Preregistration adult nursing programmes and promotion of a population health agenda: an investigation

Promoting health and preventing ill health are key standards of proficiency for pre-registration nursing education in the UK. The knowledge and skills required to fulfil this role is dependent on students developing a clear understanding of population health during their educational experience. The websites of the 60 undergraduate adult nursing programmes in England that lead to registration were explored, to see how the population health agenda is presented in the information for future candidates. It was found that only 26% of universities promote a population health agenda in the general description of the adult nursing programme, emphasising clinical skills teaching and partnerships with hospital trusts for placement provision. To embrace the breadth of 21st century nursing practice, universities should be marketing nursing proficiencies and raising awareness of the wider context in which care is delivered during recruitment. This approach to branding has the potential to challenge stereotypes and widen participation.

Applying Salutogenesis in Organisations

Organisations influence the health of society through three major paths: the health of their employees through working conditions, the health of their customers through the quality of their products or services and the population’s health at large through their socio-ecological impact. This chapter focuses on the first path of organisations’ impact on employee health through working conditions. It complements the chapter on salutogenic work by expanding the level of analysis to organisational characteristics. The chapter aims to be particularly applicable to for-profit organisations, in which it is exceptionally challenging to introduce a health agenda.

(In)Visible Disease: Motions and Emotions Engendered by Papers and Diagnostics of People Accessing Healthcare in Burkina Faso

Within the last decade, challenges of diagnosis have emerged on the global health agenda, accompanied by an expansion in the use of point-of-care and rapid detection devices in low-resource contexts where laboratory facilities are scarce. Few studies have explored how these changes are shaping people’s diagnostic journeys and their modes of accessing such technologies. In this paper I show how sick people and their families in a peri-urban area in Burkina Faso attempt to access diagnostic technologies and make themselves visible to the healthcare system through papers. In this context, I show how referral papers and diagnostic papers take on significance for people as they attempt to access care and diagnostic technologies and ‘carry’ knowledge between different levels of the healthcare system. The use of papers is often an uncertain undertaking, as they remain unintelligible to the sick and the layperson. I highlight how the form of the papers makes a crucial difference to the ways that sick people are able to use them. Papers and diagnostic technologies present both opportunities and challenges, and simultaneously engender hope, uncertainty, disappointment, and despair for the sick seeking a cure. Uncertainties, especially financial ones, arise with the possibility of new referrals and diagnostic tests, and along the way many give up or are immobilised when faced with diagnostic ambiguity.

111“Place standard” depicts the social gradient in the neighbourhood environment in Cyprus

Background Census data, GIS, surveys and audits are used to profile “place”, each with shortcomings. There are several “neighbourhood environment” tools, including the “Place Standard” a policy and advocacy tool developed in Scotland. “Place” is not a strong feature in the public health agenda in Cyprus. Methods In an internet survey, participants rated 14 features of their neighborhood environment. Exploratory factor, cluster and regression analysis were used to explore the dimensionality of the concept, neighborhood profiles and differences according to individual and area-level characteristics. Results With the exception of safety (M = 4.4, SD = 1.7 on a 1: large to 7: little improvement), 492 participants (mean age 42, 50% residents for >10 years) from 266 postcodes (33% islandwide) did not rate other features favourably. A clear dimensionality of Built, Physical, Social and Service environment supports the construct validity of the tool. People who rated their neighbourhood lower on a social position ladder were consistently more likely to rate all contextual neighrbourhood features less favourably. The social gradient was evident according to individual and area measures of socio-economic disadvantage and appeared stronger in terms of the built than the social environment. Conclusions The “place standard” shows good metric properties and captures the variability ad inequity in the neighbourhood environment. Key messages The “Place Standard” can be used to profile the context of health inequalities. Evidence of a social gradient across all features with larger differences in terms of the built environment.

“The health equity curse”: ethical tensions in promoting health equity

Background Public health (PH) practitioners have a strong moral commitment to health equity and social justice. However, PH values often do not align with health systems values, making it challenging for PH practitioners to promote health equity. In spite of a growing range of PH ethics frameworks and theories, little is known about ethical concerns related to promotion of health equity in PH practice. The purpose of this paper is to examine the ethical concerns of PH practitioners in promoting health equity in the context of mental health promotion and prevention of harms of substance use. Methods As part of a broader program of public health systems and services research, we interviewed 32 PH practitioners. Results Using constant comparative analysis, we identified four systemic ethical tensions: [1] biomedical versus social determinants of health agenda; [2] systems driven agendas versus situational care; [3] stigma and discrimination versus respect for persons; and [4] trust and autonomy versus surveillance and social control. Conclusions Naming these tensions provides insights into the daily ethical challenges of PH practitioners and an opportunity to reflect on the relevance of PH frameworks. These findings highlight the value of relational ethics as a promising approach for developing ethical frameworks for PH practice.