North Atlantic drift: the debate over US-evidenced programmes

Community Practitioner,  May, 2008  by Liz Plastow

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Around 120 delegates at the UKPHA conference joined a panel debate entitled 'UK or USA? From where should we draw our evidence to combat health inequalities?' Chairing, Professor Sarah Cowley reminded the audience that a health visiting service has been available to all mothers with new babies and pre-school children in the UK since the early 20th Century. Despite this, the UK ranked 18th out of 24 developed European countries in infant mortality in 2007, and the gap in infant mortality rates between the best and worst off families stood at 17% in 2004 to 2006 compared with 13% in 1997 to 1999.

The majority of health visiting time is taken up providing targeted services for families with assessed needs to tackle inequalities, but this flexibility is threatened by marked regional cutbacks and a lack of direct evidence to support universal provision. In contrast, dedicated funding has enabled US-modelled progammes to pilot intensive home visiting to vulnerable parents selected at antenatal booking.

Walter Barker, director of Bristol's Early Child Development Centre, spoke of the different cultural contexts in which the Family Nurse Partnership programme developed in the US, stressing its lack of flexibility on the part of practitioners or clients. He emphasised the importance of enabling parents to feel good about what they were achieving in sometimes difficult circumstances. The Sure Start model had given the opportunity to develop a wide range of approaches, some being transferred to children's centres. Solihull infant mental health specialist Jill Delaney outlined the Solihull Approach and suggested that some US evidence could be tailored for implementation by UK services.

The discussion noted that community development and empowerment at community and social group level have more substantial long-term health benefits than parenting programmes and one-to-one support. Overall, two areas of unease were expressed--the use of US evidence-based programmes being implemented at the expense of a universal service with a range of responsive parenting interventions, and the need for health visitors (HVs) to maintain a public health perspective. The audience strongly favoured HVs retaining and emphasising a public health role, using individual parent contacts to help build and develop community strengths, yet HV numbers have declined in spite of rhetoric on public health.

Liz Plastow

UKPHA Health Visitor Special Interest Group

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