The relationship between socio-economic factors and responsiveness gaps in primary, preventative and health promotion services.

OBJECTIVE: To examine whether there are individual level factors such as socio-economic status that may predict disparities in the public's experiences with and expectations of their health-care providers. DATA SOURCES/STUDY SETTING: Primary data were collected in 2010. The sample comprised of 1211 Israeli citizens above the age of 18. STUDY DESIGN: Participants were randomly approached at one points in time and presented with statements regarding practices they experience and practices that are important to them related to primary care, preventive care and health promotion. We calculated a difference scores for each health-care area. We measured socio-economic status (SES) with three separate variables relating to income, education and living location. DATA COLLECTION/EXTRACTION METHODS: Employees of a professional telephone survey firm conducted the survey. Multiple regression was used with the responsiveness gap in each of three health-care areas as the dependent variables. PRINCIPAL FINDINGS: We found that level of education is negatively related to the extent of the responsiveness gap in both primary and preventive health care and that income is negatively related to the responsiveness gap in health promotion. CONCLUSIONS: Personal characteristics such as SES are related to people's perceptions about the extent of the responsiveness gap. Policy makers can now expend efforts and resources in minimizing such responsiveness gaps among specific populations.

The pursuit of political will: politicians' motivation and health promotion.

The health promotion literature points out a significant gap between declared health promotion policy and practice. The common assumption is that one of the main obstacles to progress is "political will" and the intersectoral action necessary to create healthy environments. The concept of political will is most frequently invoked to explain a lack of action usually rooted in politicians' lack of personal courage or good sense. While stressing the fact that health and its promotion are profoundly political, we claim that the lack of political will is usually not because politicians have shown insufficient personal courage or good sense. Rather, we suggest that one of the reasons for the gap between the need for health promotion policies and political will derives from politicians' lack of attraction to several aspects associated with this policy area. In many cases, politicians are not attracted to the issue of health promotion because of the unique structural conditions usually associated with this policy domain. Using tools related to public policy theory, we suggest a conceptual framework that explains what those conditions are and answers the question of why politicians seem to lack the political will to undertake the design of health promotion policies.