Health White Paper Research Articles

Searching for social capital: historical perspectives on health, poverty and culture

Social capital has been seen as having a positive effect on health, and the concept of social capital has been viewed as of central importance to debates about healthy, sustainable communities. More generally, behaviour and its relationship with health has become much more central to policy-making, as illustrated in the Choosing Health White Paper (2005), and the concept of social capital has been one influence on the concept of social exclusion. Robert Putnam's arguments, both those expressed in Making Democracy Work (1993) and the revised version seen in Bowling Alone (2000) have been taken up by numerous social scientists and policy-makers. But despite the explicitly historical perspective that Putnam employs in Bowling Alone in particular, the history of social capital remains rather neglected in the available literature. This article is concerned with providing a historical perspective on social capital, especially the ways in which social investigators have viewed the relationships between health, poverty and behaviour. The article puts social capital alongside that of 'underclass' concepts such as the culture of poverty thesis, and examines how the latter has been invented and reinvented in the U.K. and the U.S.A. over the last 120 years. It argues that there are important similarities between the culture of poverty and social capital, but also significant differences, and these have implications for current policy initiatives. One way of analysing concepts like social capital and social exclusion more rigorously is by locating them within this longer-term history of social investigation, in which debates about health, poverty, and culture have been of

What does social enterprise mean for community nursing?

The concept of social enterprise has gained currency since the publication of the health white paper "Our Health, Our Care, Our Say" (Department of Health, 2001). Social enterprise is a way of introducing competition into health-care provision without focusing on extracting maximum profit, since in most cases any profits are reinvested into the enterprise. Rosemary Cook takes a look at the thinking behind social enterprise, its potential role in the NHS and what is could mean for community nursing.

Medical students' attitudes to Modernising Medical Careers: will it affect training or career choice?

August 2005 was a landmark in medical education in the UK as this is when the changes suggested in the 2004 Department of Health white paper Modernising Medical Careers (MMC) were implemented. MMC is a bold attempt to address the conflicting demands of the European Working Time Directive, the educational needs of junior doctors, and quality service delivery to patients.

How does policy learn from pilots?

In November 2004, the Department of Health (DH) published its public health white paper ‘Choosing Health: Making Healthier Choices Easier’ (DH 2004) following an extensive consultation to generate ideas for policy on how best to improve the health of the population and reduce inequalities in health.

Alcohol misuse: Positive response. Alcohol Health Work for every acute hospital saves money and reduces repeat attendances

Alcohol misuse: Positive response. Alcohol Health Work for every acute hospital saves money and reduces repeat attendances

The terms and conditions of conditional benefits

The volume of paper emanating from Whitehall in recent weeks has been considerable. Hot on the heels of the health and social care white paper came, from its neighbour in Richmond House, the green paper on benefit reform (DWP 2006).

White paper.

The publication last month of the Department of Health's white paper on improving community health is set to spur on changes in emergency care provision, delegates heard.

The new health strategy is full of promise

There hasn’t been time to digest the latest long-anticipated health white paper on community health services in England – Our health, our care, our say: a new direction for community services – and I will return to it again in the future. From the deluge of press releases in my email inbox it seems to have struck a chord with some organizations, while proving a grave disappointment to others.

Second-hand smoke levels in UK pubs and bars: do the English Public Health White Paper proposals go far enough?

The English Public Health White Paper proposes introducing smoke-free workplaces except in pubs and bars that do not prepare and serve food. The bar area will be non-smoking in exempted pubs. To explore the likely impact of these proposals in UK pubs and bars. A total of 59 pubs and bars within Greater Manchester in 2001 were chosen. Thirteen were mechanically ventilated, 12 were naturally ventilated and 34 had extractor fans; 23 provided non-smoking areas. We measured time-weighted average concentrations of respirable suspended particles (RSP), solanesol tobacco-specific particles and vapour-phase nicotine (VPN) over a 4-h sampling period on a Tuesday or Saturday night. Second-hand smoke (SHS) levels in smoking areas were high (mean RSP 114.5 microg/m3, VPN 88.2 microg/m3, solanesol 101.7 microg/m3). There were only small (5-13 per cent) reductions in bar areas. Mean levels were lower in non-smoking areas: by 33 per cent for RSPs, 52 per cent for solanesol particles and 69 per cent for VPN. Compared with other settings (homes and other workplaces) with unrestricted smoking, mean SHS levels were high throughout all areas of the pubs regardless of ventilation strategy. Partial measures, like those in the English Public Health White Paper, will leave bar staff in exempted pubs unprotected from the occupational hazard of SHS.

