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Introduces papers presented at a world health congress held at Trinity College in Cambridge, Great Britain. Need for the reexamination of systems in the worth increasingly threatened by AIDS, terrorism, environmental destruction and political indifference; Challenge to assumptions that are ingrained in health systems and public health programmes; Goal of the congress which was to offer new thinking on how to create equitable health systems that meet the rights of human beings everywhere.

The article announces the submission of manuscripts aimed at evaluating the progress of health-care reform in China on the tenth anniversary of its ambitious health-care reform plan with the goal of provision of affordable and equitable basic health care for all by 2020.

The article comments on British Secretary of State for Health Andrew Lansley's White Paper "Healthy Lives, Healthy People: Our Strategy for Public Health in England." It points out the failure of Lansley to support the paper's list of promises with credible policies. Particular focus is given to the British government's new approach to public health, along with the Public Health Responsibility Deal. It contends that the funds pledged to public health will not be enough to deal with the diverse problems facing the sector.

Comments on a series of three papers starting in "The Lancet" that will explore the gap between research and clinical practice. The topic of quality of care in a study by Richard Grol and Jeremy Grimshaw; The concept of evidence-based primary care medicine in the second paper; The study of problems in health-care policy in the third paper by Maynard.

Background: Global estimates of the effect of common modifiable risk factors on cardiovascular disease and mortality are largely based on data from separate studies, using different methodologies. The Prospective Urban Rural Epidemiology (PURE) study overcomes these limitations by using similar methods to prospectively measure the effect of modifiable risk factors on cardiovascular disease and mortality across 21 countries (spanning five continents) grouped by different economic levels.Methods: In this multinational, prospective cohort study, we examined associations for 14 potentially modifiable risk factors with mortality and cardiovascular disease in 155 722 participants without a prior history of cardiovascular disease from 21 high-income, middle-income, or low-income countries (HICs, MICs, or LICs). The primary outcomes for this paper were composites of cardiovascular disease events (defined as cardiovascular death, myocardial infarction, stroke, and heart failure) and mortality. We describe the prevalence, hazard ratios (HRs), and population-attributable fractions (PAFs) for cardiovascular disease and mortality associated with a cluster of behavioural factors (ie, tobacco use, alcohol, diet, physical activity, and sodium intake), metabolic factors (ie, lipids, blood pressure, diabetes, obesity), socioeconomic and psychosocial factors (ie, education, symptoms of depression), grip strength, and household and ambient pollution. Associations between risk factors and the outcomes were established using multivariable Cox frailty models and using PAFs for the entire cohort, and also by countries grouped by income level. Associations are presented as HRs and PAFs with 95% CIs.Findings: Between Jan 6, 2005, and Dec 4, 2016, 155 722 participants were enrolled and followed up for measurement of risk factors. 17 249 (11·1%) participants were from HICs, 102 680 (65·9%) were from MICs, and 35 793 (23·0%) from LICs. Approximately 70% of cardiovascular disease cases and deaths in the overall study population were attributed to modifiable risk factors. Metabolic factors were the predominant risk factors for cardiovascular disease (41·2% of the PAF), with hypertension being the largest (22·3% of the PAF). As a cluster, behavioural risk factors contributed most to deaths (26·3% of the PAF), although the single largest risk factor was a low education level (12·5% of the PAF). Ambient air pollution was associated with 13·9% of the PAF for cardiovascular disease, although different statistical methods were used for this analysis. In MICs and LICs, household air pollution, poor diet, low education, and low grip strength had stronger effects on cardiovascular disease or mortality than in HICs.Interpretation: Most cardiovascular disease cases and deaths can be attributed to a small number of common, modifiable risk factors. While some factors have extensive global effects (eg, hypertension and education), others (eg, household air pollution and poor diet) vary by a country's economic level. Health policies should focus on risk factors that have the greatest effects on averting cardiovascular disease and death globally, with additional emphasis on risk factors of greatest importance in specific groups of countries.Funding: Full funding sources are listed at the end of the paper (see Acknowledgments). [ABSTRACT FROM AUTHOR]

