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The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further 'market-style' reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers. [ABSTRACT FROM AUTHOR]

In this paper the coherence of the precautionary principle as a guide to public health policy is considered. Two conditions that any account of the principle must meet are outlined, a condition of practicality and a condition of publicity. The principle is interpreted in terms of a tripartite division of the outcomes of action (good outcomes, normal bad outcomes and special bad outcomes). Such a division of outcomes can be justified on either "consequentialist" or "deontological" grounds. In the second half of the paper, it is argued that the precautionary principle is not necessarily opposed to risk-cost-benefit analysis, but, rather, should be interpreted as suggesting a lowering of our epistemic standards for assessing evidence that there is a link between some policy and "special bad" outcomes. This suggestion is defended against the claim that it mistakes the nature of statistical testing and against the charge that it is unscientific or antiscientific, and therefore irrational. [ABSTRACT FROM AUTHOR]

This paper reviews the literature on smoking cessation interventions, with a focus on the last 20 year(1991 to 2010). These two decades witnessed major development in a wide range of cessation interventions, from pharmacotherapy to tobacco price increases. It was expected that these interventions would work conjointly to increase the cessation rate on the population level. This paper examines population data from the USA, from 1991 to 2010, using the National Health Interview Surveys. Results indicate there is no consistent trend of increase in the population cessation rate over the last two decades. Various explanations are presented for this lack of improvement, and the key concept of impact ¼ effectiveness 3 reach is critically examined. Finally, it suggests that the field of cessation has focused so much on developing and promoting interventions to improve smokers' odds of success that it has largely neglected to investigate how to get more smokers to try to quit and to try more frequently. Future research should examine whether increasing the rate of quit attempts would be key to improving the population cessation rate. [ABSTRACT FROM AUTHOR]

Public health decision makers, funders, practitioners, and the public are increasingly interested in the evidence that underpins public health decision making. Decisions in public health cover a vast range of activities. With the ever increasing global volume of primary research, knowledge and changes in thinking and approaches, quality systematic reviews of all the available research that is relevant to a particular practice or policy decision are an efficient way to synthesise and utilise research efforts. The Cochrane Collaboration includes an organised entity that aims to increase the quality and quantity of public health systematic reviews, through a range of activities. This paper aims to provide a glossary of the terms and activities related to public health and the Cochrane Collaboration. [ABSTRACT FROM AUTHOR]

Study objective: To explore the role of history in public health and its relevance to current practice and professional development. Design: An analysis of the issues surrounding the poor attention paid to the history of public health by its current practitioners. Setting: The paper is written from the perspective of practitioners in the UK but has wide applicability. Main results: The paper makes the case that the current neglect of public health history is to the detriment of public health practice. Conclusions: There is a strong case for more attention to be paid to public health history in professional formation, development, and communication. [ABSTRACT FROM AUTHOR]

In the UK, many fundamentally important policy decisions that are likely to affect the relationship between citizens and care services are now made at the sublegislative level and without adequate ethical consideration and scrutiny. This is well exemplified in the proposed guidance on the disclosure of information on children. A recent consultation paper by the UK government on the subject proposes an approach that seeks a simple technical solution to a complex problem, emphasising control and surveillance. This reflects pressure to be seen to act. The document fails with regard to ethical reflection appropriate to the complexity of the issue, an appreciation of complex relationships of trust, and a proper sense of the richness and complexity of the public interest. Such policies would, if implemented, fundamentally change the relationships between citizens and their carers, and among carers and the law and the state. This and similar proposals require far more ethical scrutiny and consideration of the public interest in the widest sense. [ABSTRACT FROM AUTHOR]

The Fogarty International Center (FIC) initiative, "International Tobacco and Health Research Capacity Building Program" represents an important step in US government funding for global tobacco control. Low- and middle-income countries of the world face a rising threat to public health from the rapidly escalating epidemic of tobacco use. Many are now parties to the Framework Convention on Tobacco Control (FCTC) and capacity development to meet FCTC provisions. One initial grant provided through the FIC was to the Institute for Global Tobacco Control (IGTC) at the Johns Hopkins Bloomberg School of Public Health (JHSPH) to support capacity building and research programmes in China, Brazil, and Mexico. The initiative's capacity building effort focused on: (1) building the evidence base for tobacco control, (2) expanding the infrastructure of each country to deliver tobacco control, and (3) developing the next generation of leaders as well as encouraging networking throughout the country and with neighbouring countries. This paper describes the approach token and the research foci, as well some of the main outcomes and some identified challenges posed by the effort. Individual research papers are in progress to provide more in-depth reporting of study results. [ABSTRACT FROM AUTHOR]

