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Background Smokers from lower socio-economic groups are less likely to be successful in a quit attempt than more affluent smokers, even when they access smoking cessation services. Methods Data were collected from smoking cessation service users from three contrasting areas of Great Britain—Glasgow, North Cumbria and Nottingham. Routine monitoring data were supplemented with CO-validated smoking status at 52-week follow-up and survey data on socio-economic circumstances and smoking-related behaviour. Analysis was restricted to the 2397 clients aged between 25 and 59. Results At 52-week follow-up, 14.3% of the most affluent smokers remained quit compared with only 5.3% of the most disadvantaged. After adjustment for demographic factors, the most advantaged clients at the English sites and the Glasgow one-to-one programme were significantly more likely to have remained abstinent than those who were most disadvantaged [odds ratio: 2.5, confidence interval (CI): 1.4–4.7 and 7.5 CI: 1.4–40.3, respectively). Mechanisms producing the inequalities appeared to include treatment compliance, household smokers and referral source. Conclusions Rather than quitting smoking, disadvantaged smokers quit treatment. More should be done to encourage them to persevere through the first few weeks. Other causes of inequalities in quitting varied with the service provided. [ABSTRACT FROM PUBLISHER]

Health policy in the United Kingdom is devolved to the four home countries. Nevertheless, England, Northern Ireland, Scotland, and Wales share a common commitment to reducing health inequalities and have set explicit targets in areas such as life expectancy, cancer mortality, long-standing illness, and smoking prevalence. However, many of the targets leave much to be desired in terms of their limited conceptual scope and their selection of methods and approaches. At one level this might be regarded as relatively unimportant. The mere fact of having health inequalities targets is laudable. But because the United Kingdom has been in the vanguard of research and policy development to reduce health inequalities, a critical appraisal of the strengths and weaknesses of the approaches adopted in the four home countries is timely. Following a description of the health inequalities targets, the article focuses on experiences in England and Scotland as examples of contrasting approaches to target setting and describes progress toward meeting targets in each country. The authors then outline key emerging issues in relation to developing targets and measuring progress, including conceptual dilemmas, biased reporting, implementation failure, and statistical fallacy. [ABSTRACT FROM AUTHOR]

Background Studies show that the well-prepared traveller is less likely to suffer travel related illness. This study is designed to examine trekkers’ knowledge of altitude sickness in an attempt to see whether knowledge can protect against acute mountain sickness (AMS) and high altitude pulmonary or cerebral oedema (HAPE/HACE). [ABSTRACT FROM PUBLISHER]

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 initiatives to tackle the wider social determinants of health inequalities excited great interest both nationally and international. This article draws on findings from the national evaluation of the initiative. it provides an overview of the HAZ experiences and explores why many of the great expectations associated with HAZs at their launch failed to materialise. It suggests that, despite their relatively limited imp act, 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-maker, practitioners and evaluators. [ABSTRACT FROM AUTHOR]

To determine the effectiveness of smoking cessation services in enabling smokers living in disadvantaged areas to access treatment services, and to assess the extent of variations between areas.Observational study of administrative information linked with survey data.A representative sample of 19 of the 95 English health areas in 2001.All England smoking data by deprivation category obtained from the Health Survey of England were used to estimate neighbourhood smoking prevalence rates. Area of residence data from smokers setting a quit date were used to calculate the proportion of smokers in receipt of treatment services in different economic deprivation categories.In general, treatment services were seeing smokers from the most disadvantaged areas where smoking prevalence rates were highest; 32.3% of all smokers in receipt of treatment services lived in the most disadvantaged quintile of areas compared with 9.6% resident in the most advantaged quintile. An indicator of‘positive discrimination’ was calculated for each health authority area to quantify the extent to which the proportion of disadvantaged smokers being treated was greater than the proportion in the local population. This figure ranged from just under 0% to 18%.National Health Service (NHS) smoking cessation services have been successful in reaching smokers from disadvantaged communities. If improved access to support for smokers living in the poorest communities can be extended, sustained and translated into long-term quitting then smoking cessation services have the potential to make a useful contribution to addressing inequalities in health. [ABSTRACT FROM AUTHOR]

