Shaping Health Policy Research Articles

The Third World Kidney Day: Looking Back and Thinking Forward

The Third World Kidney Day: Looking Back and Thinking Forward

Venous thromboembolism: a need for more public awareness and research into mechanisms.

Articles in this Series: Heit J. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol. 2008;28:370-372. Moll S. A clinical perspective of venous thromboemobolism. Arterioscler Thromb Vasc Biol. 2008;28:373-379. Gross P and Weitz J. New anticoagulants for treatment of venous thromboemobolism. Arterioscler Thromb Vasc Biol. 2008;28:380-386. Wakefield TW, Myers DD, Henke PK. Mechanisms of venous thrombosis and resolution. Arterioscler Thromb Vasc Biol. 2008;28:387-391. Link RP. National heart, lung, and blood institute programs for deep vein thrombosis. Arterioscler Thromb Vasc Biol. 2008;28:392-393. Beckman MG, Critchley SE, Hooper WC, Grant AM, Kulkarni R. CDC division of blood disorders: public health research activities in venous thromboembolism. Arterioscler Thromb Vasc Biol. 2008;28:394-395. Fenninger R. Patient advocacy to promote public awareness about thrombosis and thrombophilia. Arterioscler Thromb Vasc Biol. 2008;28:396-397. Hunt BJ. The awareness and politics of venous thromboembolism in the United Kingdom. Arterioscler Thromb Vasc Biol. 2008;28:398-399. In 2005, the US Senate declared March as deep vein thrombosis (DVT) awareness month in the United States to increase the American public’s understanding of deep vein thrombosis.1 This was triggered by the death of 39-yr-old David Bloom, a National Broadcasting Company (NBC) reporter who died on April 6, 2003 from a massive pulmonary embolism (PE), and the activities of his widow, Melanie Bloom.2 Two days before his death David Bloom had developed cramping leg pain that was not recognized as a DVT2—leg DVT was only found postmortem. He had several risk factors for DVT and PE (collectively called venous thromboembolism [VTE)]): (1) prolonged immobility (working and sleeping in a cramped position in a tank in the war in Iraq); (2) long distance flights between the US and Kuwait, (3) dehydration, and (4) postmortem the discovery that he was heterozygous for the prothrombotic variant of factor V called factor V …

Iris Borowy and Wolf D Gruner (eds), Facing illness in troubled times: health in Europe in the interwar years, 1918–1939, Frankfurt am Main and New York, Peter Lang, 2005, pp. xiv, 424, £41.90 (paperback 3-631-51948-6).

