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In July 2010, the new Coalition Government unveiled its plans to make major changes to the English National Health Service (NHS). This paper, which provides a commentary on the NHS White Paper, Equity and Excellence: Liberating the NHS, casts doubt upon the extent to which the proposals will bring about the fundamental reform that the Government intends, not least because both the British public and GP commissioners (who are expected to play a central role in transforming the NHS) appear to have a limited appetite for radical market reform. The paper also identifies a number of unintended risks, including the large transitional costs and organisational turbulence resulting from further NHS reorganisation; and the fact that key aspects of the White Paper proposals could result in significant financial instability. Given the real world limitations to translating a rhetoric of localism and democratic legitimacy into reality and a lack of hard evidence about the benefits of market reform, the Government would be well advised to take a more cautious approach to health policy formulation and implementation and to ensure that any further changes to the NHS are based on evidence, piloting and evaluation.

This paper describes the World Health Organization's project to develop a quality of life instrument (the WHOQOL). It outlines the reasons that the project was undertaken, the thinking that underlies the project, the method that has been followed in its development and the current status of the project. The WHOQOL assesses individuals' perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It has been developed collaboratively in several culturally diverse centres over four years. Piloting of the WHOQOL on some 4500 respondents in 15 cultural settings has been completed. On the basis of this data the revised WHOQOL Field Trial Form has been finalized, and field testing is currently in progress. The WHOQOL produces a multi-dimensional profile of scores across six domains and 24 sub- domains of quality of life.

This paper explores how social class and race affect the public health policy-making process in an urban area. Ethnographic methods were used to collect and analyze information about HIV/AIDS and tuberculosis policy-making by the Washington, DC Commission of Public Health, Kingdon's conceptual model of policy making was used to analyze and understand the process. The problems of HIV/AIDS and tuberculosis in the district have important social class dimensions that were not always made explicit, but were instead defined in terms of 'race' and 'place'. Social class considerations and racial politics shaped what policies were developed or not developed and implemented successfully or failed. This study, which has national and international implications, concludes that there is a need to improve our understanding of the complex social dimensions of public health problems; there needs to be more consideration of the politics of strategy formulation and how issues of social class and race affect this process; and public health needs to strengthen its constituency in order to build support for the successful development and implementation of policy.

The collection of papers which follows this brief introduction has been drawn from over 70 originally presented at the International Symposium in Medical Geography, held at the University of Portsmouth, U.K., in the summer of 1996. This symposium, the seventh in a series which has now run for over a decade, was attended by some 140 delegates from 20 countries. In retrospect, our marketing of the meeting as the “premier world event in medical geography” was not misplaced. We were able to group papers together into themed sessions covering the gamut of current concerns in the geographies of health, health care and health policy and, through generous sponsorship, a plenary session was offered on significant contributions to the geography of health by non-geographers. The papers which follow provide ample illustration of the range of topics covered in the meeting.

Social Science & Medicine is calling for papers for a special issue on the sociology of diagnosis to be guest edited by Annemarie Jutel and Sarah Nettleton. Papers may focus on diagnosis as classification or as process; on professional or lay-diagnosis; on the micro and macro levels of diagnosis; or on any other aspect of the social framing or consequences of diagnosis. This special issue will provide the opportunity to crystallise discussions and forge an innovative strand of work within the sociology of health and illness, and engage pertinent sociological questions such as

The prenatal stage and the early years are being heralded as crucially important in the trajectory of human development as early life determinants of later health development and learning have been clearly established. However, less is known about what outcomes of early development are reversible and which outcomes cannot be reversed. Vulnerabilities and opportunities for development vary by age of the child and exposure to social contexts that promote and support development. These contexts are multi-layered, with the most proximal being caregiving (hygiene, nutrition, responsive feeding, basic health routines and care), early stimulation (cognitive and learning-related interactions), responsivity (social and affective interactions, relationship building) and structure (discipline and protection from abuse) and the more distal or macro factors being poverty, access to high quality health and education services, exposure to conflict and emergency situations, to name some. If we are to improve the effectiveness of financial and other resource investments, we ought to establish the most optimal timing and life stage at which to intervene to maximize human development. The purpose of this Special Issue is to learn which human development outcomes are irreversibly perverted and which outcomes can be reversed in early childhood, thereby setting priorities for early intervention and policy investments, with a focus on low and middle income countries and implications for influencing the debate on the next generation of Millennium Development Goals post-2015. In keeping with the international scope of Social Science & Medicine we are assembling a collection of papers with strong social science content that analyze outcomes in early childhood, with an emphasis on understanding critical periods in development, including