Health action zones: A new form of partnership for tackling health inequalities? A comparative case study of four local areas in England, 1999-2002.

This study investigated the process of policy development and delivery in relation to the complex problem of health inequalities. The study examined whether Health Action Zones represented a new form of partnership that provided an effective mechanism for policy delivery. A schema of mechanisms for 'collaborative policy delivery' was constructed to provide the theoretical framework for evaluating the policy processes. It was contended that Health Action Zones could represent a practical demonstration and test of network management. The empirical investigation involved a comparative case study analysis of two HAZ and two non-HAZ areas in England. It relied on semi-structured interviews conducted over a period of three years and documentary evidence from all the sites. The development and changes in the health partnerships in the four areas were tracked between 1999 and 2002. Impact was assessed in terms of 'intermediate process outcomes' ie organisational changes and action that took forward strategies addressing health inequalities. The findings suggest that HAZ status helped accelerate growth in capacity for partnership working and the adoption of a more strategic approach to tackling health inequalities. HAZ case studies demonstrated distinct features of partnership working in comparison with the two non-HAZ case studies. HAZs systematically built leadership, management and institutional capabilities around the pursuit of health inequalities that involved organisational learning and development. Strategic progress and changes were more likely if the network building was an integral part of the mainstream processes through which players managed their inter-organisational relationships. The implications for network theory were considered. While network management has an important contribution to make to the policy process and policy delivery, it does not operate in isolation and has to be fostered and resourced. Network theory appears limited in dealing with contextual issues, particularly in coping with the political dynamics of the policy process. The importance of investment in developing the capacity of the network of players to engage in interagency working is not fully recognised. It is contended that more attention needs to be given to context, and to creating the conditions that promote network management and delivery of integrative strategies

Review of effectiveness of laws limiting blood alcohol concentration levels to reduce alcohol-related road injuries and deaths.

The review aimed to assess how effective the blood alcohol concentration (BAC) laws are at reducing road traffic injuries and deaths. It also assessed the potential impact of lowering the BAC limit from 0.081 to 0.05. The review examined: • drink-driving patterns and the associated risk of being injured or killed in a road traffic accident • how BAC limits and related legislative measures have changed drink-drinking behaviour and helped reduce alcohol-related road traffic injuries and deaths • models estimating the potential impact of lowering the BAC limit from 0.08 to 0.05 in England and Wales • lessons from other countries on using BAC laws as part of overall alcohol control and road safety policies. A conceptual framework was used to show how, in theory, a law limiting drivers’ BAC levels could lead to changes in how much drivers drink and the number of alcohol-related road traffic injuries and deaths. The review of evidence tested these theoretical links and the robustness of the underlying assumptions

Tackling health inequalities through partnership working: Learning from a realistic evaluation

UK government health policy now strongly supports local partnership working as a key mechanism for tackling health inequalities. There is, however, still a lack of evidence based operational guidance for the development of local partnerships in tackling inequalities in health, as well as continuing evidence of the deep-rooted political, organizational and cultural barriers to partnership working. This paper reports on the evaluation of a two year Health Education Authority programme of demonstration projects designed to test five different models of partnership working in tackling health inequalities. The evaluation drew on Pettigrew et al.'s (1992) concepts of receptive and non-receptive contexts for change as well as the 'realistic evaluation' of Pawson & Tilley (1997). Data were collected using a range of qualitative methods including semi-structured interviews with key stakeholders and non-participant observation. Six key themes were identified from the case studies: shared strategic vision, leadership and management, relations and local ownership, accountability, organizational readiness and responsiveness to a changing environment. The importance of understanding how project mechanisms worked in the context of national and local policy change is emphasized, and lessons are identified for UK Health Improvement Programmes, Health Action Zones and Primary Care Groups

Health Action Zones: learning to make a difference. Funded/commissioned by: Report submitted to the Department of Health June 1999 PA from mid July 1999 @ £20

Health Action Zones (HAZs) are a central part of the new health policy being forged in Britain in the late 1990s. They are part of a family of regeneration initiatives that are central to the government’s policies of tackling social exclusion and modernising public services. In particular, health action zones are expected to be ‘trailblazers’; pioneering innovative approaches to reducing health inequalities, and developing services that are more responsive to patients and users. Twenty-six health action zones have been established in England. They vary in size and complexity but they share many common characteristics. Not least among these is their emphasis on collaboration and partnership between public and private agencies and voluntary and community organisations

Mixing oil and water. How can primary care organisations improve health as well as deliver effective health care?

Primary care groups are required not only to provide health care to patients but also to improve the health of their populations, i.e. to promote better health. The former is a reactive activity, the latter proactive. One can be done on your own, independently face to face, while the other demands outside resources, involves team-working and partnerships and addresses large constituencies. Is it possible to marry these apparently diametrically-opposed activities within the primary care environment? To mix oil and water? This report, the result of an eighteen-month study, looks in detail at this issue and explores the extent to which there can be synergy between primary care and public health. It will require the WHO's definition of primary health care, based on principles of equity, community involvement and intersectorial collaboration to become a reality. This report investigates the new relationships that will need to be forged and the challenges that will have to be faced if success is to be achieved. Policy makers, health authority managers, primary care practitioners and public health professionals will all find revealing insights into what the future might hold for their roles in the development of primary care and public health