Variations and value improvement in back pain care in one area of England.

The pursuit of value and equity have been put on a legal footing in the NHS with the arrival of the legal duty for all in the NHS to improve health and well-being of the population served, to provide fair access to high quality healthcare, and to use resources sustainably and efficiently. Recognising this we used analysis of variation to help us understand the degree to which we were fulfilling our new duty for people with back pain in Mid-Nottinghamshire and where there might be opportunities for value improvement.MSK Together is a group of clinical and managerial representatives from providers, purchasers, local government, and patients who work collectively to optimise the use of resources for people with MSK conditions in Mid-Nottinghamshire.

Unwarranted variations in end-of-life care and the impact of using an electronic coordination system.

This study looks at the variations in end-of-life care in North-East Essex (eastern England) combining hospital records, official death records and the local electronic end-of-life coordination tool. These differences included dying in hospital (versus a general wish to die in the usual place of residence), and inequity in care provision: the place of death varying according to the cause of death (even for highly predictable conditions); and deprivation being associated with a greater likelihood of dying in hospital. There was a positive correlation between the use of an electronic end-of-life coordination system and dying in the preferred place of care.

Healthy Cities Phase V evaluation: further synthesizing realism.

In this article we reflect on the quality of a realist synthesis paradigm applied to the evaluation of Phase V of the WHO European Healthy Cities Network. The programmatic application of this approach has led to very high response rates and a wealth of important data. All articles in this Supplement report that cities in the network move from small-scale, time-limited projects predominantly focused on health lifestyles to the significant inclusion of policies and programmes on systems and values for good health governance.

Health impact assessment in a network of European cities.

The methodology of health impact assessment (HIA) was introduced as one of four core themes for Phase IV (2003-2008) of the World Health Organization European Healthy Cities Network (WHO-EHCN). Four objectives for HIA were set at the beginning of the phase. We report on the results of the evaluation of introducing and implementing this methodology in cities from countries across Europe with widely differing economies and sociopolitical contexts.

The introduction of health impact assessment in the WHO European Healthy Cities Network.

The World Health Organization (WHO) has been a strong and persistent voice calling for the recognition of the role of health in development and of the impact of socio-economic development on health. Health impact assessment (HIA) is one mechanism that can be used to achieve this goal. The objective of this paper is to describe HIA practice in the WHO European Healthy Cities Network and present some of the initial learning from a collective approach to introducing this relatively new methodology into municipal business.