Airways

The use of spirometry information in smoking cessation interventions has been the subject of a recently reported trial. The ESPITAP study, conducted in Spain, looked at the use of spirometry information in the context of structured motivational interviewing for smoking cessation, finding that this improved abstinence rates. One (admittedly quite limited) review also found that annual spirometry combined with a brief smoking cessation intervention was one of the more effective methods for COPD patients.

Health mapped

The second and substantially extended issue of the NHS Atlas of Variation has appeared, showing how use of healthcare varies in the UK across a range of conditions.

Fair's Fare latest issue

Fair's Fare issue 24 is now available from the EPHRU website.

Holy Grail?

An effective way to reduce costs and hospital admissions occasioned by alcohol harm is a bit of a philosopher's stone for the public health world. The South East Alcohol Innovation Programme's final evaluation should therefore be welcome reading. Three of the projects have already been taken up by the NHS as QIPP initiatives. The SHAHRP programme (School Health and Alcohol Harm Reduction Project), devised in Australia, has recently been applied in Northern Ireland with positive results. SHAHRP is also being trialled in Liverpool. In its submission to the House of Commons Select Committee on Science and Technology Inquiry on Alcohol Guidelines, the Royal College of Physicians (RCP) has suggested that government sensible drinking guidelines should be amended, particularly as regards frequency: "the RCP disputes the claim that drinking every day will not accrue a significant health risk." The report also expresses concern about the consistency and effectiveness of the government's communications in this area. The Scottish Government is making another attempt to legislate for minimum pricing, with the reintroduction earlier this month of the Alcohol Bill. And the effort to tackle alcohol harm seems also to extend to the work of Transport Scotland, as a consultation on reorganising rail services includes the suggestion (received with scant enthusiasm) that alcohol be banned on trains.

Lessons learned?

A study from the Department for Education maps Serious Case Review information with other data on the serious and fatal maltreatment of children (from ONS, the Home Office homicide database and Child Death Overview Panels). The majority of violent deaths occur in babies less than one year old, with the next most affected group being the over-14s. This trend is also a focus for a report from OFSTED, covering Serious Case Reviews from 2007 to 2011. The NSPCC report All babies count also emphasises "the disproportionate vulnerability of babies" and the importance of early intervention.

The place to be

The idea that urban green space is connected somehow with better health is a common theme in the literature. But pinning down exactly how this is the case is not easy. A systematic review in the Journal of Public Health attempts to clarify what evidence there is for health benefits from urban green space, finding the proof somewhat unpersuasive. A study from the US looks at the reverse: how far an unhealthy place (with particular emphasis on violence) relates to birthweight. Finally, another look at the Scottish effect, here asking whether it applies south of the border.

Institionalise!

This week the new Institute of Health Equity at UCL was launched. Led by inequalities expert Professor Sir Michael Marmot, the Institute will be funded in part by DH and the BMA. In his first blog post, Marmot expresses some optimism as regards the coalition government's commitment to tackling health inequalities, quoting Don Quixote: "the dogs are barking, Sancho; it is a sign we’re moving."

Deciding to make a difference

As England's public health system is on the brink of enormous change, a timely study of how public health decisions are made comes from a team at Liverpool University. Taking cardiovascular disease as a case study, researchers looked at decision-making by healthcare and public service professionals in an effort to reduce health inequalities. A study in the European Journal of Public Health compares Scotland and Belgium's policies to tackle ethnic inequalities in health, in which Scotland is shown to have played the better game (score: Belgium 1 Scotland 4, the study's authors claim).

Safeguarding

The Safeguarding Children Research Initiative, set up following the inquiry into the death of Victoria Climbie, has issued a report providing an overview of its work. One article in Community Practitioner looks at the health visitor's role in child protection. Another offers an evaluation of the Early Intervention Safeguarding Nurse pilot in North West England, which used an integrated model to address the all too common communication difficulties. NHS Information Centre has published provisional data on abuse of vulnerable adults, the first time this data has been collected on a mandatory basis.

