Making a difference

Just over a year on from the establishment of the Infant Mortality National Support Team, there's a report reviewing its impact and findings. There's the usual plea for more joined up thinking between health and local authorities, set against the background of health inequalities being part of the bigger picture. With GPs now set to commission maternity services, following a change of heart from government, the IMNST's other plea for more local focus for services looks a little closer to fulfillment.

Getting the measure of public health

DH is consulting on how public health outcomes will be measured in the new regime. Amongst ideas to catch the attention of commentators is the proposal that local councils will be paid a “health premium” for effectively addressing public health issues such as smoking and alcohol misuse, along with tackling health inequalities. A separate document on funding and commissioning arrangements offers greater insight on the government’s intentions here. This paper also provides some detail on where specific public health functions will sit, with smoking cessation, public mental health and obesity and physical activity programmes all being given to local authorities, while public health for children under 5 will be within the ambit of Public Health England, who will, initially at least, directly fund the delivery of health visiting services. More detail about health visiting will appear in (yet another) DH paper.

... and statistics (again)

More figures, this time from the OECD in its latest issue of Health at a Glance, give a snapshot of the health of the EU countries, plus Norway, Switzerland, Iceland and Turkey. There's data on health status (mortality, incidence of diabetes, cancer, HIV and dementia) along with health indicators like smoking and alcohol consumption amongst adult and child populations and (of course) obesity.

The bigger picture

Covered widely in the press is the unhappy news that the UK population has the highest prevalence of obesity in the EU. And that within the UK, the West Midlands has highest levels, at 29% of the adult population. The figures come from an EU-wide database of health inequalities indicators, I2SARE, which has just published its 2006 data. Other areas where the UK is in the spotlight for all the wrong reasons are teenage pregnancies, infant mortality and female cancer care. UK leads for the project at NEPHO provide some analysis.

Best behaviour

Educational charity The Sutton Trust highlights inequalities in the incidence of behavioural problems amongst pre-school aged children. Researchers found around 35% of boys from the poorest 5th of households had clinical-level symptoms of behavioural problems at age 3 (compared with an incidence of 15% amongst the rest of the population). Moreover there is little improvement between the ages of 3 and 7. The study looked at two cohorts of children, born in the early 1990s and the early 2000s and measured behaviour across hyperactivity/inattention, conduct problems, emotional symptoms and peer problems. The Department for Education has published an interim report the Parenting Early Intervention Programme, which provides funding for local authorities to offer parenting skills programmes to parents of 8-13 year olds who are concerned about their child's behaviour. It confirms that PEIP has successfully targeted lower income families and that parents valued the programmes and reported that they had worked. Final analysis will be published next year.

Nursery rhymes

The Department for Education has just released some analysis of take-up of early years provision by disadvantaged families which uses data from the 2008 and 2009 Childcare and Early Years Survey of Parents series to look at the effectiveness of government policies designed to improve early years provision for disadvantaged families. Unsurprisingly, the report shows that children from disadvantaged backgrounds are less likely to access free early years provision. Again, unsurprisingly, one of the key factors in low take-up is lack of information. Overall take-up of early years provision amongst 3-4 year olds is high (92%), although largely because reception classes in primary schools are the main provider for 4 year olds. The significant gap appears amongst disadvantaged children at 3 years old, where only 24% of children received early years provision, in contrast to 95% of disadvantaged 4 year olds.

Poverty index

Child poverty amongst families who are in work is at a record high, the Joseph Rowntree Foundation reports. In its 13th Monitoring Poverty and Social Exclusion Report, national figures for child poverty have dropped to 3.7m, but poverty amongst children living in working households has increased to 2.1m. out of the 13m people living in poverty in the UK in 2008-9, 5.8m are described as living in "deep poverty". The report looks at the wider context of social exclusion and, amongst its health indicators, covers low birthweigh babies, child and young adult deaths, under-age pregnancy, mental health and limiting long-term illness.

