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The aim of this study was to determine the degree to which welfare state regime characteristics explained the proportional variation of self-perceived health between European countries, when individual and regional variation was accounted for, by undertaking a multilevel analysis of the European Social Survey (2002 and 2004). A total of 65,065 individuals, from 218 regions and 21 countries, aged 25 years and above were included in the analysis. The health outcomes related to people's own mental and physical health, in general. The study showed that almost 90% of the variation in health was attributable to the individual-level, while approximately 10% was associated with national welfare state characteristics. The variation across regions within countries was not significant. Type of welfare state regime appeared to account for approximately half of the national-level variation of health inequalities between European countries. People in countries with Scandinavian and Anglo-Saxon welfare regimes were observed to have better self-perceived general health in comparison to Southern and East European welfare regimes. Keywords: Health inequalities; Welfare state; Welfare state regimes; Multilevel analysis; Self-assessed health; Europe

When New Labour came to power in the UK in 1997 it brought with it a strong commitment to reducing inequality and social exclusion. One strand of its strategy involved a focus on area based initiatives to reduce the effects of persistent disadvantage. Health Action Zones (HAZs) were the first example of this type of intervention, and their focus on community based initiatives to tackle the wider social determinants of health inequalities excited great interest both nationally and internationally. This article draws on findings from the national evaluation of the initiative. It provides an overview of the HAZ experience, and explores why many of the great expectations associated with HAZs at their launch failed to materialise. It suggests that, despite their relatively limited impact, it is best to consider that they made a good start in difficult circumstances rather than that they failed. As a result there are some important lessons to be learned about the role of complex community based interventions in tackling seemingly intractable social problems for policy-makers, practitioners and evaluators. Social programs are complex undertakings. They are an amalgam of dreams and personalities, rooms and theories, paper clips and organisational structure, clients and activities, budgetss and photocopies, and great intentions. (Weiss, 1998: 48)

Contemporary efforts to promote population health improvement and to reduce inequalities in the UK are characterised by their complexity as they engage with a multiplicity of agencies and sectors. Additionally, the emphasis on promoting evidence-based practice has challenged evaluators tasked with collecting and interpreting evidence of impact in complex local health economies. National policy makers, local implementers and other stakeholders will have varying perspectives on impact and the Labour Government's centralising tendencies have acted to 'crowd out' local voices from the policy process. Drawing on the national evaluation of Health Action Zones (HAZ) this article 'gives voice' to local stakeholders and their perceptions of impact. Informed by a Theories of Change perspective, we explore HAZ interventions to articulate the nature of impact and its limits. We analyse the claims made by local HAZs with reference to the evidence base and examine their significance in the context of overall HAZ objectives. We conclude that local implementer perspectives are no less sophisticated than those at the policy centre of central government, but that they are informed by three important factors: the local context, a need to be pragmatic and the limited potency of evidence in the public policy system. Keywords: Evaluation; Impact: Health Action Zones; Local perspectives; UK

Research has been conducted on the vaccinia virus complement control protein inhibiting the complement activation pathways. Results indicate that the structure of the complement regulation intact regulator will stimulate the design of the therapeutic complement inhibitors.

The government's report, Opportunity for All: Tackling Poverty and Social Exclusion (Department of Social Security, 1999), identified poor health as one of the major problems associated with low income. However, much of the available evidence on the relationship between income and health is of little help in forming policies to reduce health inequalities, as it has tended to be based on cross-section surveys and is therefore unable to shed much light on causal effects. Here, we make use of two British longitudinal datasets to examine the longer-term influences of income on health within a life-course perspective. We then use the results of our analysis to provide a brief critical assessment of the likely success of the government's anti-poverty strategy in reducing health inequalities. A more detailed assessment of government policy in this respect can be found in Benzeval et al. (forthcoming).

A number of studies have suggested that inequalities in the distribution of income may be an important cause of variations in the average level of population health among rich industrial nations. However, what is missing from the debate so far is any systematic review of evidence about the relationship between different measures of income distribution and indicators of population health. This paper aims to bridge that gap. First, it summarizes the recent English language literature on this topic and illustrates the methodological problems that weaken the inferences that can be derived from it. Secondly, it presents new empirical estimates of the relationship between different measures of income distribution, infant mortality and life expectancy based on the most authoritative data published to date. In contrast to most earlier studies, we find very little support for the view that income inequality is associated with variations in average levels of national health in rich industrial countries. Some possible explanations for these differences are outlined. Key words - inequality, income distribution, life expectancy, infant mortality, OECD countries

This paper examines the nature of public opinion concerning the National Health Service. Data from two series of national surveys covering the period 1983-92 are used to analyse trends in opinion. OPCS data for 1991-2 are examined in more detail to investigate the determinants of satisfaction with health services. A range of demographic, socio-economic and health status characteristics, as well as media coverage of health-related issues, are found to be significantly related to expressions of satisfaction with the NHS, in addition to recent experience of using health services. The complexity of the formation and expression of public opinion is acknowledged. In particular, the importance of taking note of the methodological implications and political context associated with expressions of public opinion is emphasised.

The National Strategy for Neighbourhood Renewal (NSNR) is a central component of British policy to reduce health disparities. This program seeks to improve local socioeconomic and physical environments through the intensive regeneration of disadvantaged communities. We describe the challenges facing evaluators tasked with assessing the impacts of 1 component of the NSNR--the New Deal for Communities initiative--and explore techniques that may be adopted in the evaluation process.

Richard Wilkinson puts forth his criticisms on the paper entitled 'Income Inequality and Population Health' which appeared in volume 46 of Social Science and Medicine in a letter yet to be published in the same journal. Among the criticisms he raised are problems with data and data analysis as well as the oversight committed regarding the use of studies with contradictory results. These concerns are answered and explained.

It is widely recognised that poverty is associated with poor health even in advanced industrial societies. But most existing studies of the relationship between the availability of financial resources and health status fail to distinguish between the transient and permanent impact of poverty on health. Many studies also fail to address the possibility of reverse causation; poor health causes low income. This paper aims to address these issues by moving beyond the static perspective provided by cross-sectional analyses and focusing on the dynamic nature of people's experiences of income and health. The specific objective is to investigate the relationship between income and health for adult participants in the British Household Panel Survey from 1991 to 1996/97. The paper pays particular attention to: the problem of health selection; the role of long-term income; and, the effect of income dynamics on health. The results confirm the general findings from the small number of longitudinal studies available in the international literature: long-term income is more important for health than current income; income levels are more significant than income change; persistent poverty is more harmful for health than occasional episodes; and, income reductions appear to have a greater effect on health than income increases. After controlling for initial health status the association between income and health is attenuated but not eliminated. This suggests that there is a causal relationship between low income and poor health. Keywords: Income; Health; Panel study; Britain; Income dynamics; Health selection