Implementation research is important in global health because it addresses the challenges of the know-do gap in real-world settings and the practicalities of achieving national and global health goals. Implementation research is an integrated concept that links research and practice to accelerate the development and delivery of public health approaches. Implementation research involves the creation and application of knowledge to improve the implementation of health policies, programmes, and practices. This type of research uses multiple disciplines and methods and emphasises partnerships between community members, implementers, researchers, and policy makers. Implementation research focuses on practical approaches to improve implementation and to enhance equity, efficiency, scale-up, and sustainability, and ultimately to improve people's health. There is growing interest in the principles of implementation research and a range of perspectives on its purposes and appropriate methods. However, limited efforts have been made to systematically document and review learning from the practice of implementation research across different countries and technical areas. Drawing on an expert review process, this Health Policy paper presents purposively selected case studies to illustrate the essential characteristics of implementation research and its application in low-income and middle-income countries. The case studies are organised into four categories related to the purposes of using implementation research, including improving people's health, informing policy design and implementation, strengthening health service delivery, and empowering communities and beneficiaries. Each of the case studies addresses implementation problems, involves partnerships to co-create solutions, uses tacit knowledge and research, and is based on a shared commitment towards improving health outcomes. The case studies reveal the complex adaptive nature of health systems, emphasise the importance of understanding context, and highlight the role of multidisciplinary, rigorous, and adaptive processes that allow for course correction to ensure interventions have an impact. This Health Policy paper is part of a call to action to increase the use of implementation research in global health, build the field of implementation research inclusive of research utilisation efforts, and accelerate efforts to bridge the gap between research, policy, and practice to improve health outcomes. [ABSTRACT FROM AUTHOR]

In the first paper in this Series we assessed theoretical and empirical evidence and concluded that the health of people living in slums is a function not only of poverty but of intimately shared physical and social environments. In this paper we extend the theory of so-called neighbourhood effects. Slums offer high returns on investment because beneficial effects are shared across many people in densely populated neighbourhoods. Neighbourhood effects also help explain how and why the benefits of interventions vary between slum and non-slum spaces and between slums. We build on this spatial concept of slums to argue that, in all low-income and-middle-income countries, census tracts should henceforth be designated slum or non-slum both to inform local policy and as the basis for research surveys that build on censuses. We argue that slum health should be promoted as a topic of enquiry alongside poverty and health. [ABSTRACT FROM AUTHOR]

Land-use and transport policies contribute to worldwide epidemics of injuries and non-communicable diseases through traffic exposure, noise, air pollution, social isolation, low physical activity, and sedentary behaviours. Motorised transport is a major cause of the greenhouse gas emissions that are threatening human health. Urban and transport planning and urban design policies in many cities do not reflect the accumulating evidence that, if policies would take health effects into account, they could benefit a wide range of common health problems. Enhanced research translation to increase the influence of health research on urban and transport planning decisions could address many global health problems. This paper illustrates the potential for such change by presenting conceptual models and case studies of research translation applied to urban and transport planning and urban design. The primary recommendation of this paper is for cities to actively pursue compact and mixed-use urban designs that encourage a transport modal shift away from private motor vehicles towards walking, cycling, and public transport. This Series concludes by urging a systematic approach to city design to enhance health and sustainability through active transport and a move towards new urban mobility. Such an approach promises to be a powerful strategy for improvements in population health on a permanent basis. [ABSTRACT FROM AUTHOR]

