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This chapter presents a number of concepts from the fields of public health and child health that are useful in the exploration of child public health. The chapter is divided into four broad themes: a) epidemiological concepts; b) concepts related to health improvement; c) concepts relating to disease prevention; and d) concepts relating to the practice of public health and health promotion.

This chapter deals with how to measure and value different degrees of health improvements — in health terms and in monetary terms. Beyond the valuation of improved health per se, the chapter discusses how to value the production gains following people's return to work as a possible consequence of the improved health. Exercises and suggested readings are included at the end of the chapter.

This chapter reviews the policy and organisational changes that have occurred since 1997 following a change of government. New Labour sought to accord a high priority to the health of the public and was strongly committed to putting both health improvement and health inequalities back on the policy agenda. An important symbol of this new policy emphasis was the appointment of the UK's first ever Minister for Public Health. The chapter presents and assesses the various policy developments from 1997 to the present day, including the two public health White Papers of 1999 and 2004 respectively. It also examines other developments affecting public health within this period, including changes in the structure of the NHS, the relaunching of commissioning under the heading ‘world class commissioning’, and the policy shifts towards markets and choice in the provision of health and health care.

This book sets the scene for the series by comprehensively assessing and critiquing the current state of the public health system in England. It places contemporary challenges and concerns in their historical context, tracing the dominant influence of a medical paradigm on the public health profession and exploring how this has given rise to difficulties for those who subscribe to social or structuralist paradigms. The history of public health is marked by struggles between these competing perspectives and recent policy developments have pointed in contrasting directions. This chapter introduces the various issues that will be tackled in subsequent chapters.

This chapter sums up the key findings of this study on the relation between neighbourhood renewal and health improvement. It highlights the potential of neighbourhoods as places for engagement for addressing health inequalities, not only at the local level, but also in the global context. The chapter also discusses Robert Wright's optimistic argument that we are continually learning how to achieve solutions to the challenges which the growing complexity of societies pose for social policy and governance.

Three questions are addressed in this chapter: Does prevention reduce medical costs? Does the U.S. spend too little on prevention? Should it spend more (and if so, on what)? Since much of the evidence comes from cost-effectiveness studies, a brief explanation of how cost-effectiveness analysis is used to evaluate medical interventions is provided. The evidence, from hundreds of studies published over the last four decades, shows that most preventive interventions add more to medical spending than they save, even as they improve health. With prevention, as with so much else, it costs more to get more. Moreover, the U.S. spends considerably more on prevention than commonly thought (see chapter 2 of this volume), even without considering the vast array of preventive activities outside the medical sector. Prevention is not a solution to the health care cost problem. Each intervention needs to be evaluated individually and the goal should be to find the most effective mix of health services, the one that makes the best use of our resources to improve health and extend life, whether through prevention or treatment.

This chapter is about the terminology and practice of the public health specialty to assist insight into its connections with health services for populations. Public health practice is about considering health at a population level. For orientation, the semantics of the term public health are also discussed as part of aiming for effectiveness of dialogue in this area of health service practice. In the public health specialty there are three core domains of public health practice, and healthcare systems will interact with all three. One of these domains, Healthcare Public Health (HCPH) is particularly relevant to the commissioning of health services. This is concerned with improving health outcomes through health services quality and effectiveness. Its work is an integral part of the commissioning function for health services. All three domains are described for the commissioner’s orientation, namely the work of health improvement, health protection, and healthcare public health.

The importance of social and environmental factors in determining the health status of a population provides the context for the role of health services in health promotion and disease prevention. Health service providers play important roles as advocates, leaders, and partners in disease prevention and health promotion strategies. The initial sections of this chapter discuss the definition of prevention, levels of prevention, and the place of population-wide and high-risk approaches. It then discusses some of the public health skills that are required in prevention programmes, including assessing needs and priorities, evidence of effectiveness, the role of behavioural and implementation sciences, and the importance of evaluation. The chapter illustrates these principles using examples from communicable and non-communicable disease control.

This chapter examines changes in the profiles of completed suicides in Hong Kong and explores the association of suicide rates with changes in the socio-economic environment over the period 1993–2003. It also discusses the impact of the rising popularity of charcoal burning on the overall risk for suicide. Finally, it compares suicide and other leading causes of death, highlighting the significance of suicide prevention to population health improvements in the Hong Kong community.

