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.