The health and care sector plays a valuable role in improving population health and societal wellbeing, protecting people from the financial consequences of illness, reducing health and income inequalities, and supporting economic growth. However, there is much debate regarding the appropriate level of funding for health and care in the UK. In this Health Policy paper, we look at the economic impact of the COVID-19 pandemic and historical spending in the UK and comparable countries, assess the role of private spending, and review spending projections to estimate future needs. Public spending on health has increased by 3·7% a year on average since the National Health Service (NHS) was founded in 1948 and, since then, has continued to assume a larger share of both the economy and government expenditure. In the decade before the ongoing pandemic started, the rate of growth of government spending for the health and care sector slowed. We argue that without average growth in public spending on health of at least 4% per year in real terms, there is a real risk of degradation of the NHS, reductions in coverage of benefits, increased inequalities, and increased reliance on private financing. A similar, if not higher, level of growth in public spending on social care is needed to provide high standards of care and decent terms and conditions for social care staff, alongside an immediate uplift in public spending to implement long-overdue reforms recommended by the Dilnot Commission to improve financial protection. COVID-19 has highlighted major issues in the capacity and resilience of the health and care system. We recommend an independent review to examine the precise amount of additional funds that are required to better equip the UK to withstand further acute shocks and major threats to health. [ABSTRACT FROM AUTHOR]

The global pandemic of physical inactivity requires a multisectoral, multidisciplinary public-health response. Scaling up interventions that are capable of increasing levels of physical activity in populations across the varying cultural, geographic, social, and economic contexts worldwide is challenging, but feasible. In this paper, we review the factors that could help to achieve this. We use a mixed-methods approach to comprehensively examine these factors, drawing on the best available evidence from both evidence-to-practice and practice-to-evidence methods. Policies to support active living across society are needed, particularly outside the health-care sector, as demonstrated by some of the successful examples of scale up identified in this paper. Researchers, research funders, and practitioners and policymakers in culture, education, health, leisure, planning, and transport, and civil society as a whole, all have a role. We should embrace the challenge of taking action to a higher level, aligning physical activity and health objectives with broader social, environmental, and sustainable development goals. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has placed enormous strain on countries around the world, exposing long-standing gaps in public health and exacerbating chronic inequities. Although research and analyses have attempted to draw important lessons on how to strengthen pandemic preparedness and response, few have examined the effect that fragmented governance for health has had on effectively mitigating the crisis. By assessing the ability of health systems to manage COVID-19 from the perspective of two key approaches to global health policy-global health security and universal health coverage-important lessons can be drawn for how to align varied priorities and objectives in strengthening health systems. This Health Policy paper compares three types of health systems (ie, with stronger investments in global health security, stronger investments in universal health coverage, and integrated investments in global health security and universal health coverage) in their response to the ongoing COVID-19 pandemic and synthesises four essential recommendations (ie, integration, financing, resilience, and equity) to reimagine governance, policies, and investments for better health towards a more sustainable future. [ABSTRACT FROM AUTHOR]

All forms of Brexit are bad for health, but some are worse than others. This paper builds on our 2017 analysis using the WHO health system building blocks framework to assess the likely effects of Brexit on the National Health Service (NHS) in the UK. We consider four possible scenarios as follows: a No-Deal Brexit under which the UK leaves the EU on March 29, 2019, without any formal agreement on the terms of withdrawal; a Withdrawal Agreement, as negotiated between the UK and EU and awaiting (possible) formal agreement, which provides a transition period until the end of December, 2020; the Northern Ireland Protocol's backstop coming into effect after the end of that period; or the Political Declaration on the Future Relationship between the UK and EU. Our analysis shows that a No-Deal Brexit is substantially worse for the NHS than a future involving the Withdrawal Agreement, which provides certainty and continuity in legal relations while the Political Declaration on the Future Relationship is negotiated and put into legal form. The Northern Ireland backstop has varying effects, with continuity in some areas, such as health products, but no continuity in others. The Political Declaration on the Future Relationship envisages a relationship that is centred around a free-trade agreement, in which wider health-related issues are largely absent. All forms of Brexit, however, involve negative consequences for the UK's leadership and governance of health, in both Europe and globally, with questions about the ability of parliament and other stakeholders to scrutinise and oversee government actions. [ABSTRACT FROM AUTHOR]

Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health. The national strategic laboratory plan should deliver a tiered, networked laboratory system as a central element. Appropriate financing should be provided, at a level of at least 4% of health expenditure. Financing of new technologies such as molecular diagnostics is challenging for LMICs, even though many of these tests are cost-effective. Point-of-care testing can substantially reduce test-reporting time, but this benefit must be balanced with higher costs. Our research analysis highlights a considerable deficiency in advocacy for PALM; pathologists have been invisible in national and international health discourse and leadership. Embedding PALM in LMICs can only be achieved if pathologists advocate for these services, and undertake leadership roles, both nationally and internationally. We articulate eight key recommendations to address the current barriers identified in this Series and issue a call to action for all stakeholders to come together in a global alliance to ensure the effective provision of PALM services in resource-limited settings. [ABSTRACT FROM AUTHOR]

This Series paper describes the first systematic effort to review the unmet mental health needs of adults in China and India. The evidence shows that contact coverage for the most common mental and substance use disorders is very low. Effective coverage is even lower, even for severe disorders such as psychotic disorders and epilepsy. There are vast variations across the regions of both countries, with the highest treatment gaps in rural regions because of inequities in the distribution of mental health resources, and variable implementation of mental health policies across states and provinces. Human and financial resources for mental health are grossly inadequate with less than 1% of the national health-care budget allocated to mental health in either country. Although China and India have both shown renewed commitment through national programmes for community-oriented mental health care, progress in achieving coverage is far more substantial in China. Improvement of coverage will need to address both supply-side barriers and demand-side barriers related to stigma and varying explanatory models of mental disorders. Sharing tasks with community-based workers in a collaborative stepped-care framework is an approach that is ripe to be scaled up, in particular through integration within national priority health programmes. India and China need to invest in increasing demand for services through active engagement with the community, to strengthen service user leadership and ensure that the content and delivery of mental health programmes are culturally and contextually appropriate. [ABSTRACT FROM AUTHOR]

The private sector has a large and growing role in health systems in low-income and middle-income countries. The goal of universal health coverage provides a renewed focus on taking a system perspective in designing policies to manage the private sector. This perspective requires choosing policies that will contribute to the performance of the system as a whole, rather than of any sector individually. Here we draw and extrapolate main messages from the papers in this Series and additional sources to inform policy and research agendas in the context of global and country level efforts to secure universal health coverage in low-income and middle-income countries. Recognising that private providers are highly heterogeneous in terms of their size, objectives, and quality, we explore the types of policy that might respond appropriately to the challenges and opportunities created by four stylised private provider types: the low-quality, underqualified sector that serves poor people in many countries; not-for-profit providers that operate on a range of scales; formally registered small-to-medium private practices; and the corporate commercial hospital sector, which is growing rapidly and about which little is known. [ABSTRACT FROM AUTHOR]

Since 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers' and employers' organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancet's Series on France, we challenge conventional wisdom about health care in France. First, we focus on policy and institutional transformations that have affected deeply the governance of health care over past decades. We argue that the health system rests on a diversity of institutions, policy mechanisms, and health actors, while its governance has been marked by the reinforcement of national regulation under the aegis of the State. Second, we suggest the redistributive mechanisms of the health insurance system are impeded by social inequalities in health, which remain major hindrances to achieving objectives of justice and solidarity associated with the conception of health care in France. [ABSTRACT FROM AUTHOR]

This first paper of the Lancet Series on ending preventable stillbirths reviews progress in essential areas, identified in the 2011 call to action for stillbirth prevention, to inform the integrated post-2015 agenda for maternal and newborn health. Worldwide attention to babies who die in stillbirth is rapidly increasing, from integration within the new Global Strategy for Women's, Children's and Adolescents' Health, to country policies inspired by the Every Newborn Action Plan. Supportive new guidance and metrics including stillbirth as a core health indicator and measure of quality of care are emerging. Prenatal health is a crucial biological foundation to life-long health. A key priority is to integrate action for prenatal health within the continuum of care for maternal and newborn health. Still, specific actions for stillbirths are needed for advocacy, policy formulation, monitoring, and research, including improvement in the dearth of data for effective coverage of proven interventions for prenatal survival. Strong leadership is needed worldwide and in countries. Institutions with a mandate to lead global efforts for mothers and their babies must assert their leadership to reduce stillbirths by promoting healthy and safe pregnancies. [ABSTRACT FROM AUTHOR]