Chapter 6 introduces the students to a proprietary framework and tools to test, refine, and prepare each student’s system improvement plan (SIP) for implementation. The students revisit their country SIP to refine its constituent process steps and to produce a process flow map of their plan. The flow map illustrates a logical chain that links the proposed inputs through sequential action steps for implementation of the plan to produce the outputs that enable the SIP to attain the projected goals. The authors introduce the proprietary D3A3 model that consists of six interlinked steps: D1—design the intervention plan; D2—determine the measures of success; D3—deliver; A1—assess; A2—analyze; and A3—act. The D3A3 model is used to guide iterative development and agile implementation of system improvement plans. The students will use the D3A3 model to conduct one or more test runs to improve their SIP and increase their confidence that it will deliver the outputs they need. In complex dynamic systems, it is hard to predict the results of change and plans should be subjected to iterative cycles of testing. For this the authors introduce a process called a model for improvement that helps designers to understand the potential impact, effort, feasibility, and risks of implementing their SIP and to progressively test and strengthen plan design and prepare it for implementation.

The De Beaumont Foundation CityHealth project aims to provide city leaders in the United States with both an assessment of their communities and with a package of policy solutions that they can use to improve the health of populations in their cities. In so doing, CityHealth serves as a model for efforts to harness science for action toward improving health in cities. With three out of every five Americans living in cities, policy change in the nation’s most populous urban areas has the most tangible opportunity to impact people’s daily lives and health outcomes. This chapter discusses the goals of the CityHealth project and its successes and challenges, and identifies models that can improve urban health worldwide.

This chapter evaluates the politics of the Obama administration's effort to promote comparative effectiveness research (CER) as the scientific foundation of health care quality improvements and cost control. It argues that elite polarization and a near parity of partisan competition degrades government problem solving in two ways. First, it creates incentives for politicians to transform what plausibly could be consensual “valence” issues, on which nearly all candidates and parties adopt the same stance, into contentious “position” issues, on which candidates and parties take different stances in a zero-sum competition for voter support. Second, elite partisan polarization can stimulate polarization among ordinary voters. Taken together, these twin dynamics can undercut the processes of elite-led social learning and technocratic problem solving on which social progress to no small extent depends. The chapter shows how these distortions played out in 2009–10, when the Obama administration moved forward with its proposal for a major investment in research on the comparative effectiveness of medical treatments, despite the lack of public buy-in for this reform project.

Having rejected the abolition of mental health law in Chapters 4 to 7, Chapter 8 explores the possibility of the reform of mental health law. It explains the Mental Capacity with Support and Support Except Where There is Harm models. It applies the interpretive compass of inherent dignity (including autonomy), equality, and participation to both models and compares them to the Abolition with Support model. It argues in favour of the Mental Capacity with Support model as being compatible with the CRPD (despite the contrary arguments from abolitionists) and more transparent than Abolition with Support. It proposes improvements to the Mental Capacity with Support model. It discusses wider reforms to the mental health system, social reforms, and how reform is possible without abolishing mental health law first.

Since the 1950s, academic and researchers have examined artificial intelligence and the use of computers for assistance with, or automation of, data collection (Schatz & Browndyke, 2002). In the ensuing 60+ years, considerable technological growth has occurred. Perhaps most influential in the field of clinical psychology was the introduction of the personal computer in the 1980s, which allowed individuals to have computing devices in the home and/ or office. Over the past 30 years, the percentage of U.S. households with a computer has dramatically increased, from 8.2% in 1984, to 42% in 1998, to 52% in 2000, to 84% in 2013 (File & Ryan, 2014; Newburger, 2001). As of 2014, approximately 50% of households have a tablet device (such as an iPad) or an e-reader (such as a Kindle or Nook) and approximately 28% of adults age 18 and older have read an e-book in the past year (up from 17% in 2011) (Zickuhr & Rainie, 2014). However, despite widespread ownership of computing devices, in clinical practice, use of technology is not as commonplace. While the vast majority of clinical psychologists have used e-mail or Internet searches in their clinical practice, in a 2009 survey, only 47% had used computerized test administration software, 60% had used a computerized test-scoring software, and 54% had used a computerized test interpretation software (McMinn, Bearse, Heyne, Smithberg, & Erb, 2011), and only 20% (test administration), 29% (test scoring), and 22% (test interpretation) had used these technologies “fairly often” or “very often.” Even as recently as 2009, in a report of an American Psychological Association (APA) Presidential Task Force on Technology, discussion of the role of technology in the future of psychology practice was limited to the use of electronic health records (in the context of documenting service delivery and reimbursement), expanding ways for streamlining assessments and service delivery, and training psychologists to use and integrate technologies (APA, 2009).