“Troubled times” seems a bland summary of the interwar years, and experts—statisticians, scientists and doctors—rather than individual or collective sufferers are “facing illness” in this volume. That said, this is an informative collection with a comprehensive introduction worth further expansion. The editors highlight the ambiguities surrounding health as a public issue in this period, with the repositioning of voluntary and charitable effort and increasing state involvement suggesting responsibility for individuals but exercising authority over them. Health matters took on greater significance in the formation and conceptualization of nations; integrating or excluding, helping to define borders and to forge identities. They were the focus of new and influential international bodies (notably the League of Nations Health Organisation, and the Rockefeller Foundation) and of scientific expertise, with developments in bacteriology, nutrition, eugenics, and social medicine interacting with contending political viewpoints. A healthy citizenry featured in varied ideologies offering “the promise of empowerment and uplift which included the option not only of a new position for the common man but of a new man per se, strengthened by improved education and status and significantly improved health” (p. 7). Differing interpretations of health, seen here as “neither an objective reality, nor a cultural construction but a synthesis of both” (p. 8), require allowance for conceptualization and contextualization by contemporaries and by historians. This involves the interaction of problem-laden objectification of certain “realities” and of their political, social or ideological usage. Most contributors are content to focus upon data or policy issues, however, and the book divides along these lines. Part One needed a summary of changes in mortality in European countries, as this cannot be established from individual chapters. Robert Lee's examination of causes of mortality, specifically defects in the quality of data and the limited implementation of an international classification system, demonstrates that “more” did not necessarily mean “better” in data provision. Mortality is a poor approximation for health and Paul Weindling reviews studies based on insurance, school and family records, and efforts to quantify morbidity and to utilize health indicators. Iris Borowy also evaluates problems surrounding the compilation and use of the League of Nations' International Health Yearbooks (1924–9) for comparative purposes. Central and south-eastern Europe, where health featured strongly in nation building, are well-represented. Hana Masova and Petr Svobodný survey health care in the new Czechoslovak Republic and the awkward combination of public health arrangements, an established sickness insurance scheme, and voluntary and state institutions with interests in social medicine. They see inclusionary innovations in social hygiene (combating “civilisation diseases”) and hospital provision before the Munich Agreement and subsequent invasion. Yugoslavia suggests contrasting interpretations. Željko Dugac focuses upon Andrija Stampar, at the Ministry of Health and working closely with the Rockefeller Foundation, who ascribed a pivotal role to public health and health education but was removed in 1931 by self-interested private physicians and ethnically-motivated anti-centralisers. Patrick Zylberman's study of the anti-malarial campaign in Macedonia depicts this as a form of border consolidation and “Serbianisation”, whereas Esteban Rodriguez-Ocana's parallel Spanish study suggests the limitations of international bodies and new medical technologies when faced by suspicious local physicians and powerful, unsympathetic landowners. Thorsten Halling, Julia Schafer and Jorg Vogele consider German infant mortality in the contexts of the epidemiological transition and of attempts to measure “human capital” assets (or, on racial or eugenicist grounds, liabilities). Sylvelyn Hahner-Rombach's examination of depictions of TB sufferers as “anti-social” is germane to this, though her comparison of medicine and scientific discourse with earlier social labelling of such “threats” seems compartmentalized. A disturbing parallel may lurk in the influence of Zionist ideology and the medical selection of Jewish migrants to Palestine, discussed by Nadav Davidovitch and Shifra Shvarts. Generally the approach is “top-downwards” in national or local studies, with some privileging of doctors, scientists or institutions as principal actors shaping health policy or medical campaigns (Lion Murard on Jaques Parisot in Nancy or Emilio Quevedo on the Rockefeller Foundation and the London School of Hygiene and Tropical Medicine). However Martin Gorsky and Bernard Harris build on James Riley's work, using Hampshire Friendly Society records to suggest that rising claim rates were driven by an ageing population, specifically the over-fifties. This offers a rare glimpse of ordinary people facing illness in a none the less valuable and informative collection.

INR continues to grow

Welcome to the first issue for 2007. We offer you a special, extended issue to mark the ICN conference to be held in Yokohama, Japan in May. We welcome a Guest Editorial by ICN President Dr Hiroko Minami on the theme ‘Nurses at the Forefront: Dealing with Unexpected’. The first two articles in this issue also are on the conference theme. One analyses Iranian nurses’ responses to the Bam earthquake in 2003, and the second explores nurses’ role in the psychosocial responses needed in emergency situations. The remainder of the articles cover a diversity of nursing issues and represent submissions from 10 countries, some covering cross border themes. The international scope and variety of content are indicators of the journal’s success since the International Nursing Review (INR) became peer-reviewed in 2000. More articles will be published in 2007 as the number of pages has been increased yet again. Many nursing authors will also welcome the news that INR has been included in the Institute of Scientific Information (ISI) Journal Citation Report (JCR). INR will receive its first impact factor in 2007, which will be released in mid 2008 by ISI. So every article published in INR from 2005 onwards will contribute to the JCR annual impact factor. The details of this process can be found in Professor Megan-Jane Johnstone’s article (written before the news of INR’s inclusion) on ‘Journal impact factors: implications for the nursing profession’ (page 35). Professor Johnstone sounds a welcome note of caution when she points out that the impact factor was originally developed for very different purposes than it is used for today. She also argues that its use as a quality indicator for nursing scholarship has threatened to place ‘in jeopardy the sustainability and hence viability of many nursing journals and academic texts’ by encouraging nurses to publish only in ‘elite’ journals. Elitism is the polar opposite of INR’s philosophy. To reiterate once again extracts from the journal’s Aims and Scope: ‘INR focuses on original articles that help to forward the International Council of Nurses’ mission world-wide by representing nursing, advancing the profession and shaping health policy. INR encourages nurses to describe their work and to document their experience and research, and to submit articles that reflect the ICN values of flexibility, inclusiveness, partnership, achievement and visionary leadership.’ INR authors are also encouraged to ‘explore beyond local or national interests to the more general, global application of the principles underlying their work’. As Editor I am grateful to those authors who previously have considered INR as a publishing venue for their work and who have submitted so many lively and informative articles. I also deeply appreciate the support and advice given by our many excellent reviewers. I have no doubt that INR is widely read. In 2005 (the last year that information was available) INR online scored 80,500 ‘hits’; up four fold from 2002. I trust that INR’s future inclusion in the annual impact factor list is an indicator of the value placed internationally on the types of articles published in the past, and which we intend to publish more of in the future.