Not another smoking survey! Healthy public policy and the need for local information

The development and implementation of healthy public policy has been a central concern of health promotion. The following paper details a study examining local opinion concerning the implementation of national guidelines into local policy regarding banning smoking in enclosed public places following the publication of the UK government's Public Health white paper. The aim of the study was to determine public opinion regarding the acceptability of banning smoking in public areas and the views of major stakeholders in the region. A public opinion survey was conducted with 859 people and semi-structured telephone interviews were held with 32 stakeholders. The study found that there was consistent support, amongst both the general public and the stakeholders, for banning smoking in public places. It also determined that stakeholders found the proposals of the Public Health white paper unclear and therefore difficult to implement. The paper concludes that a variety of support is needed for local policy implementation and makes suggestions for doing so, locating ideas within the literature.

Commentary: What's past is prologue

Hu G, Tuomilehto J, Silventoinen K, Barengo NC, Peltonen M, Jousilahti P. The effects of physical activity and body mass index on cardiovascular, cancer and all-cause mortality among 47212 middleaged Finnish men and women. Int J Obes Relat Metab Disord 2005;29:894–902. 3 Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005;293:1861–67. 4 Preston SH. Deadweight?—The influence of obesity on longevity. N Engl J Med 2005;352:1135–37. 5 Wareham NJ. The effectiveness of interventions aimed at weight loss, and other effects of diet and physical activity in achieving control of diabetes and preventing its complications. In: Williams R, Herman W, Kinmonth A-L, Wareham NJ (eds). The Evidence Base for Diabetes Care. Chichester: Wiley, 2002. pp. 355–87. 6 Sorensen TI, Rissanen A, Korkeila M, Kaprio J. Intention to lose weight, weight changes, and 18-y mortality in overweight individuals without co-morbidities. PLoS Med 2005;2:171. 7 Ryan DH, Espeland MA, Foster GD et al. Look AHEAD Research Group. Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials 2003;24:610–28. 8 Snow V, Barry P, Fitterman N, Qaseem A, Weiss K. Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2005;142:525–31. 9 Blackburn GL. Solutions in weight control: lessons from gastric surgery. Am J Clin Nutr 2005;82 (Suppl. 1):248S–252S. 10 Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr 2005;82 (Suppl. 1):222S–225S. 11 Hardeman W, Griffin S, Johnston M, Kinmonth AL, Wareham NJ. Interventions to prevent weight gain: a systematic review of psychological models and behaviour change methods. Int J Obes 2000;24:131–43. 12 Wareham NJ, van Sluijs EM, Ekelund U. Physical activity and obesity prevention: a review of the current evidence. Proc Nutr Soc 2005;64:229–47. 13 Blackburn GL, Walker WA. Science-based solutions to obesity: what are the roles of academia, government, industry, and health care? Am J Clin Nutr 2005;82 (Suppl. 1):207S–210S. 14 Wrigley N, Warm D, Margetts B. Deprivation, diet and food retail access: findings from the Leeds Food Deserts’ study. Environ Plan A 2003;35:151–88. 15 Department of Health. Choosing health: making healthy choices easier. Public Health White Paper. 2004.

Viewpoint: The liveability agenda: new regionalism, liveability and the untapped potential of sport and recreation