The billions of people with latent tuberculosis infection serve as the seedbeds for future cases of active tuberculosis. Virtually all episodes of tuberculosis disease are preceded by a period of asymptomatic Mycobacterium tuberculosis infection; therefore, identifying infected individuals most likely to progress to disease and treating such subclinical infections to prevent future disease provides a crucial opportunity to interrupt tuberculosis transmission and reduce the global burden of tuberculosis disease. Programmes focusing on single strategies rather than comprehensive programmes that deliver an integrated arsenal for tuberculosis control might continue to struggle. Tuberculosis preventive therapy is a poorly used method that is essential for controlling the reservoirs of disease that drive the epidemic. Comprehensive control strategies that combine preventive therapy for the most high-risk populations and communities with improved case-finding and treatment, control of transmission, and health systems strengthening could ultimately lead to worldwide tuberculosis elimination. In this Series paper we outline challenges to implementation of preventive therapy and provide pragmatic suggestions for overcoming them. We further advocate for tuberculosis preventive therapy as the core of a renewed worldwide focus to implement a comprehensive epidemic control strategy that would reduce new tuberculosis cases to elimination targets. This strategy would be underpinned by accelerated research to further understand the biology of subclinical tuberculosis infections, develop novel diagnostics and drug regimens specifically for subclinical tuberculosis infection, strengthen health systems and community engagement, and enhance sustainable large scale implementation of preventive therapy programmes. INSET: Panel 1: Populations and individuals who benefit from tuberculos.. [ABSTRACT FROM AUTHOR]

The article presents the final paper in a series on the links between international trade, trade liberalization, globalization, and health. The article outlines three major issues relating to establishing evidence of the implications of linkages between trade and health, building capacity for analysis of these links and ensuring that the health community has a voice in trade negotiations and decisions. An agenda for action by various health organizations such as the World Health Organization, the World Trade Organization, the World Bank and International Monetary Fund, among others, is also outlined.

Interconception is defined as the period of time between pregnancies or the first 24 months post partum. During interconception, visits for maternal and child health offer the opportunity for parents to be engaged with health messages, and the health-care professionals involved are more easily identifiable than in the preconception period. Beneficial outcomes, such as improved weight management and nutritional intake, might be reached in a shorter timescale in the interconception period than in the preconception period. We aimed to synthesise articles and guidelines on interconception care to develop recommendations for research, public health policy, and practice. In this literature review and policy analysis, we searched four academic databases (Cochrane library, Embase, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature), using MeSH and free-text terms (including but not limited to "interconception", "post-partum", "nutrition", "diet", and "primary care"), for reviews published in English on nutrition for parents in the interconception and post-partum period between Jan 1, 2010, and Jan 21, 2021. Outcomes related to maternal nutrition and weight management were considered. A scoping search on interconception pilot studies and a review of guidelines published by UK public health organisations and government agencies were also conducted online. Strength of evidence was assessed for review articles by two reviewers using Health Evidence guidelines developed by McMaster University, Canada. Findings were analysed as a narrative synthesis. We included 47 documents from a scoping search of grey literature and websites, 29 full-text review articles (after screening 1780 titles and abstracts), and six pilot studies from our database search on interconception and post-partum care. 535 (30%) of 1780 titles and abstracts, and 23 (33%) of 70 full-text papers, were double-screened by another reviewer to ensure consistency. Most reviews were of strong quality (20 [69%]), followed by moderate (seven [24%]), and weak (two [7%]). Interconception care opportunities for parents include the post-partum period, family planning, routine practice, and risk assessment. Various stakeholders have a role in interconception care including general practitioners, health visitors, dieticians, nutritionists, health psychologists, community groups, local authorities, and charities. The guidelines advise increased utilisation of existing community-based services. Interconception offers an opportunity for health-care professionals to promote maternal health through routine appointments, but training in communication skills based on empowering behaviour-change principles will be required. Risk assessments should be conducted on the basis of previous pregnancy outcomes—eg, follow-up care following gestational diabetes. Although we found little evidence on interventions in the interconception period, this review provides recommendations for UK health-care systems that could improve life-course health for mothers and potentially their offspring—eg, by reducing childhood obesity. RANK Foundation and Public Policy Southampton. [ABSTRACT FROM AUTHOR]