Out to lunch

SMART lunchboxes may conjure up images of plastic containers decorated with your toy or TV character of choice, but seemingly this is not the case. A recent RCT published in the Journal of Epidemiology and Community Health records an intervention designed to improve the nutritional contents of children's packed lunches. The team used SMART lunch boxes, which consisted of a cooler bag and a variety of SMART plastic boxes for specific food items, along with advice on creating healthy lunches and child friendly incentives (including jokes and stickers). The same team also looked at nutritional standards for lunch box contents amongst primary school children in the UK, which was covered widely in the press earlier this year. Press reports were, in turn, deconstructed by NHS Choices.

Counting the cost

The National Obesity Observatory has published a report on the economic burden of obesity, surveying research done since the publication of the Foresight report in 2007.
A recent survey from the OECD also considers economic issues: Obesity and the economics of prevention examines the role of markets and governments in tackling obesity, as well as considering which interventions work. There’s a special focus also on regulating food advertising. Latest briefings from the National Obesity Observatory provide data on adult and child obesity, linked to socioeconomic status.

Widening gap

Smoking breeds inequalities, according to the Faculty of Public Health. Showcasing the new Local Tobacco Control Profiles for England, FPH Vice-President John Middleton notes that the gap between rich and poor (and north and south) means that there is a “need to do much more to help vulnerable groups to access stop smoking services, information and any other support that is available.” The Tobacco Profiles offer data at local authority and PCT level, providing comparisons for key indicators with regional and national averages.

Visiting Hours

The government's earlier promise to create 4 200 new health visitor posts is affirmed in the Public Health White Paper and there is good news for the Family Nurse Partnership programme, which is namechecked as an evidence-based intervention that works. The Healthy Child Programme and the Change4Life Convenience Store Programme also receive honourable mention.

White out

After nearly five months of waiting, the Public Health White Paper (Healthy Lives, Health People) has arrived. And, as well as filling in the public health elements of Liberating the NHS, this document also very explicitly offers itself as a response to the Marmot report on inequalities. However, its main task is to usher in more of the localism already seen in previous consultation papers. Devolving the public health function largely to local authorities is the most substantive move. Yet, once again, the devil’s in the detail and the detail is in a further consultation document, to be published next year. The same goes for the Local Health and Wellbeing Boards, the role of Public Health England in funding and commissioning, the Public Health Responsibility Deal and others. A less than considered but considerably impassioned response can be found at Health Policy Insight. More measured tones at the King’s Fund, with the HSJ and the Guardian focusing on funding and timing of transfer.

Change4Convenience?

DH has published an evaluation of a programme to promote healthy food choices, targeting convenience stores in deprived areas. The Convenience Store Programme, which ran in the North East, builds on the Scottish Neighbourhood Shops Initiative. Both programmes aimed to increase consumer purchasing of fruit and vegetables, principally via layout and branding in shops, along with some promotion to consumers.

Cuts, spending and society

... is the name of the Joseph Rowntree Foundation's microsite, dedicated to highlighting the prevalence of poverty in the UK and the vulnerability of the poorest in society to spending cuts. Ahead of today's Comprehensive Spending Review announcement, JRF looks at what lies ahead for local authorities in their adult social care provision, the area which is generally expected to suffer most.

Inequalities in numbers

ONS provides a series of articles on inequalities in England and Wales, using the National Statistics Socio-Economic Classification (NS-SEC) over the years 2001-2003, principally looking at mortality rates.

Sanctuary

Sanctuary Schemes are multi-agency initiatives which provide support to enable victims of domestic violence to stay in their own homes. Such schemes have been running in some areas for more than ten years. The Communities and Local Government Department has published an evaluation covering 2009/10, concluding that the schemes do achieve their aim of providing a safe alternative for households experiencing domestic violence and also prevent the disruption of homelessness. There's also a good practice guide for agencies considering setting up a Sanctuary Scheme

Learning Disabilities

DH has published an update on efforts to improve healthcare for people with learning disabilities. This is in response to the Parliamentary and Health Service Ombudsman's Six Lives report in 2009, which investigated the deaths of six people with learning disabilities, highlighted by Mencap in their report Death by indifference.

Disabilities

The Department for Education provides an interim report on the piloted introduction of individual budgets for families with disabled children which offers faint praise for progress so far. The pilots, which began in April 2009, will run until March 2011. Responding to the Kennedy report on children’s services, Health Secretary Andrew Lansley’s paper Achieving Equity and Excellence for Children includes a commitment to keeping the idea of individual budgets. However, this issue will also fall into the ambit of the SEN and disabilities Green Paper, due out later this autumn, which may clarify the government’s position.

