposes a new engagement between mental health services and the social inclusion and employment agendas that are a core part of the Government's programme. Initiatives such as Welfare to Work, New Deal and health action zones are explained, and suggestions are made about some of the opportunities they present for improving mental health services and the lives of service users.

Education and health inequalities Input Paper 10 to the Independent Inquiry into Inequalities in Health, January 1998

The available evidence suggests that there are important links between educational inequalities and concurrent and subsequent health inequalities. Much of the literature further indicates that these inequalities are cumulative in their effect over the life course of individuals, families and communities. This evidence, drawn from UK and international studies, suggests that any attempt to tackle health inequalities through educational interventions needs to be conceived as part of a broader medium‐ to long‐term project. It would also need to involve local communities, as well as collaboration between agencies, in order to build up the social capital that the research suggests contributes to positive educational and health outcomes. The paper includes some policy recommendations, which the research suggests could make a significant contribution towards the reduction of inequalities in health. These priorities for intervention, which should initially be targeted towards areas of greatest disadvantage, involve the continued development of high quality community‐oriented pre‐school provision to meet the particular needs of disadvantaged communities; the further development of health education in schools within a wider institutional structure of health promoting/healthier schools; and better co‐ordination between health, education and other services, for example within the currently proposed Health and Education Action Zones.

From collaboration to commissioning: developing relationships between primary health and social services

Since the publication in 1989 of the white paper, Caring for People , the benefits of collaboration between primary health and social services have been emphasised—albeit with little guidance on...

Public Services under New Labour: collaborative discourses and local networking

A by-product of the fragmentation of services that occurred at local government level under the Conservative Government was the emergence of networks and other forms of joint working. These became formalised particularly through various economic and urban regeneration schemes. But elsewhere they were often an ad hoc response to the changing local governance structures. The election of the Labour Government in 1997 has, this article contends, seen the emergence of a more collaborative discourse in which networking and partnership are the intentional outcomes of many of the central government's policy initiatives, including the Education and Health Action Zones and the Social Exclusion Unit. This collaborative discourse is founded on a perception of the importance of trusting, mutually beneficial relationships, as distinct from adversarial, low trust relationships, to achieving central government aims and objectives. Based on interviews with local authority Leaders and Chief Executives, and other 'elite' actors, the article explores how well local authorities are responding to the challenges and opportunities that these policy initiatives will bring both with regard to internal structures and decision making processes, as well as to the role of the local authority in local governance networks.

Health action zones are up and running

Health action zones are up and running

Action stations.

Health Action Zones are central to the government's health strategy. Rosemary Cook explains what they are

Health Action Zones: Towards a Paradigm Shift in Health and Health Care?

This Paper Looks at Health Action Zones, to be established from April 1998 with the intention of moving towards prevention of illness and promotion of health. It suggests how localities could begin to conceptualise a programme of work, and warns of some of the difficulties they may meet.

Health action zones to kick off in April

Health action zones to kick off in April