Influencing Holistic Health Policy

Beliefs that health policy-making is an inherently ‘ideological’ or ‘irrational’ process appear to have worked to prevent researchers from developing better understandings of the kind of evidence that does work to influence policy. Without a model of policy-making that positions policy decision-makers as capable of being informed by specific forms of evidence that speak to policy contexts, it is difficult for research to begin to shape health policy. Recent years have seen the development of a research industry that focuses on developing and describing research approaches for shaping health and social services policy. This analysis paper offers a highly selective overview of generic features of policy-relevant research for holistic health. It aims to support efforts to develop better evidence for health policy by exploring elements of the genre of policy-relevant research, particularly as it applies to the challenges of holistic health policy-making. First, it offers a conceptual definition of holistic health policy-making, as well as research evidence for this kind of policy making, identifying some of the generic features of policy-relevant research. Second, it outlines some of the key practices for delivering sound evidence for health policy, in ways that highlight the salient differences between doing research for holistic health policy, and doing academic research in health. The paper concludes with directions for developing better evidence for holistic health policy-making that question the assumptions of quality which often inform elite funding agencies, calling for their diversification.

Management's possible benefits from teamwork and the nursing process

Teamwork and the nursing process are discussed here in relation to nurses' job satisfaction. More and more nurses are leaving the profession, claiming job dissatisfaction. Since there is a shortage of nurses, nursing management is attempting to identify the causes of this dissatisfaction and find ways to correct the problem. 1 Aiken L Clarke S Sloane D Sochalski J Busse R Clarke H et al. Nurses' reports on hospital care in five countries. Nurses' Reports Health Affairs. 2001; 20: 43-55 Crossref PubMed Scopus (1110) Google Scholar , 2 Antrobus S Kitson A Nursing leadership: influencing and shaping health policy and nursing practice. J Adv Nurs. 1999; 29: 746-753 Crossref PubMed Scopus (102) Google Scholar , 3 Heasell S Job satisfaction and employment prospects for nurses. Br J Nurs. 1999; 8: 1379-1382 PubMed Google Scholar , 4 McKeown C Thompson J Learning the art of management. Nurs Manage. 1999; 6: 8-11 Google Scholar , 5 Rafferty AM Ball J Aiken LH Are teamwork and professional autonomy compatible, and do they result in improved hospital care?. Qual Health Care. 2001; 10: 32-37 Crossref Google Scholar , 6 Ventura MJ 1999 earnings survey: bedside care is paying off. RN. 1999; 62: 52-58 PubMed Google Scholar Teamwork and the nursing process are discussed here in relation to nurses' job satisfaction. More and more nurses are leaving the profession, claiming job dissatisfaction. Since there is a shortage of nurses, nursing management is attempting to identify the causes of this dissatisfaction and find ways to correct the problem. 1 Aiken L Clarke S Sloane D Sochalski J Busse R Clarke H et al. Nurses' reports on hospital care in five countries. Nurses' Reports Health Affairs. 2001; 20: 43-55 Crossref PubMed Scopus (1110) Google Scholar , 2 Antrobus S Kitson A Nursing leadership: influencing and shaping health policy and nursing practice. J Adv Nurs. 1999; 29: 746-753 Crossref PubMed Scopus (102) Google Scholar , 3 Heasell S Job satisfaction and employment prospects for nurses. Br J Nurs. 1999; 8: 1379-1382 PubMed Google Scholar , 4 McKeown C Thompson J Learning the art of management. Nurs Manage. 1999; 6: 8-11 Google Scholar , 5 Rafferty AM Ball J Aiken LH Are teamwork and professional autonomy compatible, and do they result in improved hospital care?. Qual Health Care. 2001; 10: 32-37 Crossref Google Scholar , 6 Ventura MJ 1999 earnings survey: bedside care is paying off. RN. 1999; 62: 52-58 PubMed Google Scholar