Ethnicity

NHS Evidence Ethnicity runs its Annual Evidence Update from 18-22 October. This round-up of the year's research highlights the much discussed topic of rising breast cancer rates in South Asian women, along with carers from BME communities, end of life care and healthcare for torture survivors.

Going green

A new study published by CABE (Commission for Architecture and the Built Environment) assesses the "the inter-relationship between urban green space, inequality, ethnicity, health and wellbeing." Researchers looked at areas of Manchester, Birmingham and London with similar amounts of green space, high levels of deprivation and significant black and minority ethnic populations.

Alcohol data

The latest update of the Local Alcohol Profiles shows a continued rise in alcohol-related hospital admissions. On average nationally, over the past 5 years there has been a 65% increase in admissions due to alcohol harm, with highest levels of harm occurring in the North West and North East of England. Eastern England and the South East come off best, according to the Alcohol Learning Centre. The BBC, meanwhile, reports on a decline in alcohol consumption, based on figures from the British Beer and Pub Association. The jury's out on whether this is a response to recession or public health messages about responsible drinking.

Getting it right ...

... for children and young people ... is the title of the report by Professor Sir Ian Kennedy, commissioned in the wake of such tragic and high profile cases as that of Baby Peter. It aims to examine not the specific instances of failure, but the culture that fails more generally to prioritise the health and wellbeing of children and young people. Areas of concern the report highlights include significant regional variations in levels of service, trends in infant mortality and teenage pregnancy as compared with the rest of the EU, GPs' limited training in paediatrics and lack of co-ordination in the complex network of services. Amongst the report's recommendations is (no surprises here) that there should be some considerable effort towards joined-up thinking: top of the list, in an interesting piece of timing, is that "policy relating to the health and well-being of children and young people" should be the responsibility of a single government department. This is by no means the first time Sir Ian Kennedy has addressed these kinds of issues: he chaired the Bristol Royal Infirmary Inquiry in the late 1990s.

What's in a name?

Members of the Childhood Wellbeing Research Centre consider childhood wellbeing in the UK in a report for the Department for Education. As well as looking at definitions and measurement, the report's authors discuss the UK policy context and how children's own views are gathered and represented.

Looked after children

The Department for Education is consulting on changes to the rules governing fostering and children's homes and the statutory guidance. Largely this is to reflect changes in legislation and practice since the rules and guidance were developed, following the 1989 Children Act. The proposed changes also aim to clarify where restraint may be used and "to seek views on who must have access to reports made by the registered person which cover improving the quality of care provided to children and monitoring matters such as complaints, recruitment records, illness, minutes of meetings." Responses should be submitted by 19 November 2010.

Better than a cure

Emma Stone, writing on the Joseph Rowntree Foundation's blog, considers the cost and value of low-level preventive support, particularly as regards support for older people. The blog is prompted by the Scottish Finance Committee's inquiry into preventative spending, oral evidence session for which will take place this autumn. An article in the latest issue of the Journal of Public Health asks some difficult questions about the cost-effectiveness of prevention: Lifestyle intervention: from cost savings to value for money.

Motivating factors

There's been a lot of attention in the literature to uptake of cancer screening, especially uptake of breast cancer screening. A review published in Quality in Primary Care considers poor uptake amongst British South Asian women, as compared with the general UK population. A critical examination of information brochures provided to women about to undergo screening appears in the European Journal of Public Health, looking at brochures issued in Germany, Italy, Spain and France.

Taking the long view

Inequalities in premature mortality in the UK have risen during the first years of the 21st century, in spite of plenty of serious attention and government intervention, a study published in the BMJ asserts. Looking at data from 1921 to 2007, the review's authors note that, although generally life expectancy has continued to rise, the gap between rich and poor areas is also increasing, to the extent that "inequality in mortality is now greater than at any time since comparable records began."