The nature and significance of equity and equality in relation to health and healthcare policy is discussed in the light of a recent article by Culyer. Culyer makes the following claims: (a) the importance of equity in relation to the provision of health care derives from the human need for health in order to flourish; and (b) for the sake of equity, equality of health among the members of particular political jurisdictions should be the aim of health policy. Both these claims are challenged in this paper. The argument put forward is that it is only when needs arise and are met in particular contexts that need and equity are fused. The state and its agents and agencies should distribute what it distributes impartially, whatever it distributes. Whether or not equity applies to the distribution of healthcare services depends on how they are provided and not on their nature as "primary goods". Contrary to what Culyer suggests, a policy of trying to produce the outcome of health equality would be inequitable. It would not be impartial and it would fail to treat persons as persons ought to be treated. [ABSTRACT FROM AUTHOR]

In recent years, 'nudge' theory has gained increasing attention for the design of population-wide health interventions. The concept of nudge puts a label on efficacious influences that preserve freedom of choice without engaging the influencees' deliberative capacities. Given disagreements over what it takes genuinely to preserve freedom of choice, the question is whether health influences relying on automatic cognitive processes may preserve freedom of choice in a sufficiently robust sense to be serviceable for the moral evaluation of actions and policies. In this article, I offer an argument to this effect, explicating preservation of freedom of choice in terms of choice-set preservation and noncontrol. I also briefly explore the healthcare contexts in which nudges may have priority over more controlling influences. [ABSTRACT FROM AUTHOR]

The phone-hacking scandal that led to the closure of the News of the World newspaper in Britain has prompted international debate about media practices and regulation. It is timely to broaden the discussion about journalistic ethics and conduct to include consideration of the impact of media practices upon the population's health. Many commercial organisations cultivate relationships with journalists and news organisations with the aim of influencing the content of health-related news and information communicated through the media. Given the significant influence of the media on the health of individuals and populations, we should be alert to the potential impact of industry -- journalist relationships on health care, health policy and public health. The approach taken by the medical profession to its interactions with the pharmaceutical industry provides a useful model for management of industry influence. [ABSTRACT FROM AUTHOR]

An international conference on differences in health and health care provision is to be held in Rotterdam, Netherlands, from June 23-25, 2004. For further details one can contact Lilian Hoonhout, Department of Health Policy and Management.

Objectives: To examine whether, in former communist countries that have undergone profound social and economic transformation, health status is associated with income inequality and other societal characteristics, and whether this represents something more than the association of health status with individual socioeconomic circumstances. Design: Multilevel analysis of cross-sectional data. Setting: 13 Countries from Central and Eastern Europe and the former Soviet Union. Participants: Population samples aged 18+ years (a total of 15 331 respondents). Mean outcome measures: Poor self-rated health. Results: There were marked differences among participating countries in rates of poor health (a greater than twofold difference between the countries with the highest and lowest rates of poor health), gross domestic product per capita adjusted for purchasing power parity (a greater than threefold difference), the Gini coefficient of income inequality (twofold difference), corruption index (twofold difference) and homicide rates (20-fold difference). Ecologically, the age-and sex-standardised prevalence of poor self-rated health correlated strongly with life expectancy at age 15 (r= -0.73). In multilevel analyses, societal (country-level) measures of income inequality were not associated with poor health. Corruption and gross domestic product per capita were associated with poor health after controlling for individuals' socioeconomic circumstances (education, household income, marital status and ownership of household items); the odds ratios were 1 .1 5 (95% confidence interval 1 .03 to 1 .29) per 1 unit (on a 10-point scale) increase in the corruption index and 0.79 (95% confidence interval 0.68 to 0.93) per $5000 increase in gross domestic product per capita. The effects of gross domestic product and corruption were virtually identical in people whose household income was below and above the median. Conclusion: Societal measures of prosperity and corruption, but not income inequalities, were associated with health independently of individual-level socioeconomic characteristics. The finding that these effects were similar in persons with lower and higher income suggests that these factors do not operate exclusively through poverty. [ABSTRACT FROM AUTHOR]

