The health of their nation: how would citizens develop England's health strategy?

Background. England's first health strategy, The Health of the Nation, was formulated without systematic input from the citizens whose health it targe ted. Several studies indicate that citizens, when asked to prioritize servi ces, rank interventions for acute and life-threatening conditions highest. But how they view and what they want in the areas of prevention, public hea lth, or care for the chronically and mentally ill is not known. Aim. To explore citizens' attitudes towards England's health strategy as se t out in The Health of the Nation and to elicit their ideas for developing it further. Method. The study was conducted in four general practices and a secondary s chool in southwest England. The design was a qualitative analysis of testim ony from 24 audiotaped focus groups. Twenty-three groups were drawn from li sts of National Health Service registered patients, stratified by The Healt h of the Nation target category, and one group was drawn from 13 to 15 year -old girls at a mixed secondary school. In all, 173 citizens took part in t he 24 focus group meetings. Results. In group discussions, these citizens demonstrated an understanding of The Health of the Nation strategy, which enabled them to form views and develop relevant arguments. They produced 26 specific ideas for developing the strategy across its five key areas. There was congruence with the acti on plans of a national expert group convened by the Department of Health an d charged with reviewing the strategy's progress. The focus groups went bey ond the experts' proposals, with further practical ideas to achieve The Hea lth of the Nation targets. Conclusion. Citizens in this study contributed a broad range of relevant, a ppropriate, and innovative ideas on how to develop health strategy. The use of focus groups to achieve this is practical and efficient.