Working out what the numbers mean

Figures showing geographic differences in place of death have been examined by the Natioanl End of Life Care Networks in a report, Variations in Place of Death in England: Inequalities or appropriate consequences of age, gender and cause of death? Analysis indicates that people on low incomes are more likely to die in hospital, which begs the question as to whether this reflects a greater prevalence of diseases requiring hospital care in the terminal stages amongst deprived populations. West Midlands Public Health Observatory has produced a mapping tool to show selected indicators concerning older people, at local authority and regional level.

Message not getting through

A study by the Health Protection Agency reveals that pregnant women from ethnic minority backgrounds are more at risk from listeriosis. Looking at data from 2001 to 2007, the HPA's research also shows that, overall, there were more listeria cases in deprived areas than in the most affluent. One key concern is that the message about avoiding foods that may be contaminated with listeria during pregnancy is not getting through.

Not really news

... especially not good news...The National Audit Office's report, Tackling inequalities in life expectancy in areas with the worst health and deprivation, takes a long, hard look at DH's achievements as regards inequalities. And the verdict? A good effort, but not exactly value for money.
"The Department of Health has made a concerted effort to tackle a very difficult and long-standing problem. However, it was slow to take action and health inequalities were not a top priority for the NHS until 2006. We recognize that this is a very complicated issue and that it took time to develop an evidence base. However, the best, cost-effective interventions have been identified and now must be employed on a larger scale in order to have a greater impact and improve value for money.
"The Department should target its efforts on the most deprived areas of the country and develop costed proposals to maintain or increase investment in preventative interventions to tackle the conditions which lead to health inequalities."
Amyas Morse, head of the National Audit Office, 2 July 2010.

Health Policy Insight casts a wise look back to Julian Tudor Hart's inverse care law.

Unfair distribution

The recently revised NICE guidelines on COPD provide some grim reading. Currently, NICE says that COPD affects between 2% and 4% of the population, but the burden of the disease falls heavily on areas of deprivation: "men aged 20-64 employed in unskilled manual occupations being 14 times more likely to die from chronic obstructive pulmonary disease than those in professional occupations ." At the moment, COPD is the UK's 5th leading cause of death but this is expected to rise, with the condition becoming the 3rd leading cause of mortality worldwide. And it doesn't stop there: NICE's review suggests that this is a substantially under-diagnosed condition, under-represented in death certificates and in primary care prevalence assessments.

More about health budgets

Two recent articles in the BMJ argue that it’s not just about ringfencing health budgets: social welfare and the health of the nation are far more entwined than that. Joan Benach and others look at the international situation, while David Stuckler and colleagues examine the UK perspective in more detail.
Age UK (the name for the merger between Age Concern and Help the Aged) argues that the Autumn spending review should include ringfencing of social care budgets, too. The King’s Fund’s John Appleby also notes ominously that the real extent of cuts will only be made clear in the Autumn spending review and looks at the ripple effect for health of cuts and the Office for Budget Responsibility’s prediction of slower economic growth.

Education

NICE is currently consulting on draft guidance for personal, social and health education (PSHE), especially focusing on relationships, sex and alcohol. The consultation period ends on 15 July.

Breastfeeding

Figures released by DH last month suggest that there has been no significant rise in breastfeeding when measured at 6-8 weeks, although there has been a slight rise in breastfeeding intiation. The Breastfeeding Network believes it's (in part) the marketing that's to blame: the slogan "breast is best" is offputting and misleading, implying that breastfeeding is the exception, not the physiological norm. DH has also published a summary of consumer insight research on breastfeeding and introducing solid foods, which considers current marketing strategies as well as qualitative research with mothers.

Healthy eating

NICE has nailed its colours to the mast on the matter of reducing trans-fats in foods, in new guidance on prevention of cardiovascular disease. The guidelines also push for a more rigorous approach to food labelling, using the traffic light system, a policy recently rejected by the European Parliament. An article in the Journal of Public Health surveys attitudes to and use of food labelling systems in Europe. Looking at inequalities in cardiovascular disease mortality, a team from Australia has published some work on the association between CVD mortality and educational achievement and considering how far this can be explained by known risk factors, such as smoking and being overweight.

