The nutritional status of both women and men before conception has profound implications for the growth, development, and long-term health of their offspring. Evidence of the effectiveness of preconception interventions for improving outcomes for mothers and babies is scarce. However, given the large potential health return, and relatively low costs and risk of harm, research into potential interventions is warranted. We identified three promising strategies for intervention that are likely to be scalable and have positive effects on a range of health outcomes: supplementation and fortification; cash transfers and incentives; and behaviour change interventions. On the basis of these strategies, we suggest a model specifying pathways to effect. Pathways are incorporated into a life-course framework using individual motivation and receptiveness at different preconception action phases, to guide design and targeting of preconception interventions. Interventions for individuals not planning immediate pregnancy take advantage of settings and implementation platforms outside the maternal and child health arena, since this group is unlikely to be engaged with maternal health services. Interventions to improve women's nutritional status and health behaviours at all preconception action phases should consider social and environmental determinants, to avoid exacerbating health and gender inequalities, and be underpinned by a social movement that touches the whole population. We propose a dual strategy that targets specific groups actively planning a pregnancy, while improving the health of the population more broadly. Modern marketing techniques could be used to promote a social movement based on an emotional and symbolic connection between improved preconception maternal health and nutrition, and offspring health. We suggest that speedy and scalable benefits to public health might be achieved through strategic engagement with the private sector. Political theory supports the development of an advocacy coalition of groups interested in preconception health, to harness the political will and leadership necessary to turn high-level policy into effective coordinated action.

Current evidence points to the potential of systematically applying broader thinking about causal mechanisms, beyond individual choice and responsibility, to the design, implementation and evaluation of policies to reduce health inequalities. We provide a set of questions designed to enable critique of policy discussions and programmes to ensure that these wider mechanisms are considered.

ObjectiveTo identify and learn from efforts to design and implement a standardised policy for labelling of invasive tubing and lines across a regional health system.DesignSingle case study involving qualitative interviews and documentary analysis.SettingA devolved health system in the UK National Health Service (NHS).ParticipantsNHS staff (n=10) and policy-makers (n=8) who were involved in the design and/or implementation of the standardised policy.ResultsThough standardising labelling of invasive tubing and lines was initially seen as a common-sense technical change, challenges during the process of developing and implementing the policy were multiple and sociotechnical in nature. Major challenges related to defining the problem and the solution, limited sustained engagement with stakeholders and users, prototyping/piloting of the solution, and planning for implementation. Some frontline staff remained unconvinced of the need for or value of the policy, since they either did not believe that there was a problem or did not agree that standardised labelling was the right solution. Mundane practical issues such authorisation and resourcing, supply chains for labels, the need to restructure work practices to accommodate the new standard, and the physical features of the labels in specific clinical settings all had important impacts.ConclusionsNewly standardised tools and practices have to fit within a system of pre-existing norms, practices and procedures. We identified a number of practical, social and cultural challenges when designing and implementing a standardised policy in a regional healthcare system. Taking account of both sociocultural and technical aspects of standardisation, combined with systems thinking, could lead to more effective implementation and increase acceptability and usability of new standards.

This paper presents a hypothesis about how social interactions shape and influence predictive processing in the brain. The paper integrates concepts from neuroscience and sociology where a gulf presently exists between the ways that each describe the same phenomenon - how the social world is engaged with by thinking humans. We combine the concepts of predictive processing models (also called predictive coding models in the neuroscience literature) with ideal types, typifications and social practice - concepts from the sociological literature. This generates a unified hypothetical framework integrating the social world and hypothesised brain processes. The hypothesis combines aspects of neuroscience and psychology with social theory to show how social behaviors may be "mapped" onto brain processes. It outlines a conceptual framework that connects the two disciplines and that may enable creative dialogue and potential future research.

The art of medicine Health, welfare, and the state-the dangers of forgetting history Recent public policy in the UK has been dominated by a discourse which asserts that public expenditure on universal health coverage and welfare is a burden on the productive economy and unaffordable in what has been deemed a time of austerity. There is a widely held assumption that universal welfare provision, as offered by most modern, welfare states is a luxury, only afforded since the World War 2 by wealthier economies. According to this view, if the productive efficiency of the economy falters, then this luxury should be trimmed back aggressively. Reduction in universal welfare will relieve enterprise, capital, and socalled hard-working families from the burdens of taxation required to fund these unproductive public services and (by implication) those unproductive families-the poor. We argue from history that there should be an end to setting the goal of economic growth against that of welfare provision. A healthy and prospering society needs both. We suggest that they feed each other.A long-term historical perspective shows how universal benefits funded by progressive taxation can both assure health and welfare and support social cohesion, with concomitant processes and behaviours likely to be important stimulants for a productive economy. Investing in universal health coverage and welfare makes for national prosperity every bit as much as the increasing wealth of an economy provides the funding for enhanced health and social security. We begin with England's 200-year rise to global economic pre-eminence during the course of the 17 th and 18th centuries. This was intimately associated with the innovation, under Elizabeth I's rule, of the Poor Laws. Elizabeth acceded to the throne at a difficult time.The country was at war with France, and was near bankrupt, there were poor harvests, and the dissolution of the monasteries by her father, King Henry VIII, had removed the associated welfare system provided by the Catholic Church. The Elizabethan Poor Laws of 1598 and 1601 were an extraordinary response; pragmatic in origin, but drawing nonetheless on principles of the common good. The laws were based on social relations and mutual rights and responsibilities of local communities caring for all kith and kin. They provided, for the first time, access to support in times of need for all people settled in the parish. They enshrined an absolute "right of relief" for every subject of the Crown. They created a nationwide system of social security through a progressive community tax to fund provision at local level. This was predicated on the assumption that poverty is an unavoidable and common risk, which can be shared and mitigated.Relief was provided by the Anglican parish (averaging 500 persons each in 1600) as the designated unit of Tudor local government. Each parish was mandated to establish a fund to offer a comprehensive safety net against destitution as required and throughout the year for vulnerable groups, including orphans,...