Start right

The Department for Education is consulting on entitlement for free early education for children from age 2, from September 2013. This follows a commitment annouced earlier this year to extend free pre-school education to the most deprived 2 year olds. The consultation paper includes draft statutory guidance for local authorities on delivery of free early education as well as on implementation of the new provisions.

Plain truth

Australia has stepped up its anti-smoking regime, with the passing in the senate of legislation to enforce plain packaging for tobacco products. A close-run thing, the progress of the Australian government has been watched with interest from the UK and elsewhere. The bill returns to the lower house for a vote considered to be a formality, before coming into force in December 2012. Tobacco companies continue to threaten legal challenges to the rules, however. In England, cigarette sales from vending machines were banned from 1 October. The BMA's recommendation that smoking be banned in cars has come in for a some ridicule in certain areas of the press, after its press release somewhat overstated the level of threat from secondhand smoke in cars.

Just not working

What lies behind persistent levels of worklessness in some deprived areas is the subject of research issued by DWP. Using individual level data from the Work and Pensions Longitudinal Study (WPLS), researchers look in particular at transition into and out of worklessness and employment and geographic migration. A study in the Cambridge Journal of Regions, Economy and Society also considers trends in worklessness in the weaker local economies and assesses future prospects.

Watch out

Weight Watchers works best, according to a study published in the Lancet. The RCT recruited overweight and obese adults from primary care practices in the UK, Australia and Germany, randomised to receive a commercial weight loss programme or standard care. Results indicated that "participants in the commercial programme group lost twice as much weight as did those in the standard care group." A recent audit of the UK's weight watchers on prescription programme was similarly positive.

Mind the gap: what doctors can do

The BMA has published a guide for doctors on how they can contribute to reducing health inequalities, focusing on a holistic approach to medical practice. A study in Social Science and Medicine examines how far general practitioners (in France) contribute to increasing health inequalities by overestimating the health of patients with lower educational attainment. The researchers found that patients of lower and medium educational level were more at risk of being overestimated in terms of self reported health.

Fair's Fare Issue 23

The latest round up of Fair's Fare blogs: Issue 23 is now available on EPHRU's website

Screen daze

A special issue of Ethnicity and Health provides a survey on haemoglobin disorders. Articles include a consideration of the ethical issues related to screening , familial influence in screening and the implications of living with sickle cell disease.

The Scottish effect: what's behind the numbers?

Scotland's mortality rate is higher than those for England and Wales and the presence of deprivation does not provide an adequate answer. A study in the Journal of Public Health tests the effect's reality at individual level by including in their analysis people who were Scottish born as well as those living in Scotland. They found that the higher mortality rate applied also to those who had left Scotland and subsequently lived in England and Wales, leading to the suggestion that taking a "life course" approach to the subject may well provide illumination. The Scottish national phenomenon can also be narrowed down to a Glasgow effect: a recent study in Health and Place asks whether this is associated with selective internal migration (they find there's no evidence for this). A comparative study, looking at premature mortality in deprived areas in England and Wales as well as Scotland, finds that between 1991 and 2001 rates amongst men rose by 14% in Scotland, while there was no significant change in England and Wales. The rise in Scottish mortality rates was largely driven by results for Glasgow (as rise of 15% for the period). The Glasgow Centre for Population Health is currently engaged on a programme of research into this effect, looking for insights provided by a comparison with Liverpool and Manchester.

Left out

Social exclusion has long been considered an issue for people with mental illness. A study in Social Inclusion and Mental Health offers a survey of current evidence, based on the findings of the Royal College of Psychiatrists Scoping Group on Social Exclusion and Mental Health. Another piece of research in the same journal looks at ways to address the impact of social exclusion on mental health in Gypsy, Roma, and Traveller (GRT) communities.

Staying put

An interesting piece of research in the Journal of Epidemiology and Community Health examines the association of housing type with reduced rates of admission to institutional care, in particular asking whether this is because wealthier people can afford to buy in care rather than move into care homes or because homeowners are unwilling to sell in order to fund residential care (findings indicate the latter). On the Guardian's Joe Public blog, Claudia Wood considers the effect of personal care budgets on residential care. She's also the author of a Demos report on personalisation of care, Tailor Made.