Budget response

The Chancellor's announcement that Child Tax Credit would be increased was greeted with rather more than faint praise by the Joseph Rowntree Foundation. However, the blog does go on to outline how the new budget will affect people in poverty, focusing on changes to inflation measures, the VAT hike and cuts in public sector budgets. Health professionals have already criticised the earlier decision to cut plans for the further extension of free school meals elligibility.

Working out what works

It usually appears that while it's relatively easy to identify health inequalities, finding robust evidence for what works in tackling those inequalities is rather more challenging. Some recently published articles tend to uphold that assumption. A UK-based team offers a systematic review of interventions and at a more theoretical or policy level, the Marmot review team publish an account of the use of rapid review techniques to develop policy proposals. Meanwhile, at the coalface, another article reflects bleakly on the effectiveness of partnership working and community engagement.

Drugs misuse

NHS Evidence National Library for Public Health has produced its annual evidence update on drugs misuse. Offering a survey of the past year's learning on the subject, the 2010 update focuses on femaler offenders.

Contraception services

NICE has been consulting on provision of contraceptive services to socially disadvantaged young people up to age 25. The consultation closes 23 June.

Doctors mind the gap

A policy statement from the Royal College of Physicians sets out the organisation's vision for tackling health inequalities. The result of a series of dialogues over the past six months, the report considers options for change. As well as advocating an emphasis on prevention rather than treatment and considering how doctors engage with and empower patients, the policy statement also acknowledges a need for public health and social aspects of medicine to be better taught.

Prison health

The Care Quality Commission has reported on how PCTs are commissioning prison health care over the period 2008-9. CQC commends progress in management and clinical governance. However, it notes there is room for improvement as regards arrangements for transfer and release and drug treatment systems.

Weight watchers?

DH has published research on how to make weight management services more appealing. The report, from research consultants ESRO, looks at motivation to lose weight, barriers to engaging with weight management services and what various groups of people want from such services.

Alcohol policy

Early this month NICE came out in favour of minimum pricing for alcohol, just as the Scottish Parliament vetoed a similar proposal. NICE’s approach is contained in its guidance on preventing harmful drinking and treating the physical complications of alcohol use disorders. More recently, a study by NICE looks at the evidence for reducing the current drink-drive limit.

School dinners indicator

Once again the numbers of children eligible for free school meals has increased, with over 18% of nursery and primary school aged children and 15% of secondary school aged children now eligible. An article in Children and Young People Now quotes a representative from the NUT who noted that this is in part a result of budgetary provision but that it also could reflect the effects of recession. With the Child Poverty Act 2010 setting a target of 2020 to end child poverty in the UK, these figures offer another challenge to the government. Consultation on statutory guidance for local authorities and others (including SHAs and PCTs) under the Act was published in March.

Age equality

DH has published the results of its consultation on the implications for health and social care of the 2010 Equality Act's measures on age, following a report that DH commissioned from Sir Ian Carruthers and Jan Ormondroyd.

Green thoughts

The latest issue of Health and Place include a review of qualitative research on physical activity in urban parks. As its authors suggest, this kind of data has been excluded from recent analysis, but may help to inform design or evaluation of interventions to increase physical exercise in an urban setting. Earlier this month, a team from the University of Essex published a meta-analysis of green exercise studies from the UK, looking for "the Best Dose of Nature and Green Exercise for Improving Mental Health." The study was widely reported in the press and is thus itself the subject of appraisal on the NHS Choices Behind the Headlines column.

Community spirit

The latest reports to come from the 2007-08 Citizenship Survey have been published. They cover community empowerment and volunteering and charitable giving. The empowerment report looks at whether people think they can influence decision making at a local and national level and how far they trust the decision makers, as well as levels of civic engagement.

Alcohol data

The latest Local Alcohol Profiles for England are available from the Northwest Public Health Observatory. Data is provided at PCT and Local Authority level. ERPHO's new dashboard presentation gathers together key online resources concerning alcohol for the eastern region.

Obesity update

NHS Evidence's Public Health specialist library offers its annual evidence update on childhood obesity, a very useful survey of contributions to the sum of knowledge on the subject over the past year. A study published in the International Journal of Epidemiology confirms the relationship between lower educational attainment and likelihood of being overweight or obese. Researchers looked at self-reports from national health surveys covering 19 countries in Europe. In the Journal of the American Medical Association, a study tests the impact of negative attitudes to obesity amongst clinicians and concerns about lack of respect amongst obese patients. The study, which looked at samples of patients from the Medicaid and VHA populations in the US, found no evidence of reduced quality of care and that "being obese or overweight was associated with a marginally higher rate of recommended care on several measures."