Despite having achieved an average life expectancy of 75 years, much the same as that of more developed countries, Mexico entered the 21st century with a health system marred by its failure to offer financial protection in health to more than half of its citizens; this was both a result and a cause of the social inequalities that have marked the development process in Mexico. Several structural limitations have hampered performance and limited the progress of the health system. Conscious that the lack of financial protection was the major bottleneck, Mexico has embarked on a structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH), which has introduced new financial rules and incentives. The main innovation of the reform has been the Seguro Popular (Popular Health Insurance), the insurance-based component of the SSPH, aimed at funding health care for all those families, most of them poor, who had been previously excluded from social health insurance. The reform has allowed for a substantial increase in public investment in health while realigning incentives towards better technical and interpersonal quality. This paper describes the main features and initial results of the Mexican reform effort, and derives lessons for other countries considering health-system transformations under similarly challenging circumstances. [ABSTRACT FROM AUTHOR]

Summary Background Valid information about cause-specific child mortality and morbidity is an essential foundation for national and international health policy. We undertook a systematic review to investigate the geographical dispersion of and time trends in publication for policy-relevant information about children's health and to assess associations between the availability of reliable data and poverty. Methods We identified data available on Jan 1, 2001, and published since 1980, for the major causes of morbidity and mortality in young children. Studies with relevant data were assessed against a set of inclusion criteria to identify those likely to provide unbiased estimates of the burden of childhood disease in the community. Findings Only 308 information units from more than 17 000 papers identified were regarded as possible unbiased sources for estimates of childhood disease burden. The geographical distribution of these information units revealed a pattern of small well-researched populations surrounded by large areas with little available information. No reliable population-based data were identified from many of the world's poorest countries, which account for about a third of all deaths of children worldwide. The number of new studies diminished over the last 10 years investigated. Interpretation The number of population-based studies yielding estimates of burden of childhood disease from less developed countries was low. The decreasing trend over time suggests reductions in research investment in this sphere. Data are especially sparse from the world's least developed countries with the highest child mortality. Guidelines are needed for the conduct of burden-of-disease studies together with an international research policy that gives increased emphasis to global equity and coverage so that knowledge can be generated from all regions of the world. [ABSTRACT FROM AUTHOR]

Offers a paper presented at a congress of experts on global health and health policies which was held at Trinity College in Cambridge, UK. Consideration of everyday bioethics as opposed to bioethics tied up with technological advances in medicine; Examples where the two forms of bioethics collide; Argument for universal principles in bioethics which calls for equal dignity of every individual and equity of life, disease and death; How current systems tend towards thinking of health as a value rather than a right; Efforts of global communities to address this thinking; Contention that the policy of the U.S. in Iran proves the contradiction between thought and effort in today's world; Belief that the future of health and health policies is connected to the resolutions of the frequent contradictions found between policies and efforts.

Offers a paper presented at a congress of experts on global health and health policies which was held at Trinity College in Cambridge, UK. Exploration of moral values as they impact public health policies; Use of ethics and moral values to mobilise support for global health initiatives; Presentation of four schools of moral thought used to justify health programmes; Humanitarianism, utilitarianism, equity and rights; Definition of each school of morality; Influence that the selection of information has on ethical assessments of programmes; Different ways that moral values can support global health initiatives.