Begging the question

Bus passes: do they make you fat? Actually, no, according to research from the Department of Primary Care and Public Health at Imperial College London. Using data from the English Longitudinal Study of Ageing, the team found (via the mysteries of logistic regression analysis) that the provision of bus passes to people aged 60 + has encouraged increased use of public transport and that this is associated with lower levels of obesity. Or, to put it more succinctly, bus passes "may have conferred a protective effect against obesity."

Stating the *** obvious

The government's new obesity call to action has been (almost) universally reviled. It's quite an achievement to elicit the scorn of the media (Daily Mail to New Statesman), experts from the medical profession (as told to the BMJ) and Jamie Oliver. Possibly the most arresting headlines were derived from the elegant summary by Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health, who suggested that the government's proposed calorie cut was "equivalent to 16 dry roasted peanuts, containing six calories each." Behind the infamous call to action is a change in the advice from the Scientific Advisory Committee on Nutrition (SACN) on energy requirements, cutting advised maximum intake for women to 2079 and for men 2605 calories per day. Alongside the obesity strategy, Change4life is given a makeover, with an extended scope (including alcohol harm and physical activity).
An article in the Journal of Public Health Policy offers some insight into what the UK public thinks causes obesity, while a piece in the European Journal of Public Health casts a sceptical eye over partnerships between the food industry and public health.

Competition - it's not as bad as you think

Increasing competition in the NHS has not brought an increase in health inequalities, according to research from the Centre for Health Economics (CHE) at the University of York. The studies examined the effects of market reforms under the Labour government in the 2000s, using Hospital Episode Statistics (HES) to look at hospital usage related to socio-economic status. These studies in particular challenge the view that increased competition would allow hospitals to "cherry-pick" patients and avoid treating those from more deprived background who may be less healthy and more challenging to treat. The teams from CHE found no change in the association of deprivation and hospital use for several key elective admissions between 2000 and 2008 and no change also in the relationship between deprivation and disease prevalence, "indicating that observed need did not grow faster in more deprived areas than
elsewhere." A more general assessment of Labour's interventions to promote competition in the NHS is provided by the King's Fund, also offering "key warnings" to the present government.

Outlook bleak

The number of people living in poverty in the UK is set to rise, according to a report from the Institute of Fiscal Studies (IFS) and the Joseph Rowntree Foundation (JRF) According to this research, both relative and absolute poverty amongst children and working age adults are expected to increase as earnings growth is forecast to remain weak and inflation high. The other factor this report considers is the effect of current government policy, looking at the mix of the new Universal Tax Credit and changes to benefits such as Local Housing Allowance, which from April 2013 will be indexed in line with consumer price index rather than the retail price index. IFS argues that this combination of reforms is likely to increase poverty: both IFS and JRF have frequently stressed that the Child Poverty Act targets are challenging and this report offers no encouraging vision of the future.

Mind the gap

... and measure the health inequalities gap with South East Public Health Observatory's (SEPHO) Health Inequalities Gap Measurement Tool, which shows gaps in mortality rates by grouping local populations according to relative levels of deprivation. Results can be arranged by local authority, PCT and SHA; the gap tool uses mortality data from 2001 to 2009.

Out to lunch

Jamie's School Dinners may have been landmark TV but this and similar initiatives run into trouble with children's food preferences, according to a study published in Critical Public Health. Its authors take a socio-ecological approach to assessing how primary school dining halls can contribute to improving children's nutrition related behaviour. DH proudly announced last month that high street restaurants (amongst which children's favourite McDonalds) have signed up to the Public Health Responsibility Deal calorie labelling programme.

Home sweet home

The Teenage Supported Housing Pilot, one of the nine Child Poverty pilots, involved seven local authorities in a project that provided assistance to teenage parents, focusing on 16 and 17 year olds or those not living with parents. In its final evaluation, the researchers for the Department for Education stressed the importance of flexible delivery and the role played by frontline staff. The Whitehall II study continues to offer further insights. One of the latest relates to the effect of housing on the mental health of older people. Researchers looked at data from the General Health Questionnaire (GHQ) for the cohort, which was administered six times as part of the Whitehall II study of British civil servants from 1989-2005. This study supports the view that it is housing quality and financial security, rather than home ownership, that impact on the mental health of older people. The Housing Learning And Improvement Network has published a series of briefing papers that consider the implications for the housing sector of the government's health and social care agenda.

