Hard Currency, Solidarity, and Soft Power: The Motives, Implications, and Lessons of Cuban Health Internationalism.

This article explores Cuba's health assistance and support for other countries. It explores the rationale and motivations for Cuba's internationalism in health. It then details the various aspects of its health interventions, including emergency relief, strengthening of health systems, treatment programs, training of health professionals, engagement in multilateral cooperation, and biotechnology. The article analyzes the benefits of Cuba's health internationalism for Cuba and for others. It also explores potential adverse consequences and criticisms of Cuba's approach. The article concludes by noting that Cuba has been ahead of the game in integrating foreign policy and health policy and that its experience may hold lessons for other countries seeking to develop global health strategies.

Representing Whom? U.K. Health Consumer and Patients' Organizations in the Policy Process.

This paper draws on nearly two decades of research on health consumer and patients' organizations (HCPOs) in the United Kingdom. In particular, it addresses questions of representation and legitimacy in the health policy process. HCPOs claim to represent the collective interests of patients and others such as relatives and carers. At times they also make claims to represent the wider public interest. Employing Pitkin's classic typology of formalistic, descriptive, symbolic, and substantive representation, the paper explores how and in what sense HCPOs represent their constituencies. We found that policymakers themselves are less concerned with formal mechanisms adopted by groups and are more concerned with credibility, in particular whether HCPOs carry the confidence of their constituents. While some concerns about legitimacy remain, particularly in relation to funding from commercial interests, we argue that HCPOs bring a unique perspective to the policy process and to focus purely on formalistic representation provides only a partial understanding of their representative role and a constrained view of their collective moral claims.

"Enticing case study" or "celebrated anomaly"? Policy learning from the Cuban health system.

Cuba is regarded as having achieved very good health outcomes for its level of economic development. It has adopted policies and programs that focus on prevention, universal access to healthcare, a strong primary care system, the integration of health in all policies, and public participation in health. It has also established a strong and accessible system of medical education and provides substantial medical aid and support to other countries. Why then, it may be asked, has the Cuban experience not had greater influence on health policies and reforms elsewhere? This article, based on a literature review and new primary sources, analyzes various factors highlighted in the policy transfer literature to explain this. It also notes other factors that have created greater awareness of Cuban health achievements in some countries and which provide a basis for learning lessons from its policies.

The Big Society in an age of austerity: threats and opportunities for Health Consumer and Patients' Organizations in England.

BACKGROUND AND OBJECTIVE: Health consumer and patients' organizations (HCPOs) seek to influence policy. But how are they affected by developments in the policy context and political environment? DESIGN: The article draws on original research into HCPOs in the UK by the authors, including a major survey undertaken in 1999 and interviews with HCPOs and policymakers between 2000 and 2003 as well as a further survey in 2010. It also draws on a review of key government policies on health and the voluntary sector since 1997. RESULTS: Developments in the political environment and policy context have created both opportunities and threats for HCPOs as they seek to influence policy. These include policies to promote choice and competition in public services; support for a greater role for the voluntary sector and civil society in health and welfare (including the current government's 'Big Society' idea); NHS reorganization; changes to the system of patient and public involvement; and austerity measures. Devolution of powers within the UK with regard to health policy and the rising profile of the EU in health matters have also had implications for HCPOs. DISCUSSION AND CONCLUSION: This analysis raises key issues for future research in the UK and elsewhere, such as how will HCPOs be able to maintain independence in an increasingly competitive environment? And how will they fare in an era of retrenchment? There are also challenges for HCPOs in relation to maintaining relationships in a new institutional setting characterized by multilevel governance.

The voluntary sector and health policy: the role of national level health consumer and patients' organisations in the UK.

This article explores the policy role of health consumer and patients' organisations (HCPOs), an important subset of the UK voluntary health sector. Based on research findings from two surveys, the article examines the activities, resources and contacts of HCPOs. It also assesses their impact on health policy and reform. There is some evidence that HCPOs can influence policy and reform. However, much depends on the alliances they build with other policy actors (including other HCPOs), their resources and leadership. HCPOs seem to have more impact on the detail of policy than on the direction of travel. In addition, there are potentially adverse consequences for HCPOs that do engage with the policy process, which may partly explain why some are wary of such involvement. For example, it is possible that HCPOs can be manipulated by government and other powerful policy actors such as health professionals and the drugs industry.

Health, lifestyle, belief and knowledge differences between two ethnic groups with specific reference to tobacco, diet and physical activity.

AIMS: To compare physical activity levels, body mass index, habitual diet, tobacco use and prevalence of non-communicable disease between the two ethnic groups and to identify predictors for differences between groups. BACKGROUND: Tobacco use, poor diet and physical inactivity are major lifestyle risk factors for chronic cardiovascular diseases, certain cancers, diabetes and chronic lung diseases. There are higher risk and incidence of these diseases in some ethnic groups, for example Asians have higher incidence of diabetes. DESIGN: Cross sectional survey. METHODS: Cross sectional survey of Asians of Indian descent and white British adults conducted between October-December 2009. Main outcome variables were lifestyle behaviours and BMI. Self-reported disease diagnosis was also collected. In a regression analysis, predictors of outcome variables were demographic variables and beliefs/attitudes/knowledge towards lifestyle behaviours. RESULTS/FINDINGS: Body mass index, tobacco use and non-communicable disease (except diabetes) were lower in Indians. Indians reported lower physical activity levels and greater salt use than Whites. Tobacco use was higher in Whites, but knowledge, attitudes and beliefs were similar between Whites and Indians. CONCLUSION: Health risk behaviour and morbidity are different between the two ethnic groups. Gender, age, educational level, beliefs, attitudes and knowledge do not explain these differences. Health promotion that aims to improve knowledge will probably not work and innovative methods are needed to improve health in high risk groups.