Lay Acquiescence to Medical Dominance: Reflections on the Active Citizenship Thesis

In this paper we demonstrate that the drive to regulate alternative and complementary forms of health care, in particular assessments of their safety and efficacy, reflects an entrenched medical dominance that excludes lay people from exercising active citizenship regarding determinations of the effectiveness of these therapeutic approaches. However, the almost virtual silence of lay perspectives in debates surrounding the efficacy of these therapies cannot be explained by a unidirectional process of professional exclusion alone. Using findings from qualitative research conducted with people living with Parkinson's disease, we argue that lay acquiescence to medical expert dominance plays a role in militating against the individual's exercise of active citizenship in shaping health policy. Our analysis also demonstrates that attention to lay meanings of efficacy, as well as to aspects of personal biography, such as age and health status, are factors that shape lay acquiescence.

S.01.04 Psycho-education in management of schizophrenia

Advanced practice nurses (APNs) have unique knowledge, skills, and experiences that are essential for health policy creation. Involvement in policy creation is an essential component in APN education, yet few APNs are involved in this essential nursing role. The national policy case study outlines the steps needed to utilize these professional skills and offers a call to action for APNs to make a difference in shaping health policy for patients, communities, and the nursing profession at local, state, and national levels.

An active learning experience in health policy for baccalaureate nursing students.

Nurses have the potential to promote the public's health through active involvement in shaping health and social policy. Preparing nursing students to influence public policy is a major component of the curriculum in public/community health nursing. A series of learning experiences was designed to engage students in this process. First, students participate in information sessions at the State Health Department and the State House. This provides them with opportunities to engage in dialogue with public health leaders as well as advocates from both professional organizations and community groups. Next, students identify the legislators who represent them in the community and write a narrative that describes the legislators' interest and commitment to health-related legislation. Lastly, students work in clinical groups to analyze a public health problem that can be addressed through public policy interventions. This has led to the students testifying at legislative hearings and working with community groups involved with the issue. The students present their findings to their peers and to the wider college community. Through these learning experiences, students gain practical experience in understanding the political process that leads to important policy change. This in turn prepares them for their roles as professional nurses and involved citizens.

Political Elections Shaping Health Policy

Political Elections Shaping Health Policy

The nurse's role in changing health policy related to patient safety.

Nurses' roles in shaping health policy in the United States related to patient safety have not been fully expanded. This article explores various patient safety issues and how nurses can become involved to shape health policy in this area.

Incorporating multiculturalism into oncology nursing research: the last decade.

To use the Oncology Nursing Society's cultural competence guidelines to review research studies conducted by oncology nurse researchers with racial and ethnic minorities and published in the Oncology Nursing Forum during 1990-2000. Using selected key words (e.g., cultural competence, cultural diversity, multiculturalism, minorities, African American/Black American, Hispanic/Latino, Asian/Pacific Islander, Native American/Alaskan Natives) the authors identified 27 studies that met the inclusion criteria for review. Case studies, sponsored lectureships, review articles, commentaries, editorials, and the like were excluded. Within the context of the cultural competence guidelines, the primary strengths included sufficient background information and literature to establish the existence of the problem in the targeted culture, use of conceptual and theoretical frameworks to guide the study, identification of salient study limitations, and recommendations for dissemination of the findings to a general audience. Limitations included discussion of culture beyond the background and literature review, consideration of potential ethical concerns the target population may have about the methods to be used, inclusion of racial and ethnic minorities in the design and implementation of the study, and implications for oncology nursing education. Although much has been gleaned from previous oncology nursing research published from 1990-2000, more fully incorporated content related to cultural competence is needed. This is needed particularly in studies specifically targeting racial and ethnic minority populations. Including cultural competence when designing and reporting research has a greater potential to inform oncology nursing practice, design future research studies, strengthen existing nursing curricula, and help to shape health policy related to racial and ethnic minority populations. The Oncology Nursing Society Multicultural Outcomes: Guidelines for Cultural Competence provides guidance for enhancing the next generation of oncology nursing research with ethnically and culturally diverse populations.

