Objective: Health targets describe government intentions for improving population health. The present paper determines whether the targets which twelve developed countries have set for obesity match the seriousness of the public health problem. Design: Policy documents on general public health, obesity, nutrition and physical activity were obtained by repeated searches of government websites. Details of all relevant targets on overweight, obesity, nutrition and physical activity were extracted. Results: Only four of the countries studied have set targets for specific reductions in the prevalence of obesity. Two have targets that only mention reducing the prevalence of obesity and two other countries wish to halt the rise in prevalence. Two countries currently have targets which are much less ambitious than those in previous policies. No obesity targets are stated in the policies of four countries. Many of the countries studied have set detailed nutrition targets, but these seldom identify desired changes in dietary behaviour. No country has set targets for a reduction in energy intake. The physical activity targets reflect recommendations from the 1990s. Few targets are set for health knowledge or behavioural intentions which are prerequisites for desired lifestyle changes. Conclusions: Most of the countries studied have either set no targets or set very modest targets for reducing the prevalence of obesity. Many countries have physical activity targets that are likely to be insufficient to prevent obesity. Governments need to reconsider targets on obesity and to develop shorter-term targets which monitor desired lifestyle changes.
Policies differ markedly in their organization, the goals and targets that are set, the strategic approaches proposed and areas identified for intervention. Most countries could improve their policies by following the recommendations in the World Heath Organization's European Alcohol Action Plan.
Public health policy underwent substantial transformation during the latter half of the 20th century. The landmark statement was the 1948 World Health Organization (WHO) constitution, which identified good health as a fundamental right and gave the responsibility to governments to achieve it for all their people. However, following World War II, developed countries made substantial investment in health care with less attention paid to public health. The importance of public health was slowly recognised over the period from 1970 to 2000 with the publication of several reports from different organisations. The first authoritative policy statement that the important determinants of health lay outside health care was in the Lalonde Report from Canada. These ideas were subsequently expressed in the WHO Alma-Ata declaration and were emphasised a year later by the US Surgeon General. The idea of setting goals for health improvement also began in the 1970s. The Lalonde Report and the United Kingdom Black Report recommended that targets be used, but the first explicitly stated health targets were set by the US in 1979. WHO also identified the need for such targets at this time, but did not introduce them until 1984. Since then health targets have become a central feature of public health policy in developed countries. The Ottawa Conference on Health Promotion in 1986 championed the view that health promotion was central to achieving health goals internationally. It helped clarify the types of actions needed: that individuals need to be provided with the supportive environment and economic resources to be able to lead healthy lives. In a further development, the Healthy Cities Project was launched with the specific aim of involving political decision-makers in building a strong lobby for public health at the local level. The Healthy Cities Project illustrates how to provide means and opportunity for interventions to be implemented in communities. Concerns with inequalities in health were emphasised in the WHO declaration of Alma-Ata, and were the focus of the United Kingdom Black Report. The Jakarta Conference on Health Promotion in 1997 urged international action on poverty, as it is the major threat to health. International acceptance of the need to tackle inequalities took longer than the acceptance of health targets, but it is now an important feature of public health policy. The advent of the 21st century marked the coming of age of public health. The renewed version of 'Health for All', 'Health for All in the 21st Century', emphasised the one constant goal of WHO that all individuals should achieve their full health potential. Public health is now regarded internationally as being a priority with this WHO goal being adopted as the overarching goal of policy. The challenges it faces in tackling problems such as obesity, inequalities in health, smoking, alcohol and substance abuse are great and will require policies which tackle the economic, social and environmental determinants of health.
This study investigates how public mental health policy addresses the role and needs of those who care for people with mental health problems. Public mental health policy recognises that carers are at increased risk of poor health. Countries want to ensure that mental health services are responsive to the needs of "carers", that carers participate in the planning and implementation of services and that more information should be made available to carers. Respite care is recommended as a way to improve the health of both carers and service users. Unfortunately, policies only identify possibilities for intervention, and rarely identify specific actions to be taken or clarify who has responsibility for delivering interventions. Further the financial implications of the proposals and the need for additional trained staff are seldom discussed. Current proposals for helping carers are inadequate.
In this paper, we investigate the role of cell death in promoting pattern formation within bacterial biofilms. To do this we utilise an extension of the model proposed by Dockery and Klapper [13], and consider the effects of two distinct death rates. Equations describing the evolution of a moving biofilm interface are derived, and properties of steady state solutions are examined. In particular, a comparison of the planar behaviour of the biofilm interface in the different cases of cell death is investigated. Linear stability analysis is carried out at steady state solutions of the interface, and it is shown that, under certain conditions, instabilities may arise. Analysis determines that, while the emergence of patterns is a possibility in 'deep' biofilms, it is unlikely that pattern formation will arise in 'shallow' biofilms.
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