Measuring the health of urban populations: what progress have we made?

This paper considers the progress that has been made over the past 15 years in establishing an information base for the measurement of health variations, and for the assessment of the health needs of vulnerable populations living in urban areas. Four small areas, two in Coventry and two in Leicester, were explored. An extensive exercise in data trawling was undertaken and the available data were examined. On the basis of this exercise, the findings and recommendations of a paper published 15 years ago were revisited to assess the extent of the progress that had been made in the development of appropriate data sources. It was found that considerable progress had been made in provision of data relating to health status and health determinants, but that knowledge of small area populations had failed to keep up with the changing demographic structures of recent years. As a consequence, the possibilities for the exploitation and interpretation of health status and health determinant data are limited. An approach to data collation which combines available quantitative and qualitative data sources is currently being trialled in one of the four areas studied. It is argued that this provides the approach that will be most effective for the foreseeable future.

Transport and health--a five-country perspective.

Devolution in the UK has, inadvertently, provided a natural experiment for comparing the impact of different approaches to policy and practice on populations that are broadly similar by most criteria. Realizing the potential gold mine that this presents for comparing policy and practice in the field of public health, the UK Public Health Association has established a Devolution Strategic Interest Group to explore and capitalize on this. From the start, the Group has included the Republic of Ireland in its purview to add an extra dimension of diversity and innovation. Having previously looked at the organization of health care and public health, and at policy and practice on food, nutrition and obesity, the Group opted to look at transport and health this year. Here, the links between separate relevant policy streams are less obvious and clearly less developed than those for food, nutrition and obesity. Also, the perceived need to raise the issue up the public health agenda provides a new challenge to campaigning action for the Group.

Obesogenic island: the financial burden of private transport on low-income households.

BACKGROUND: The physical and social environment influences access to a healthy lifestyle, of which transport is one determining factor. This paper estimates the cost of transport on the island of Ireland. METHODS: Budget standards were developed on the basis of costs of baskets of core goods and services required for daily living. The transport budget was based on the needs of an urban living family. Financial capacity of the family relative to transport basket costs was determined. RESULTS: Transport costs vary depending on family type and car ownership. The motoring costs for a family with two unemployed adults, with a weekly financial capacity of 388.28 euros and 427.70 euros, respectively, for the Republic of Ireland and Northern Ireland, amount to 94.78 euros and 74.68 euros, representing 18 and 10% of the family's weekly income. CONCLUSION: The prohibitive costs of private transport present an opportunity for policy makers to consider creating supportive environments incorporating the more cost-effective and environmentally friendly options of public transport. Without such measures, dependence on private transport will exacerbate the incidence of food poverty and the health inequalities consequent upon it.

An analytical framework of physician productivity and variation in utilization.

The utilization of medical services by patients is an important determinant of doctor productivity, but this factor does not appear to have been given much attention in previous studies. In order to answer the question of why is there a wide variation in doctor output at low level medical facilities in China, an analytical framework of doctor productivity and utilization is developed. The simulation model is used to produce data that can be analyzed by such a framework. Great uncertainty about patient flows is one reason for the average lower and varying doctor productivity in lower level health facilities. Until uncertainty can be reduced, more flexibility is needed at the lower level to cope with changing utilization patterns and patient characteristics. The management by doctors of non-patient care activities (preventive programmes, medical research, teaching, and administration) is crucial to any approach to using doctor resources more effectively and efficiently.

Using problem structuring methods in strategic planning.

In this paper we present approaches to problem structuring that have been employed to derive planning guidelines as part of a comprehensive strategic planning process. The approaches were developed for use in the context of a developing country, where quantitative data is particularly scarce. They rely heavily upon the informed judgement of technical planning officers. We discuss ways of ensuring that the approach remains flexible and participative.

An approach to setting priorities in health planning.

This paper describes work undertaken in Pakistan within a project to strengthen the health planning system, aimed at improving the capacity of the planning cells to identify priorities and develop broad strategic guidelines. The work starts from the premise that identification of priorities requires two stages. In the first stage, problems must be structured and defined in a way that is accepted by all major stakeholders in the planning process. In the second stage, a transparent process of decision making must exist which will provide the means for the planning group to establish priorities and time-scales. The tools chosen in this instance were selected in relation to the characteristics of the local environment, and the paper describes these.

Health planning in Pakistan: a case study.

Health planning is an essential function of the state. For it to be successful, a number of conditions need to be satisfied. In particular it needs to be flexible, participative and integrated with other decision processes. Despite some strengths, the health planning system in Pakistan has generally failed to provide the framework to allow such an approach. Links between strategic and operational planning have been weak; decision-making has been very centralized; there has been a lack of functional clarity; the respective roles of bureaucrats and politicians have been unclear; and, links between capital and recurrent budgets and between planning and implementation have been weak. As a result, there is a number of imbalances in the allocation of resources. The introduction of a revised health planning system for Pakistan is discussed. The constraints on such a system and an initial assessment of its success are presented.