The objective of the article was to offer an operational framework to assess cross cultural adaptation processes of instruments developed in other linguistic, social and cultural contexts. It covers the need for using robust measurement tools; the importance of 'universal' instruments that permit cross cultural fi ne-tuning; and stresses the need for adapting existent instruments rather than developing new ones. Existing controversies and proposals for different procedures in current literature are reviewed and a model for adapting instruments is presented. This synthesis covers the operational steps involved in evaluating concepts, semantic and operational items, and presents psychometric analysis guidelines that underlay an evaluation of measurement equivalence. Finally, the need for adequately controlling the quality of information presented in epidemiological studies, including a meticulous cross-cultural adaptation of research agendas, is reinforced.

Brazil is a large complex country that is undergoing rapid economic, social, and environmental change. In this Series of six articles, we have reported important improvements in health status and life expectancy, which can be ascribed largely to progress in social determinants of health and to implementation of a comprehensive national health system with strong social participation. Many challenges remain, however. Socioeconomic and regional disparities are still unacceptably large, refl ecting the fact that much progress is still needed to improve basic living conditions for a large proportion of the population. New health problems arise as a result of urbanisation and social and environmental change, and some old health issues remain unabated. Administration of a complex, decentralised public-health system, in which a large share of services is contracted out to the private sector, together with many private insurance providers, inevitably causes confl ict and contradiction. The challenge is ultimately political, and we conclude with a call for action that requires continuous engagement by Brazilian society as a whole in securing the right to health for all Brazilian people.

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Mental health has been found to contribute significantly to the global burden of disease. This has raised the profile of mental health in developing countries. Many countries still do not have mental health policies, nor do they incorporate mental health in their primary care package. Community mental health profiles are needed to inform policy. There is a demand for more studies of mental health and the inclusion of mental health measures in more general, comprehensive, population-based health surveys. This article reviews the use and performance of a World Health Organization-endorsed instrument known as the Self-Reporting Questionnaire 20 items (SRQ20). The paper concludes that the high face and criterion validity, ease of use and suitability for administration by lay workers support the use of the SRQ20 as a cost-effective instrument with which to measure community mental health.