Slicing up the pie

Independent think tank Civitas launches a lively attack on how PCT funding has been calculated in order to tackle health inequalties.

Five a day?

DH has reported on the effectiveness of its programme to offer fruit to children in primary school, the School Fruit and Vegetable Scheme (SFVS). The programme has now been operating for at least four years across the country and this is the third evaluation. The study found that children receiving SFVS do eat more fruit and vegetables and that this does appear to shape longer term eating habits. This school-based intervention does not, however, impact substantially on home diet.
Meanwhile the press has had fun with a cohort study published in the Journal of the National Cancer Institute, which found that increased fruit and vegetable consumption appeared to have minimal impact on cancer risk. NHS Choices’ Behind the Headlines site gives a helpful account of the study.

Not just a postcode lottery

A report from the National Cancer Equality Initiate (NCEI), a body tasked by DH with researching the evidence for inequalities in cancer across the UK, suggests that data collection and analysis is improving. Highlighting opportunities provided by the National Cancer Intelligence Network (NCIN) in bringing together the various sources of information, NCEI’s report also identifies significant gaps in evidence (particularly as regards socio-economic deprivation, ethnicity, religion and disability) and sets some priorities for future work. Amongst these is the new cancer patient experience survey, which will take place for the first time this year. There is also the suggestion that multidisciplinary teams undertake patient level equality audits and review these annually as part of the National Cancer Peer Review Programme. Early adoption sites for this will be sought this year. NCIN also previews its Cancer Equalities Portal, which offers data by cancer type and equality group.

State of the nation

The 2009 Health Profile for England was released at the end of March. Key data include rising rates of diabetes and alcohol related hospital admissions and deaths, improvements in housing stock, activity patterns amongst children and smoking prevalence. In comparing England with countries in the EU (the 15 nations that were EU members in 2004), the UK has higher than average infant mortality rates and adult obesity levels.

What really works?

The Audit Commission takes a rather dim view of inequalities spending in its recent bulletin, Healthy Balance. After praising some achievements, it does rather suggest that there’s not too much to show for the estimated £21 billion NHS spend in 2009/10. There’s criticism of government’s lack of consistency and excess of policy and guidance, which leaves PCTs and local authorities facing “conflicting demands.” Absence of targeted spending and precise assessment is also attacked: what is needed is “much clearer sight of what is being spent and much sharper evaluation of its impact.” The report ends by bleakly quoting the conclusions of the Marmot review: “health inequalities will remain until we tackle the inequalities in society.” Findings from a study of systematic reviews in the Journal of Epidemiology and Community Health also focus on a lack of clarity as regards the effectiveness of interventions designed to tackle the wider social determinants of health inequality.

National Support Teams

DH has published a resource manual from the Health Inequalities National Support Team (HINST) which addresses various aspects of the inequalities agenda. Based on HINST’s work with Spearhead PCTs, these papers aim to set out what works in tackling health inequalities, from data collection and analysis to direct interventions. Included are 11 "how to guides," covering such topics as developing a strategic framework for community engagement and addressing the quality and cost effectiveness of prescribing in the context of long term conditions.

In care

Draft public health guidance from NICE focuses on the physical and emotional health and wellbeing of looked after children. The guidance, which has been developed by NICE and the Social Care Institute for Excellence (SCIE), is expected to be released in its final form in September. Key recommendations include the need to commission services that are “integrated, preferably on the same site,” provision for the team around the child of a “consultancy service to help consider and work collaboratively on complex cases and situations” and access to specialist services for babies and children under 5 “which offer early and preventive interventions for babies and young children to avoid placement breakdown.” Also, because of the high level of emotional and mental health issues amongst looked after children and young people, there is, throughout the recommendations, a strong focus on Child and Adolescent Mental Health Service (CAMHS) input. Responses should reach NICE by 16 April 2010.