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. [Copyright &y& Elsevier]

The aim of this paper is to develop a better understanding of the relationship between income and health using a cross-sectional survey of the general British population. It is divided into two parts. First, it examines a number of methodological inconsistencies in the existing literature and assesses their consequences for the inferences that can be drawn about the income-health association. These issues include: the measurement of income and its functional form; health selection; and the role of confounders. Second, it explores the relative strength of the income-health association in contrast to that of other socioeconomic measures. The relationship between income and health is complex. However, having taken into account a range of methodological problems, income is still significantly associated with health. The association appears to be non-linear and is attenuated but not removed by controlling for health selection effects. The inclusion of a wide range of confounders into models of income and health reduces the association between them, but does not make it insignificant. In comparison to other socioeconomic measures, income appears to be a better discriminator of health status than education or occupation. However, tenure and car ownership seem to be at least as good if not better than current income. [ABSTRACT FROM AUTHOR]

Examines the relationship between income and health over time for adult participants in the British Household Panel Survey from 1991 to 1996/97 with respect to three key aspects of the association. Multivariate models; Significance of average and current income for health; Health risks of persistent poverty and occasional episodes of poverty; Healthy survivor effect.

Investigates the public views on the aspects of health care system in Great Britain. Influence of methodological issues in public perceptions; Role of media in the changing the public opinions; Assessment on the levels of satisfaction with National Health Service.

This article examines the nature of public opinion concerning the National Health Service in Great Britain. The first aim of this article is to review trends in public opinion during the late 1980s and early 1990s. It begins by examining data from two series of annual surveys of national opinion. Next, new data collected on behalf of the King's Fund Institute are presented. Responses are analyzed from four surveys of satisfaction with aspects of health care in Great Britain, conducted between August 1991 and May 1992, which have a combined total sample of almost 8,500 people. To begin with, and drawing on the latest available evidence about levels of satisfaction with aspects of the NHS, the study shows that a number of important similarities can be identified across different surveys of public opinion and the NHS. The next part of the article examines the factors associated with satisfaction with both the NHS and some of its constituent parts. A simple conceptual framework for understanding the determinants of public perceptions of the NHS is outlined, and the results of multivariate analyses are presented. These models establish that opinions about the NHS are partly a function of health status and socioeconomic, demographic, regional and other factors, as well as recent experience of using services. The paper concludes by interpreting the findings in the light of current understanding of opinions and contemporary health policy debate. INSETS: NHS in the news, 1991-92.;Health status and recent utilization of health services..

Examines key aspects of private financing in social policy in Great Britain. Operations of a welfare state; Reliance on private insurance; Social division of welfare; Implications for social welfare.

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. (Am J Public Health. 2005;95:626-628.). [ABSTRACT FROM AUTHOR]

Focuses on the scheme employed to monitor and evaluate the implementation of 'Working for Patients' initiated by the National Health Services in Great Britain. Summary of the research projects; Details of the project; Background of the managed competitions employed in the project.

The article reports that policy design and implementation in public health are more neglected than political values. It states that the change of government leadership in England helps to explain why health inequality policies are being refreshed. A broad territory must be covered by any serious consideration of the impact of political science on public health. Much of politics is about values which do not bring themselves easily to scientific examination. According to the author, politics and government is vital to public health and it is time to focus more effort on the improvement of service delivery and performance.

Focuses on the influence of health policy on the improvement and length of the quality of life in Great Britain. Proposition on the improvement of the structure of the National Health Service; Argument on health policy; Impact of health policy on the differences between the health status among social groups.

Introduces a weighted capitation formula for the National Health Service in Great Britain. Proportion between health care resources and health care needs; Allocation of resources for hospital and community health service; Criticisms on the weighted capitation formula.