During the last century demographic and epidemiological transitions
have had a radical impact upon health and health service provision. A considerable
body of research on the sociological aspects of living with chronic illness has accumulated.
Debate has focused on how social environments shape disability-related experiences,
and the extent to which individual responses define health outcomes. Through the
establishment of the Expert Patients Programme (EPP) in 2001, the Department of Health
has sought to enhance NHS patients' self-management capacities. This paper discusses
three areas relevant to this: the policy formation process leading up to the EPP's
present stage of development; the evidence base supporting claims made for its effectiveness;
and the significance of psychological concepts such as self-efficacy in approaches
to improving public health. The conclusion discusses NHS developments in primary
care and public involvement in health and healthcare, and the implications that initiatives
such as the EPP carry for the future. It is argued that to facilitate a constructive
process of 'care transition' in response to epidemiological and allied change, awareness
of cognitive/psychological factors involved in illness behaviours should not draw
attention away from the social determinants and contexts of health.