A Continuing Challenge: The Shortage of Educationally Prepared Nursing Faculty

The profession is facing a unique shortage of nursing faculty. Schools of Nursing have always had a shortage of doctorally prepared nursing faculty. The academic norm for faculty teaching in baccalaureate and graduate programs to hold earned doctoral degrees was established later in nursing than for other disciplines. At best, 50% of nursing faculty in such programs have met this academic standard. In addition, the shortage is predicted to escalate in the next decade due to the retirement of a "graying professoriate" of nursing faculty. The shortage of nursing faculty is interwoven with the current national shortage of nurses. The shortage of nurses requires the educational programs of the profession to supply more graduates. But the shortage of nursing faculty will limit student enrollments and likely decrease the number of graduates. Conversely, the shortage of nurses will offer many opportunities and choices to nurses and may decrease the number selecting graduate studies and an academic career, thus contributing to the shortage of nursing faculty The shortage of nursing faculty will also have consequences for the generation of the knowledge base for nursing practice. With a decreased number of individuals to conduct research and the loss of senior investigators through retirement, continuing development of nursing's knowledge base may be curtailed. The shortage of nursing faculty will also limit the professional leaders who are able to shape health policy in the state, national, and international arenas. This article outlines a number of factors influencing the shortage of nursing faculty. Several institutional School of Nursing strategies are suggested for countering the shortage situation. In addition, several national professional and policy strategies are suggested. More creative strategies need to be developed and evaluated by Schools of Nursing and by the profession.

The role of the courts in shaping health policy: an empirical analysis.

The transformation of health-care delivery from fee-for-service medicine to managed care represents a fundamental philosophical shift away from the prevailing medical ethos that the needs of the individual patient take precedence over competing social values, such as reducing health-care costs. In managed care, financial incentives to reduce health-care utilization may result in denying an individual’s claim for medical services.Litigation challenging managed care’s resource allocation decisions often presents the need to resolve conflicting social policy goals, such as the tension between an individual patient’s access to health care and a managed care organization’s (MCO’s) need to restrain costs. Conflicts may arise when a patient’s desire for unconstrained health care clashes with a provider’s and an insurer’s cost containment strategies. In turn, cost containment strategies may raise questions about restrictions on physician autonomy and conflicts among stakeholders for control over resource allocation decisions.

How do physicians lobby their members of Congress?

Physicians are uniquely qualified to educate legislators about health care issues, but little is known about how physicians lobby members of Congress. From the staff of 84 randomly selected members of Congress (49 senators and 35 representatives), we interviewed the legislative assistants who work on health care legislation and meet with constituents and lobbyists on behalf of their senator or representative. We asked about (1) the frequency of meetings between legislative assistants and physicians, (2) the issues discussed, and (3) the perceived effectiveness of lobbying. Senate and house legislative assistants met with an average of 10.0 and 4.0 physicians per month, respectively. This suggests that approximately 29,000 such meetings occur annually. The most common issues discussed were Medicare reimbursement (mentioned by 67 [81%] of 83 subjects), managed care reform (62 subjects [75%]), and funding for medical research (21 subjects [25%]). Other issues, such as access to care for the uninsured, tobacco control, abortion rights, and violence prevention, were rarely discussed. Most legislative assistants rated physicians as effective (37 [44%]) or somewhat effective (39 [46%]) as lobbyists. The most common suggestion for improving physician lobbying was to focus less on reimbursement and to address a broader range of health care issues. Physicians are frequent and effective lobbyists on reimbursement, managed care, and research issues. Policy makers appear receptive to increased physician input on a broader range of health care issues. Including these issues in lobbying efforts has the potential to shape health policy in a way that improves patient care and public health. Arch Intern Med. 2000;160:3248-3251.