Objective: To assess the short term health effects of improving housing. Design: Randomised to waiting list. Setting: 119 council owned houses in south Devon, UK. Participants: About 480 residents of these houses. Intervention: Upgrading houses (including central heating, ventilation, rewiring, insulation, and re-roofing) in two phases a year apart. Main outcome measures: All residents completed an annual health questionnaire: SF36 and GHQ12 (adults). Residents reporting respiratory illness or arthritis were interviewed using condition-specific questionnaires, the former also completing peak flow and symptom diaries (children) or spirometry (adults). Data on health service use and time lost from school were collected. Results: Interventions improved energy efficiency. For those living in intervention houses, non-asthma-related chest problems (Mann-Whitney test, p = 0.005) and the combined asthma symptom score for adults (Mann-Whitney test, z = 2.7, p = 0.007) diminished significantly compared with control houses. No difference between intervention and control houses was seen for SF36 or GHQ12. Conclusions: Rigorous study designs for the evaluation of complex public health and community based interventions are possible. Quantitatively measured health benefits are small, but as health benefits were measured over a short time scale, there may have been insufficient time for measurable improvements in general and disease-specific health to become apparent. [ABSTRACT FROM AUTHOR]

Decisions in healthcare are made against the background of cultural and philosophical definitions of disease, sickness and illness. These concepts or definitions affect both health policy (macro level) and research (meso level), as well as individual encounters between patients and physicians (micro level). It is therefore necessary for evidence-based medicine to consider whether any of the definitions underlying research prior to the hierarchisation of knowledge are indeed compatible with its own epistemological principles. [ABSTRACT FROM AUTHOR]

Insignificant or modest findings in intervention trials may be attributable to poorly designed or theorised interventions, poorly implemented interventions, or inadequate evaluation methods. The pre-existing context may also account for the effects observed. A combination of qualitative and quantitative methods is outlined that will permit the determination of how context level factors might modify intervention effectiveness, within a cluster randomised community intervention trial to promote the health of mothers with new babies. The methods include written and oral narratives, key informant interviews, impact logs, and inter-organisational network analyses. Context level factors, which may affect intervention uptake, success, and sustainability are the density of inter-organisational ties within communities at the start of the intervention, the centrality of the primary care agencies expected to take a lead with the intervention, the extent of context-level adaptation of the intervention, and the amount of local resources contributed by the participating agencies. Investigation of how intervention effects are modified by context is a new methodological frontier in community intervention trial research. [ABSTRACT FROM AUTHOR]

Quantitative methods are central to public health and public health research. The historical roots and philosophical foundations of this predilection for the quantitative, however, are little known and seldom discussed. [ABSTRACT FROM AUTHOR]

The widening gap in health outcomes between rich and poor is particularly evident among children and social inequalities in health are therefore of great concern to readers of this journal. Reducing inequalities in health is an important component of UK health policy. [ABSTRACT FROM AUTHOR]

Placing health in the agendas of all policy makers remains a challenge. Finding new ways to boost Health in All Policies should be a continuous process. Currently, health information initiatives gather core health statistics, indicators related to healthcare, along with individual level risk factors such as smoking or obesity. However, there is a lack of identifiable information showing the effect of non-primary health policies on population health. A research agenda is proposed, focusing on three related areas that would frame health information in such a way that the implications for decision-makers from non-health sectors are clear: (a) research in order to provide solid and quantitative evidence linking the social and environmental determinants of health with their ultimate health outcomes; (b) research that shows and quantifies the effect of policies and specific interventions on these determinants; and (c) the development of policy-linked indicators which provide a quantitative estimate of the health that would be gained (or disease burden that could be avoided) by adoption of a specific policy. [ABSTRACT FROM AUTHOR]