In recent years the relationship between sport and strategic planning has grown in importance as both the economic and social benefits of hosting major sporting events and developing sporting infrastructure have increasingly permeated policy making agendas and funding regimes at local, regional and national levels. Additionally, in Britain a great importance is now being placed upon developing a strategic agenda for sport and its implications for the development of sustainable communities, liveable places and healthier populations. Sports policy in Britain, which traditionally focused upon the dual strands of increasing participation and raising performance levels, has begun to shift towards viewing the potential benefits and impacts of sport in more holistic and cross-cutting ways. This has been expressed in relation to urban and rural renaissance, neighbourhood renewal, health, crime prevention and quality of life agendas. It has also been highlighted in policy statements - for example, through A Sporting Future for All (2000) and later Game Plan - a strategy for delivering Government's sports and physical activity objectives (2002), the Social Exclusion Unit's Policy Action Team 10 Report on Arts and Sport (2001) as well as in a number of Planning Policy Guidance notes and the new Planning Policy Statement 11 (PPS 11) on Regional Spatial Strategies in England - all of which explicitly attempt to develop the untapped potential of sport and recreation to contribute to emerging planning policy. This can be articulated in a number of ways. First, the urban and regional impacts of hosting major sporting events or building new sports stadiums have received widespread attention. In particular, given the level of investment involved and the potential to master-plan large areas of brownfield land, the legacy impacts of the 2002 Commonwealth Games in Manchester and the envisioned regenerative impacts of the London 2012 Olympic bid have become highly politicised. Secondly, the links between the ways in which cities are designed and long-term health problems associated with inactive lifestyles are generating a good deal of policy interest. This is often expressed as a growing concern about the development of so-called 'obesogenic' urban environments and has prompted research about the relationship between urban design, public health and physical activity (Sui, 2003). The issue was recognised by the British government in Game Plan (2002) which outlined the links between physical activity, health, education, criminality, drug abuse and overall quality of life. Moreover, the recent Public Health White Paper (2004) makes clear that the British population is more obese and less active than previous generations, leading to calls for increased opportunities and access to sports facilities. There is also an economic imperative to improve the health of the nation as it is estimated that the lack of physical activity costs the English economy over £2 billion per annum. Thirdly, the continuing loss of playing fields and community recreational facilities, which reduces access to physical activity, is seen as problematic. The reworked Planning Policy Guidance Note (PPG) 17 encourages local authorities to audit existing sport and recreational facilities and set these out in a strategic way. It also emphasises that local authority planning decisions must take into account the impact of any loss of community open space or recreational facilities and offer appropriate compensation. In particular, Sport England, the strategic body primarily responsible for delivering the government's sporting objectives, has called upon strategic planning authorities to use such a system to influence the future provision and funding of sport more positively as well as levering in higher levels of investment associated with new development through enhanced developer contributions. In short, PPG 17 seeks to protect playing fields and open space as well as give sports policy a strategic voice in future planning, arguing that sport and recreation are essential in implementing broader government policies. …

Choosing mental health: a response to the government white paper

Choosing Health is the first government public health white paper since Saving Lives: Our Healthier Nation, published in 1999. It aims to make the NHS ‘a health service, not a sickness service,’ and is strongly influenced by the Wanless reports. This paper presents a critical review of the main elements of the white paper that relate to mental health, and sets out the actions that policy makers and service delivery organisations need to take to build genuinely mental health promoting public services within a mentally healthy society.

UK - Royal College of Psychiatrists’ response to Public Health White Paper – Mental illness is different from physical illness

UK - Royal College of Psychiatrists’ response to Public Health White Paper – Mental illness is different from physical illness

A review of the Public Health White Paper – Choosing Health: making healthy choices easier

A review of the Public Health White Paper – Choosing Health: making healthy choices easier

D-day for mental health.

THERE COULD be no better time for a review of mental health nursing. It is 11 years since the last one, which in itself suggests change must be overdue if professional practice is to keep pace with health service reforms. As the largest professional group in mental health care, nurses will be relied on to deliver the reforms outlined in the Mental Health Bill, as well as the measures to improve race equality in the service. Nurses will also be promoting good mental health as outlined in last autumn's public health white paper. All these initiatives can only benefit from the chance to take stock.

Eat, drink and be merry – but only in moderation

As the festive season approaches, the old saying ‘eat, drink and be merry’ comes to mind. However, the launch of the recent public health White Paper Choosing Health (DoH 2004) reinforces that we should eat sensibly and drink in moderation. The White Paper represents a significant step forward from previous government strategies on public health, and signals a reassuring shift in focus towards greater health promotion and protection by our health services. It starts to address the role and responsibilities of the food and drink industry in tackling the obesity epidemic and, if the strategies are effective, ultimately, this could impact the complications that result from wide-spread overindulgence (diabetes being an obvious example) in society.

More than White Papering over the cracks

After months of expectation, the public health white paper, Choosing Health, was published in November and prompted widespread debate and discussion. The debate, for the most part, focused on just a few aspects of the paper – on its proposals for limited bans on smoking and its approach to the food industry.

Public health white paper spells out long-term disease management role of community matrons.

Ministers have spelled out their plans to make community based senior nurses central to delivering their public health agenda.

Pollution and poverty real threats to public

The public health White Paper was finally released on 6th July under the optimistic title Saving Lives (Department of Health [DoH], 1999). The problem is that it is far from clear how many lives this raft of legislation will save and, more disturbingly, the beginnings of a political argument over whether those it is intended to help really deserve it.