ABSTRACT
Wales has poor health comparedwith other European countries (National Assembly for Wales 2002). The populations of former coalfields in general have particularly high rates of limiting long-term illness (Joshi et al. 2000). The determinants of poor health in parts of Wales are not very different from those found in other postindustrial areas: poverty, inequality, poor housing, educational underachievement, health-damaging ways of life. However, the spatial distribution of the population has produced numerous relatively small, contained areas of social exclusion, close to but dislocated from major sources of economic growth. Against this background, recent health policy in Wales has been marked by a
number of themes. A particularly strong emphasis on the cross-cutting nature of health has emerged, supported by an emphasis on the need for partnership working (National Assembly for Wales 2000; Welsh Assembly Government 2002). There is also growing evidence of a political philosophy that places less emphasis on healthcare deliverables, andmore on social determinants, public participation and citizenship:
The Assembly has developed . . . a number of strategies to counteract social exclusion and to create a socially inclusiveWales. It recognises the importance of building and supporting strong communities where the values of citizenship and collective action can grow . . . This (Health) Plan builds on wide consultation over the elements that make it up and is part of the process of replacing elite policy making by participative policy development. Our policy here is to build on this commitment and to continue to enhance the citizen’s voice at the heart of policy.
