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.
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.
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.
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.
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.
