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Pilot testing the verona Benchmark as a strategic tool for strengthening the effectiveness of alliances for health. The experience of the Caerphilly Local Health Alliance.
Despite recent improvements the health of people in Wales is poor compared with that in the majority of European countries and in other parts of the UK 1. Within Wales, there are substantial inequalities in health between different communities with considerable variation in Standardised Mortality Ratio at the Unitary Authority level 2.
However there is real opportunity for tackling these issues in Wales. The establishment of the National Assembly, a clear national commitment to improving health and tackling inequalities in health, an explicit policy agenda that recognises the underlying influences on health and a new emphasis on partnership provide the background to the involvement of Wales in the Verona Initiative.
The policy context for health improvement
In just a few years, Wales has experienced substantial change in its political and administrative structures. Since 1996 Wales has experienced Local Government reorganisation (to a single sphere system of twenty two Unitary Authorities), Health Authority reorganisation (five in number), National Health Service trust reconfiguration and the election of a new Government. The former Health Promotion Authority for Wales was integrated into the National Assembly for Wales. The establishment of the National Assembly, in July 1999, with devolved responsibility for policies and standards of public services has been the most significant change.
The Labour government was elected in May 1997 with a commitment to improving health in Wales. In May 1998, the Welsh Office published "Better Health Better Wales" setting out a vision to improve health and well-being through strategies which promote and protect health and reduce inequalities in health1.
"Better Health Better Wales" acknowledged the wider social, economic and environmental determinants of health and emphasised that effective action depended upon the joint efforts of many people and agencies1. The Government set out its aims and priorities through a strategic framework to:
* Prevent disease and improve health and well-being,
* Bring the level of those with the poorest health up to the level of those with the best,
* Improve the health and well-being of children,
* Encourage individual responsibility, and
* Improve the health and safety of people at work.3
The...