Sharing nicely

There's a small storm brewing over the government's proposed approach to funding allocations as regards inequalities, as HSJ has published details of how this works out in practice. It focuses on how funding allocations are made up and the proportion that is allocated on the basis of health inequalities,which has been cut from 15% to 10% in the 2011/12 allocation. The research was done for Public Health Manchester and was included in its submission to the Health Select Committee's inquiry into Public Health. Other submissions to the Committee have been critical of how far the government is including recommendations from the Marmot Report: the King's Fund and BMA's submissions make similar points. However, the report from Public Health Manchester does make clear in numbers who the winners and losers could be under the new arrangements. A DH spokesman quoted by HSJ rather suggested that perhaps this was just one (not entirely correct) interpretation of funding allocations. In the recent past, both the Audit Commission and the National Audit Office have expressed doubt as to the value for money that old arrangement has offered, arguing for better targetting and clearer evaluation of outcomes. The new design for the health premium, based on incentivisation, seems like a response to this criticism. Whether it works for reducing inequalities is another thing, though.

Roughing it

Levels of homelessness in the UK have begun to rise, according to figures released in September by the Department for Communities and Local Government: up 17% this April-June on the same period in 2010. While figures are low in the context of the past decade, it does seem that the trend is upwards. Crisis, the homelessness charity, has published a report that looks at the likely impacts of economic downturn and weakened welfare protection on homelessness in the UK. The government's pledge to end rough sleeping and prevent homelessness, set out in the policy document No second night out nationwide, acknowledges that there is no simple solution to this complex problem. And this is also the main theme of a new study from the Joseph Rowntree Foundation, which looks at evidence from a recent programme of work on multiple exclusion homelessness.

Tangled web

The connection between income inequality and health and social problems is commonly acknowledged, but the exact nature of that link is much harder to explain. A new report from the Joseph Rowntree Foundation asks the big question: does income inequality cause health and social problems? While its authors find little evidence for an entirely affirmative answer, they do note that some research does show a causal relationship and also that income inequalities might be more harmful beyond a certain threshold (following Wilkinson and Pickett's argument in The Spirit Level). While the UK was somewhat below that threshold in the middle of the last century, since the late 1980s we've been well above it. One of the report's authors, Karen Rowlingson, offers a good summary on the LSE blog.
Japan was once the byword for social equality, but since the market liberalisation of the 1990s, things have changed. A conference paper published in the Journal of Epidemiology and Community Health (JECH) charts the widening gap between rich and poor and the relationship between the social change of the 1990s and health inequalities in the second millennium.
An essay from Clare Bambra, also in JECH, muses on the role of the welfare state as determinant of health. The essay focuses on the public health "puzzle" evidenced in international studies of health inequalities: why do Scandinavian states, with rather more generous welfare provision, not have the smallest health inequalities?

Visiting time

The Royal College of Nursing (RCN) has published a consultation paper on public health nursing and the role of health visitors, in the light of the changing NHS landscape and the planned expansion in health visitor numbers. This document builds on two earlier position papers, on community nursing and health visitors, seeking to capture views of RCN members and develop some clarity about the health visiting role. The RCN wants to be clear that the focus of health visiting is on maternal and child wellbeing in the early years (0-5) and that general public health goals should be the concern of every nurse. Responses are due by 4 November 2011.

NICE advice for alcohol service commissioning

Guidance on commissioning alcohol services from NICE aims to help with benchmarking levels of alcohol dependence and harmful drinking in populations, along with methods for working out cost effectiveness of increasing screening and brief interventions. All of this is based on existing guidelines on alcohol harm (CG 115, CG 100 and PH 24). Health Scotland has published an evaluation of implementing brief interventions in the NHS since 2008, covering primary care, A&E and antenatal care. As the Scottish government prepares to legislate for minimum alcohol pricing, a study of views amongst people in north west England on pricing found that most people surveyed though that lower prices increased drinking while higher prices would have no effect on alcohol consumption. Alcohol Research UK has published a qualitative study of attitudes to the pricing question, finding that most people surveyed were not convinced that minimum pricing would be effective (although the study also found that most people didn't fully understand how the policy might work, either). A study from the Joseph Rowntree Foundation looks at how far young people's attitudes to drinking are influenced by the media.

