Review : Ethics for health care (2nd edition) by Catherine Berglund

Ethics is a broad discipline and in health the debate between bioethics and behavioural ethics is one that goes to the centre of public health debates.

Designing a health system for equity

The key discussions about the relationship between health and equity have understandably concerned the causal relationship between various social, economic, cultural and environmental determinants of health and the health status of populations by socioeconomic status, class or other divisions that may be used to illustrate health inequalities. (Acheson (1998); "Bringing Britain together" (1998); Kawachi et al (1997); Canada (1997); Dixon (1999); Marmot (1998); Wilkinson (1996); RACP (1999); WHO (1998), Cochrane/Campbell (2000))

Similarly, there has been key discussion about the nature of organizations and their ability to affect and/or respond to change. We know quite a deal about organizations and their structures. And we now have (as we be shown below) an understanding from both practice and theory of the changes needed for organizations to evolve successfully.

General practice : contribution to health and equity

The evidence that a primary health approach enhances health outcomes, increases system effectiveness and is cost effective gives a new impetus for general practice within the continuum of health services. At the same time, in Australia the establishment of the Divisions of General Practice and their continued support has led to a new found confidence in general practice.

Health system reform and social capital

Jim Hyde suggests that the research on building the capacity of communities and the accumulation of social capital shows that how we organize our health systems - in both micro and macro contexts - is important. He argues that collaboration, flexibility and community participation must become central in health structures.

Getting research into policy : lots of ideas but how do we make it happen? Insights from the policy experience

Evidence and health policy discussions to date have largely focused on the relationship between those generating research evidence and policy decision-makers and how improving this relationship will increase research use in policy development. All too often policy makers are perceived as the problem, not understanding or seeing the importance of research evidence. Policy makers do have a responsibility to source and use available evidence, as do researchers to the sharp and meaningful production and syntheses of policy relevant research evidence. This takes more than improved communication mechanisms between individual researcher and policy makers. Evidence-informed policy making is a science in its own right requiring the development and application of methods that conceptualise, synthesise and exchange research evidence. Policy organisations need to develop as receptor sites for research and its application to day-to-day decision-making, this is a significant program of work if it is to be done well and affect the evidence culture of organisations.

Capacity building : just rhetoric, or a way forward in addressing health inequality?

Issue addressed: It is time to move beyond defining the problem of health inequality to taking action. The response required is complex and calls for system wide action. It is in this context that a discussion of increasing the capacity of the health system to respond to health inequality is both timely and essential. Methods: This paper looks at a capacity building framework that has been developed by the New South Wales Health Department and provides an example of a number of projects that have applied capacity building strategies. Conclusion: Addressing health inequality presents a significant challenge to health promotion practitioners. Emerging capacity building theory provides direction for strategies to build the capacity of a health system to address equity. It proposes a set of practical actions using the five focus areas of organisational development, workforce development, resource allocation, partnerships and leadership. So what?: A capacity building approach by itself will not provide the mandate and framework for the action that needs to be taken to address health inequality, but it helps to ensure that once potential solutions are identified the health system has the capacity to respond.