All change

More annual reporting, this time from Change4Life, which is also a year old. But have the delightful plasticine figures made a difference? Targeting families with children aged 5-11, the strategy has made a definite hit on the brand recognition front and (according to their own tracking group) mothers have made changes to their children’s diet or activity levels. Change4Life analysis also looked at food buying behaviour. In a pilot study using Tesco Clubcard data, researchers found that the Change4Life households did “contain a large proportion of lower income families” and that there had already been some changes in purchasing, such as choosing low-sugar drinks.
Recent articles from BMC Public Health take a slightly more sober view of lifestyle change interventions: Is there a demand for physical activity interventions provided by the healthcare sector? and The influence of a high intensity physical activity intervention on a selection of health related outcomes both provide interesting reading.

How are we doing?

The Oneplace initiative and the Comprehensive Area Assessment which under pins it, offers the public a scorecard view of local service provision via a website. Oneplace has published a report of its first year, bringing together judgments from a range of inspectorates, including the Audit Commission, the Care Quality Commission, Ofsted and others. The report provides a rather broad brush approach (red and green flags) but includes the usual examples of good practice.

Language gap

The educational charity, the Sutton Trust, has published a report on the impact of "cognitive gaps in the early years," as shown especially in language skills. Using the Millennium Cohort Survey, researchers found that children from the poorest families are nearly a year behind their peers from middle income families at age 5. The report identifies good parenting and a supportive home environment as key factors and suggests, amongst other ideas, that outreach projects from Sure Start are the way ahead.

New Deal for Health?

More evaluation of the New Deal for Communities programme (see Fair's Fair 19 January for earlier reports), this time looking at health outcomes. There's a focus on projects in the four NDC case study areas, Fulham, Hackney, Salford and Sandwell, as well as considering more generally how NDC partnerships work and looking at how these kinds of initiatives can be sustained.

A healthy start

The Audit Commission has cast its beady eye over local implementation of government policy for children aged 0-5 during the past ten years. Giving children a healthy start looks at the impact of government funding on the health of under fives, considering how well local agencies manage the finances on offer and how far they are providing value for money. The report also discusses means to improve service delivery to vulnerable and hard-to-reach populations, such as lone and teenage parents and BME groups. Initiatives like Sure Start and the Healthy Child Programme are duly namechecked. However, criticism, when it comes, is reserved for lack of strategic commitment, with under fives' health "not always reflected in strategic plans, and ... rarely given priority in local area agreements (LAAs)." Along with the report, there's also a video showcasing some local initiatives.

February's issue of the European Journal of Public Health has a focus on environmental inequalities and health, ahead of the WHO Ministerial Conference on Environment and Health in Parma on 10-12 March. Articles cover ambient air quality, waste management and housing amongst other topics.

Marmot review published

Poorer people in the UK have shorter lives and are more likely to live with disability is the headline from the Marmot review report, Fair Society, Healthy Lives. The report puts a number on the gap: "the average difference in disabilityfree life expectancy is 17 years." Although the past 10 years have seen a significant rise in spending on healthcare and in general prosperity levels, these inequalities, set out clearly in the Black report of 1980, persist and have deepened.

While the diagnosis may be clear and largely undisputed, the cure is another matter. At a time when the healthcare system, along with broader social welfare policy, is under some financial pressure, this may not be a message governments are prepared to embrace. A guarded welcome from the King's Fund notes that "cash invested in initiatives to tackle health inequalities doesn’t produce instant returns," encouraging the government to stick with the programme. Professor David Hunter, writing in the BMJ, observes "eerie echoes " with the timing of the Black report, which, although commissioned by a Labour government, was issued into the hands of a Conservative one, remarking also that "there are few votes in health inequalities."

Anatomy of inequality

How unequal is British society? The National Equality Panel, in its report on economic inequality, breaks the bad news (or tells us what we know already) about the distribution of wealth in the UK. In spite of all efforts to change the situation "the large inequality growth between the late 1970s and early 1990s has not been reversed. " While some of the widest gaps (such as those in educational qualifications amongst some ethnic groups) have narrowed, there remain "deep-seated and systematic differences in economic outcomes between social groups" in all the dimensions the Panel considered. The report looks at educational achievement, employment status and income as well as wealth per se.