Home alone

There are plenty of projects that target social isolation amongst older people, but how can you tell what works? A team from the Peninsular College of Medicine and Dentistry has reviewed such interventions, finding there was "evidence of substantial heterogeneity" amongst studies and that comparatively few were well-conducted. Most effective interventions tended to offer social activity and/or some group support; those that engaged older people's active participation also tended to be more successful. A three year action research programme assessing neighbourhood approaches to loneliness from the Joseph Rowntree Foundation may be worth watching. A study considering the relationship between neighbourhood environment and positive mental health amongst older people in Hertfordshire showed that a sense of cohesion with neighbours was associated with better mental wellbeing and less reporting of neighbourhood problems, independently of socio economic and health status. Finally, a team from Birmingham University looks at older people's strategies for dealing with winter cold.

Mickey Mouse Research?

Health promotion - it's all about role models. Latest child friendly association for the NHS's Change4Life healthy living brand is ... Lazytown. According to researchers PCP, Sportacus is "the healthiest children’s character on UK television" although Scooby Doo and Tom and Jerry were also considered very active (no mention of the other Mouse). This new promotion is designed to appeal to children aged 2 to 5 and to address healthy eating and physical activity issues. The under 5 age group was included for the first time in the government's recent physical activity guidelines .

Nice cup of tea and a sit down?

...or not: a nutritional analysis survey of biscuits and similar delights from DH makes sobering reading for anyone contemplating a tea break. There's also a survey of processed foods with particular reference to trans fatty acids (anything from pizza to ice cream). An editorial in a recent issue of the Journal of Epidemiology and Community Health muses about the the global obesity epidemic and the relationship between the demand and supply sides of the food system. A study in Critical Public Health, meanwhile, looks at the evidence for menu labelling as measure for preventing obesity.

Sleeping policemen

Road traffic casualties are known to show wide socioeconomic variation, but evidence as to what works to reduce them is in short supply. A new RCT published in the Journal of Epidemiology and Community Health assessed the effect of 20mph traffic speed zones in London. Researchers, who looked at data from 1987-2006, found that zones targeted in deprived areas only had a limited effect and that the socioeconomic gap continues to widen.

Just a check up

Does the NHS Health Check programme achieve the reach, both in volume and equality, that it needs to? A team from Imperial College London takes a look at uptake amongst high risk patients . A study based in Stoke on Trent considers how to deliver the programme in financially constrained times.

A nudge is a good as ...

The government's Nudge unit or, more properly, the Behavioural Insight Team (BIT) has suggested that smokers be encouraged to use smoke-free cigarettes, an idea that has not been met with universal approval. The suggestion, which has been pounced upon by the press, comes in the BIT's annual update. In the US, electronic cigarettes (e-cigs) are not approved as smoking cessation products and the Food and Drug Administration continues to have concerns about their manufacture and marketing. Thus, there was substantial press coverage of a study of e-cig users in the International Journal of Clinical Practice that sounded a slightly more positive note.

Funny money?

A cunning plan or just a vague idea? Social impact bonds have been cautiously welcomed as the first large-scale trials are announced. These trials, in Hammersmith & Fulham, Westminster, Birmingham and Leicestershire, will be based on an earlier pilot at Peterborough Prison, relating to reoffending. Social impact bonds have also been trialled in Essex and Liverpool. Meanwhile, the Big Society Bank has been renamed, now to be known as Big Society Capital.