Prevention better than cure? Health consumer and patients' organisations and public health.

Previous studies of groups representing patients, users and carers in the UK indicate that their principal focus is on health care and treatment services. In recent years, UK government policy has emphasised prevention and health promotion as part of its wider public health agenda. This paper investigates how this might have affected health consumer and patients' organisations (HCPOs) by presenting findings from an online survey of 312 UK groups undertaken in the summer of 2010. The sample was identified using the publicly available membership lists of a number of large alliance organisations. The survey achieved a 39% response rate. The findings suggest that the main focus of lobbying and campaigning remains on health care rather than public health issues. However, a significant minority of groups stated they prioritised public health campaigning and lobbying. Possible explanations for engagement with the public health agenda include: the presence of public health on the government's agenda, the influence of other, more powerful interests in the health policy process, and growing awareness among groups of health promotion, prevention and environmental causes of illness. The paper argues that although HCPOs may be more active in the public health policy arena, more research is needed - notably with regard to their relationship with devolved governments, EU institutions and the current UK government's public health and voluntary sector agenda. The reasons why some groups engage more than others with the public health agenda also merit closer investigation. Moreover, not enough is currently known about the influence of HCPOs on the public health agenda and policies in this field.

Health consumer and patients' organizations in Europe: towards a comparative analysis.

Despite the rise of health consumer and patients' organizations (HCPOs) in modern health-care systems, studies are few and far between. In particular there is a lack of comparative research across Europe and at the pan-European level. In an effort to address this gap, an expert workshop was held in Vienna in February 2006. This involved 22 delegates from 10 European Countries and was funded by the European Science Foundation (ESF). The workshop reviewed the development of HCPOs in Europe and their role in the policy process in order to establish a platform for further research in this field. It found evidence of an increase in HCPOs across European countries, increased engagement with policy makers and political institutions, and the creation of alliance organizations bringing together HCPOs across the sector. However, variations between countries were observed, relating to different political, cultural and health system contexts. There was no consensus on whether the rise of HCPOs constituted a new social movement. An increase in HCPO activity at the pan-European level was noted, reflecting the increased interest of EU institutions in health policy. At both domestic and European levels, concerns about the representativeness and legitimacy of HCPOs were raised as well as questions about their independence (notably with regard to the drugs industry). HCPOs face a number of obstacles including: lack of capacity and resources, fragmentation and the power of more established interests within the health-care system. The workshop concluded that further research is needed in this field, in the form of a comparative study of HCPOs in European countries and an analysis of their activities at the pan-European level.

Health consumer groups in the UK: a new social movement?

This paper argues that a health consumer movement has developed in the United Kingdom over the last decade. Drawing on two empirical studies of groups that promote and/or represent the interests of patients, users and carers, it argues that groups formed by people with personal experience of a condition are now more widespread. Feelings of pain and loss can lead to the identification of others in a similar position, and to the formation of groups and action in the political sphere. Research shows that groups share a common discourse and follow similar participative practices, and there is extensive networking. Informal and formal alliances have formed to pursue joint action and indicate a wider health consumer movement. As governments have also increased the opportunities for participation, this has the potential for patients and carers to shape services in ways more responsive to their needs.

Influencing the national policy process: the role of health consumer groups.

INTRODUCTION: Whilst recent research has focused on consumer involvement at local level in the UK, there have been few studies of the representation of user, carer and patients' interests nationally. This paper concentrates on the role of health consumer groups in representing the collective interests of patients, users and carers in the national policy process. METHODS: The research consisted of (a) a semi-structured postal questionnaire survey of 123 health consumer groups; (b) semi-structured interviews with key informants from 39 health consumer groups; and (c) semi-structured interviews with 31 policy actors. RESULTS: Health consumer groups were diverse in their origins, scope and structure, and undertook a wide range of activities relating to policy and service provision. Whilst around half the groups described their primary purpose as service provision, over four-fifths identified influencing policy at national level as 'very important' or 'important'. Health consumer groups had developed relationships with civil servants, ministers, MPs and peers to widen their policy objectives. Key facilitators in the policy process included experiential knowledge, relationships with policy makers and working in alliances with other health consumer groups or other stakeholders. Key barriers included problems relating to the political agenda, problems with the consultation process, lack of resources and working within a context of unequal power relationships. CONCLUSION: Health consumer groups are becoming increasingly involved in the health policy process and collectively are becoming an increasingly influential stakeholder. They have a key role to play in ensuring that the patient, user and carer voice is heard in the policy process.