Offers a paper presented at a congress of experts on global health and health policies which was held at Trinity College in Cambridge, UK. Examination of human dignity and its definition; How it is necessary to study the social relations among human beings and the concepts and values underlying them; Isaiah Berlin and his writings on liberty; Tolerance lessons from Jonathan Sacks in his book "The Dignity of Difference"; Works of medical historian Oswei Temkin on the history of respect as a concept in human health; Other famous thinkers on the subject; Belief that the notion of dignity could prove to be a catalyst for revision of thought about the conduct medical programmes.

Offers a paper presented at a congress of experts on global health and health policies which was held at Trinity College in Cambridge, UK. Examination of the debates over unequal medical care within and between countries; Belief there is a parallel debate at the philosophical level on justice or fair and equitable treatment for all people; Application of John Rawls' theory of justice on the application of health and a proposal for an alternative philosophical framework rooted in Amartya Sen's capability approach and Aristotle's political theory for thinking about inequalities.

Offers a paper presented at a congress of experts on global health and health policies which was held at Trinity College in Cambridge, UK. Exploration of the unevenness of medical care worldwide which results in remarkably varied life expectancies; Offers traditional philosophies of justice and health care and an alternative view that is rooted in Amartya Sen's capability approach and Aristotle's political theory; Discussion of how these principles can be applied for health improvement across the globe.

The author discusses a paper by Olle Lundberg and colleagues on the relationship between measures of health and welfare-state policies. He comments on the original version of the report Nordic Experience: Welfare States and Public Health, noting that it explicitly addresses social inequalities in health and mortality within countries. He explains that Lundberg's paper does not address the social inequalities. He criticizes policies which target those whom he describes as truly needy.

Reports on the changes in health policy in Australia. Issue of the medical workforce as priority; Argument of the Victorian Health Department paper on the notion of supplier-induced demand; Recommendations of the Victorian paper; Main policy challenge from New South Wales; Focus of the policy; Important feature of the draft policy; Switch of focus from policy to personality.

The article comments on the proposed Sustainable Development Goals (SDG) for the post-2015 period. Topics discussed include a paper by Ole Norheim and colleagues which proposes to avoid 40% of premature deaths in each country, the factors to be considered in deliberations on the SDG health goal and targets, and a partnership that has been established to accelerate the achievement of MDGs pertaining to maternal, neonatal, and child health.

The article discusses a paper published within the issue by Karen Eggleston and colleagues on disparities in health and health care in Myanmar.

Focuses on why prison health should be a public health priority. Information from the WHO report, "Status Paper on Prisons, Drugs and Harm Reduction," suggesting harm-reduction strategies are needed to stop the spread of communicable disease in prisons; Factors contributing to health inequalities, especially among prisoners; Behavior patterns that need intervention; View that health policy is based on political prejudice and that government has to stop denying the existence of injecting drug use and sexual intercourse in prisons.

Reports on an approach to medical practice in the United Kingdom in which patients will be actively encouraged to become partners in decisions about their treatment. Increase in health user groups; Use of the Internet to widen the information base; Increase of patient choice of hospitals for elective surgery; Reference to a December 2003 policy paper entitled "Building on the best--choice responsiveness and equity in the NHS"; Role of Harry Cayton in the push for more patient involvement.

Presents medical news briefs for the week leading up to May 27, 2000. Legislation protecting participants in United States medical trials; Japanese initiative to improve medical care in remote parts of the country; Series of mock terrorist attacks by the US federal government designed to test responses of local authorities; Call for a ban in Austria of diapers that contain tributyl tin (TBT).

Reports on the publication of the Labour Party's health white paper, which accepts the purchase-provider framework of the British government's reforms and recognizes the role of family doctors in commissioning health care. Scrutiny of Labour's proposal by health service; Criticisms to the government's reforms; Labour's opinion on the health care issue; Basis of Labour's adoption of the purchaser/provider principle.