Virginia Plain

Tobacco Control this month features discussion of plain packaging for cigarettes and other tobacco products. Australia is well on its way to becoming the first country to legislate on the matter (bills have recently been passed by the lower house), so there's some coverage of responses to this policy move. Also included are studies of young adults' and young women's perceptions of packaging, plain or otherwise. Five tobacco firms in the US have started legal action against the Food and Drug Administration over requirements to include graphic depictions of the dangers of smoking on packaging from September 2012. Meanwhile latest figures from the NHS Information Centre reveal that the number of people trying to quit via NHS stop smoking services has trebled in the past 10 years, although success rates have recently declined slightly. A study of recent quitters in Australia looks at rates of use and perceived helpfulness of a variety of cessation methods, while a team from St George's University of London evaluates the effectiveness of the NHS Quit Kit. A systematic review in the Lancet sifts the evidence on cigarette smoking as a risk factor for coronary heart disease amongst women compared with men.

But why?

An editorial in a recent edition of Maternal and Child Nutrition asks the difficult question: why have recent UK trials had no significant effects on breastfeeding rates? Early results from the 2010 Infant Feeding Survey, covering initial incidence of breastfeeding and smoking during pregnancy, show a rise on previous years, at 82% in England (up from 78% in 2005). A team from Salford looks at inequalities in immunisation and breastfeeding in relation to ethnicity and deprivation. The effect of Baby Friendly Initiative training in primary care has been examined by a team from Bristol, recently, as well as a group from the North West. Health and Social Care publishes a study of the role of Children's Centres in offering support for breastfeeding. Results from what is billed as "the most comprehensive UK study" on the effects of breastfeeding on children, mothers and employers will be presented at a policy discussion at the British Academy in October.

Something about ISER study???

The big question

As noted in the press, the Lancet devotes an issue to the matter of obesity, epidemiology and chronic disease, with four articles and some commentaries. Along with a global overview of the situation, there's also an analysis of UK and US trends, looking in particular at the economic burden. A third paper showcases a new web-based bodyweight simulation model, while the final paper argues that although interventions to halt the obesity epidemic may well be required at several levels, governments should be taking the lead.

The power of persuasion

… is not enough, according to The House of Lords Science and Technology Committee, which has published a report on its year-long investigation into behaviour change. The report focuses on two case studies of nudging: reducing CO2 emissions and obesity. In the context of the latter, the health trainers programme (because it aims to address inequalities) comes in for commendation, whilst the Public Health Responsibility Deal receives the opposite.

Back to school

As the new round of the National Child Measurement Programme (NCMP) starts up, DH publishes results of a review by the Thomas Coram Research Unit of the show so far. The review looks principally at delivery of the programme, although does also challenge the perception that most parents view the programme negatively. Areas for concern as regards local delivery included feedback letters, as well as lack of capacity in weight management services for effective referral. The report highlights the importance of effective engagement with schools, especially through the involvement of a Healthy Schools Co-ordinator, along with sharing results with schools. In the interests of spreading the word more effectively, the National Obesity Observatory has produced a set of slides explaining the NCMP and key data on child obesity. The latest survey on take up of school meals has been published by The School Food Trust and the Local Authority Caterers’ Association.

Planning for health

Some useful guidance on incorporating health issues into spatial planning from the Spatial Planning and Health Group and also The Town and Country Planning Association (the latter looks particularly at how this fits with Joint Strategic Needs Assessment - JSNA). Meanwhile HSJ reports on Liverpool's Green Infrastructure Strategy, a joint initiative between the PCT and te City Council, designed to enhance the contribution of the city's green space to reducing inequalities.

Food for thought

In the context of the Public Health Responsibility Deal, DH commissioned the National Heart Forum to survey the regulatory landscape for marketing of food and drink to children. The report will be considered by the snappily titled Food Network High Level Steering Group in the course of its work next year. Under the same banner, the Calorie Reduction Expert Group has proposed reducing levels of daily calorie recommended by 100kcal/day. Again, this recommendation will be examined by the Food Network High Level Steering Group.

Getting the message right

DH has published a strategy for social marketing for the public health arena. One of the key messages is "less is more:" while acknowledging the success of some campaigns, DH now suggests that it's time for a somewhat slimmed down approach, even going so far as to pilot payment by results. An article in Critical Public Health takes a cool look at the use of health trainers to help people in deprived areas self manage health behaviour. How people understand healthy living and how they use health information to make health choices is the subject of a study in Social Science and Medicine, based on interviews with people in the UK and Canada.