So, farewell then...

Tributes to Sir Donald Acheson have been pouring in: the Guardian, the Times and the Telegraph have all carried obituaries recently. Acheson, who died on 10 January 2010, was Chief Medical Officer between 1983 and 1991. Although the end of his term of office was somewhat clouded by the BSE crisis, he is remembered more appreciatively for his ability to persuade the Thatcher government “to adopt a liberal approach” in tackling AIDS, focusing on education, rather than compulsory AIDS testing (says the Guardian). He is also widely credited with raising the profile of public health. However, it is for his 1998 report on health inequalities that he will be best remembered. Tasked by the incoming Labour government with examining the causes of a widening gap between the health of rich and poor, the report has shaped public health policy for a decade. Looking ahead, it is expected that the Marmot Review, which picks up where Acheson left off, will be published in February.

Can the government make you happy?

Researchers for the Young Foundation mull over this question in their report, the State of Happiness. Looking at wellbeing driven policy interventions in a variety of places across the UK, the report concludes that "wellbeing can be made a practical policy goal." It examines results from the Local Wellbeing Project, a combined effort from the Young Foundation, IDeA and a group of local authorities, amongst others.

Healthy eating - right from the start

Start4life is the latest campaign from the Change4life stable, focusing on helping parents of babies and young children establish healthy feeding habits in their offspring. Along with the usual website, there is a short film featuring "one of the famous Change4Life plasticine characters being moulded by a mum" to be shown in antenatal clinics and on BabyTV . Advice covers breastfeeding, introducing solid food and avoiding sweet foods. There are posters and leaflets, which can be downloaded from the website or ordered by telephone.

Deprivation in New Deal for Communities areas

Is the Government's regeneration programme, New Deal for Communities (NDC), which began in 1998, really working? A report from Communites and Local Government Department examines data from the Economic Deprivation Index (EDI) for the 39 New Deal areas between 1995 and 2005. It considers whether there has been any substantial reduction in economic deprivation in NDC areas and looks at how progress in NDC areas compares with their wider locality and other deprived areas. Although absolute rates of deprivation fell during the decade under observation, the report makes it clear that NDC areas continue to compare unfavourably with other areas as regards progress in reducing economic deprivation. The report also notes some interesting trends at lower levels of detail (using lower super output area level data and some case studies), which show that deprived areas are far less homogenous than might be expected. This detailed analysis shows how small pockets of deprivation can easily be hidden when looking at more general trends of improvement. There's also a companion report that looks at public spending in NDC areas.

Childhood obesity rise a class matter?

There may be evidence of a levelling off in the rise in UK childhood obesity figures (see Fair's Fare 16 December), but it's not affecting everyone equally, according to research published in the International Journal of Obesity. The team from University College London (UCL) looked at data from the Health Survey for England between 1997 and 2007, aiming to update trends amongst school-age children and consider how the "socioeconomic gradient" has changed. They found that although there has been stabilisation in the prevalence of obesity, "children from lower socio-economic strata have not benefited from this trend." The latest release from the Health Survey for England, providing data from 2008, was published in December. Along withthe usual summary data, the subject focus for this release is physical activity and fitness. The survey also provides information on smoking, obesity, healthy eating and alcohol consumption.

Prison health

Enhancing the Healing Environment (EHE), the King's Fund programme of nurse-led projects designed to improve the healthcare setting for patients, has been up and running in prisons over the past year. DH has now agreed to extend the programme to a further 10 Prisons and Young Offender Institutions (YOIs) in 2010. EHE was first used in acute care, but has now been employed in mental health settings, end-of-life care and services for people with learning disabilities. Applications to join this new round of EHE in prisons should be in by 22 January.

Health promotion commissioning guidance

The Royal Society for Public Health has published a guide for commissioners considering health promotion and looking in particular at the role of social marketing. Produced in association with the National Social Marketing Centre, the guide offers examples of good practice and self-assessment tools.

Domestic Violence

Following the government's cross-departmental strategy for curbing violence against women and girls (Together we can ...), the Home Office has issued draft guidance for local commissioners and partnerships. Comments are due in by 15 March 2010.