The discipline of public health has played an important role in showing that the health of populations depends on more than the amount and quality of the health services available. The relationship between health services and health status has been a traditional theme within the discipline. This paper proposes that public health has a part to play in current health reform debates and research, which have been dominated by attention to economic incentives and the technical operation of the systems. The focus has been on the inputs to and processes within health systems, with relatively little attention to the likely impact of these changes on outcomes and population health. The paper considers one aspect of health reforms which affects population health status: the part played by the social values of choice and equity. It gives an analysis of these concepts to help evaluate reforms, and as a basis for empirical research into the impact of reforms. It considers how the NHS reforms have affected choice and equity and how to increase patient choice and uphold certain types of equity which many health service staff and the public believe to be important. It shows how some types of choice conflict with some types of equity and that different groups in society benefit according to whether choice or equity is more prominent in health reform. The purpose of this paper is to help researchers, public health practitioners and policy makers consider, for a particular health reform, the following questions: i) will reforms increase the choices which are important to most people?, ii) what will the effect be on different types of equity?, iii) how will the changes affect population health?, iv) how should public health aims be pursued in systems with market competition?.
- Health reform