Abstract. This introduction sets the scene for the remainder of the book by considering first the international context of widespread concern about the improvement of numeracy skills. This is related to reform movements in the United Kingdom, the United States and other countries aimed at modernising primary (elementary) school mathematics curricula. A detailed account is given of the National Numeracy Strategy in England, a systemic government-imposed response to concern about standards implemented in 1999/2000. This includes a discussion of the alternative meanings of numeracy. An earlier initiative sponsored by a United Kingdom charitable trust reacting to concern about primary numeracy was the Leverhulme Numeracy Research Programme. This large-scale longitudinal study and linked set of case-study projects, focusing on reasons for low attainment, took place during 1997-2002. This book, and each other in the same series, is based on results of that research. The timescale fortuitously enabled the research team to also report on some effects of the systemic reform in the National Numeracy Strategy. 1. THE INTERNATIONAL CONTEXT In many countries, there are recurring periods of national concern about the low standards of calculation skills shown by children in primary (elementary) schools. Recently, these concerns have become more urgent and more political with the publication of international comparisons of mathematical achievement, first at secondary and more recently at primary level (e. g. Lapointe, Mead, & Askew 1992; Mullis et al. , 1997).

Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.