Scandinavia's lessons to the world of public health

The Scandinavian Journal of Public Health embarks on a new phase, under the editorship of Professor Stig Wall. It is timely, then, to consider what unique contributions might be made by the journal. Certainly, the Nordic countries, with their highly regarded universities and well-developed research centers, have much to share with the rest of the world across the broad spectrum of basic science, clinical medicine, and population research. However, much of this excellent research is not unique to this part of the world and it is the thesis of this editorial that, in the area of public health, Scandinavia can play a leading role in shaping contemporary thought. The Scandinavian Journal of Public Health should therefore provide a forum for description and discussion of public health issues in the Nordic context, not only for the bene®t of the Nordic community but also to help those of us from other parts of the world who wish to better understand the theory and practice of public health. Epidemiology and public health have recently been criticized for taking an increasingly smaller role in shaping health policy. Reliance by contemporary epidemiology on ``the black box'' (1), ``the web of causation'' (2), ``risk factorology'' (3), and other paradigms has, according to some thinkers, limited the ®eld's ability to meet new challenges to population health. The increasingly individualistic approach within a medical model causes public health in some countries, such as the US, to be subsumed as another medical speciality, rather than as a primary goal of public policy and social values (3). Others worry about the future of epidemiology (4) and believe that public health is in transition (5). If so, then where will we ®nd the science and experience to choose the best course? This increasing insinuation that public health may be irrelevant raises the need for model systems to examine more collectivist and holistic approaches as alternatives to the individualistic, medical approaches. It is possibly safe to say that the Nordic countries have traditionally taken a much more comprehensive and societal approach to health in general, and public health in particular. To illustrate this, let us contrast two recent policy documents outlining national health strategies for the next decade ± one for a Nordic country (Sweden) (6) and the other for the United States (7) (Table I). The ``Green Paper'' describes the public health strategy for Sweden and sets down, possibly for the ®rst time, public health objectives that address the actual determinants of health and disease at the societal level. Objectives 1 ± 4 and 6 ± 13 deal with broad issues of economic disparity and poverty, homelessness, unemployment, non-participation in political decision-making, personal development, workplace environment, segregation, education, and care of the elderly. Only seven objectives deal with speci®c diseases and health-risk behaviors. Nonetheless, all 19 objectives have quanti®able indicators for ful®llment of each objective. In stark contrast are the Healthy People 2010: Health Objectives for the Nation, released in January 2000 by the Department of Health and Human Services of the United States (7). These objectives also have two overall goals: (i) to eliminate health disparities (between groups de®ned by gender, race/ ethnicity, income and education, rural location, disability, and sexual orientation), and (ii) to improve the quality and years of healthy life. While the goals suggest broad societal changes and determinants of health, the focus areas of Healthy People 2010 largely address a biomedical model. Of the 28 objectives, 23 describe health issues that deal with speci®c diseases or risk behaviors, with de®nable indicators, usually entailing reduction in speci®c mortality or prevalence estimates. These two sets of health policy objectives for the ®rst decade of the 21st century suggest a fundamentally different approach to public health operating at different levels of social integration and organization. According to the biopsychosocial model of Engel, health is determined by a series of levels of process (8). According to this model, the Swedish Public Health Plan is operating at the level of society and culture, whereas the American plan is generally operating at

The key to overcoming inequality is political commitment

One of the main conclusions of Gwatkin's article was the need "to rethink the way in which health goals are established, and recast them in terms more relevant for inequality reduction". His recommendations and most of his article itself focus on the content of health policy and do not deal with the political processes and factors that shape health policy, such as competing interests. The need for more reliable information on health inequalities (and the role of the international organizations in providing it) cannot be doubted. Its absence is a reflection of the lack not only of knowledge but of political commitment. The reverse is not true: if the health policy of a given country includes the reduction of inequalities, we cannot conclude that the political commitment to implement such objectives exists. Why does the political commitment not exist? What factors prevent the reduction of inequities from being given priority in health policy? What could change the existing situation? Answers to such questions naturally vary from place to place. What I discuss here refers to the post-socialist countries, especially Hungary, but I believe that parts of it are valid elsewhere too. In the 1990s in the post-socialist countries, the emergence of a group of wealthy people has coincided with a decline in economic performance, as reflected by a shrinking gross domestic product (GDP). Obviously, if some people are getting richer it can only be at the expense of the other social strata, partly the middle class and mainly the poor, who get poorer and poorer. In Hungary, for example, the gap in income between the lower and the upper decile from 1990 to 1997 increased from 4.5 to almost 9. The majority of the political elite, irrespective of their political allegiances, have tried to get into the richest part of society in the course of this social realignment. The political elite is much more sensitive about the inequalities between countries (which are to their disadvantage) than to the inequalities within their own country (which are to their advantage). The challenge felt most keenly by the political and economic elite, not only for their countries but for themselves, is to catch up with the West. Questions of internal inequality are much less compelling. A good example of this is health. In non-Western countries a major objective in health policies is to narrow the gap between their own and Western life expectancy, while unequal life expectancies within the country get no attention. Miklos Tamas-Gaspar, a philosopher who was a key figure of the liberal intellectual resistance in the socialist period, describes the new political elite in harsh but accurate terms: The ideas of welfare, public interest and good governance are meaningless to them. They do not want power because they want to save the world or make improvements or promote social justice, ... though they might sometimes inadvertently use such phrases. The new elite are as indifferent to the fate of the poor as their communist predecessors were (1). The apparent contradiction between the new political elite's lack of interest in social justice and the priority given to poverty alleviation as a social policy objective is deceptive. This policy can also be interpreted as the desire to increase GDP while remaining firmly on the development track that increases inequalities. In the last decade not only socioeconomic factors but elements of the health care system itself have worked against the development of an equity-oriented health policy. The basic economic and budgetary interest was to reduce spending on welfare and health in order to reduce state redistribution. The concern of the physicians was quite contrary to this: it was to increase their own income and to reduce the gap between their own technology and that of the West. The effect of these factors on health policy was to make its share of the national resources the main concern, with little interest in increasing efficiency, and none at all in equity. …

Nursing leadership: influencing and shaping health policy and nursing practice.

The leadership discourse in the United Kingdom has to date been concerned with professional issues and as a result has focused upon developing nurses and nursing. This paper reports on the findings of a research study which examined the broader socio-political factors impacting upon nursing leadership. The study forms an integral part of the Royal College of Nursing's leadership programme. The principal aim of the research was to examine critically contemporary nursing leadership within the context of health policy. An ethnographic approach was used. Informal semi-structured interviews were undertaken with a purposive sample of 24 leaders who were recognized for their effectiveness in leading nursing. Data were analysed for themes. The main themes are presented and discussed here. The findings of the study question the political success which the internally focused nature of leadership has had for the profession. Nursing and therefore nursing leadership is shaped dramatically by the impact of politics and policy. The research discovered that in recognition of this, contemporary nursing leadership has both an internal and an external focus. That is, effective nursing leadership currently is a vehicle through which both nursing practice and health policy can be influenced and shaped. The research also identified the profile of the effective nurse leader, together with the processes through which leaders interpret and translate between the macro issues of policy and the micro issues of practice. In addition, an understanding of what nursing leadership is, has been proposed. Appropriate recommendations for the future of nursing and nursing leadership are outlined.

Our healthier nation: a role for midwives?

The Government has now published the White Paper ‘The New NHS: Modern Dependable’ and the Public Health Green Paper ‘Our Healthier Nation.’ These document will shape health policy into the next millennium and are an important first step in developing a coherent strategy to tackle the state of the nation's health. Both documents recognize that inequalities exist in our society and that inequalities are associated with wide variations in health.

Introduction: "Lies, Damn Lies and Statistics: How Empirical Research Shapes Health Law and Policy"

Introduction: "Lies, Damn Lies and Statistics: How Empirical Research Shapes Health Law and Policy"