Children's Services

Guidance for commissioners for children's, young people's and maternal services from NHS North West takes a life course approach to the issue as well as looking at common themes across all age groups, such as child poverty, vulnerable children and young people and emotional health and wellbeing. The Government's response to the Munro Review of child protection offers the usual pieces of evidence for efforts towards reform (not just health visitors), with particular emphasis on the Supporting Families in the Foundation Years paper.

Personalizing healthcare

Personal health budgeting is likely to continue to expand in the UK, so this evaluation of individual budgets for families with disabled children is interesting. The pilots ran for two years from April 2009 in six sites in England and have reported varying levels of success in broadening how funding can be used by families: "work in progress" is the verdict from the Department for Education's evaluation. DH has also published an evaluation of personal health budgets programme, looking at the cost of implelementation.

Nanny state?

Liberal thinktank Centre Forum has stepped into the social mobility debate with a report on early years and parenting. The key message is the idea of a parenting "5-a-day": 5 positive actions that could be marketed in the same way as current healthy eating campaigns. The paper also recommends incentivising adherence by lower income families. There was a cautious welcome from Children's Minister Sarah Teather .

Prison health

The CQC has once again reviewed healthcare for young offenders and praises improvements in how healthcare is managed by Youth Offending Teams (YOTs). As is often the case, there is criticism of how transfer from child to adult services, along with transfer between custody and community and the usual pleas for better communication between YOT staff and healthcare workers. As the commissioning role for prison based substance abuse treatment is transferred from the Ministry of Justice to the Department of Health, some guidance about how the changeover will work from DH. Further details on service design will be offered in the forthcoming Building Recovery in Communities framework (BRiC), which has been the subject of recent consultation.

Mind the gap

How poor is poor? A new research report from the Department of Work and Pensions looks at how child poverty is measured in the UK, under the Child Poverty Act and the National Child Poverty Strategy and considers how to measure depth of poverty (the poverty gap). Meanwhile, according to the Joseph Rowntree Foundation's measure, the Minimum Income Standard, living costs have risen by 5% on last year, with the greatest burden on families with children, who would need to earn at least 20% more (before tax and benefits) to meet this Minimum Income Standard.

A good start in life

The critical importance of a child's early years in terms of life chances and health is now widely acknowledged, as is the association of the two issues. The Government sets out its stall in some new pages from the Department for Education (DfE) website. DfE has also published Supporting Families in the Foundation Years, in which it sets out policy for this area and responds to Frank Field's earlier report on child poverty, Graham Allen's first early intervention report and Dame Clare Tickell's report on early years. Highlighted offers include health visitor recruitment (again!), slimming down the Early Years Foundation Stage but including greater focus on parents, a reprieve for Sure Start centres, introducing greater flexibility for parental leave and extending free early education for the most disadvantaged 2 year olds. Some of these policy moves are familiar. Offering free pre-school education to disavantaged 2 year olds follows a recent pilot, although this plan was announced last year, too, and is not entirely dissimilar to the previous government's commitments. DfE has also published an evalution of Sure Start, with an economic focus.

Moving on up

Exercise for young children was the main story as the CMOs' physical acivity guidelines were published last month. However, the accompanying report, which surveys physical activity in the UK, provides evidence across all age groups for the risks associated with inactivity and the benefits of exercise. This is the first set of UK-wide physical activity guidelines and also the first time that under 5s have been included. The focus on sedentary behaviour is new, too. A study from a team in Bristol looks at the relationship between neighbourhood deprivation and physical activity amongst older adults. An evaluation of a physical activity care pathway in a primary care setting considers the cost recruitment via disease register screening and opportunistic screening. Although the opportunistic screening was inevitably cheaper, patients recruited via disease register screening had higher completion rates and generally better outcomes in terms of behavioural change.

Weight management

A selection of recently published research on obesity and weight management:
The NHS practice of offering Weight Watchers on prescription for obesity is examined by the MRC Human Nutrition Research Unit. As the abstract says "This is the largest audit of NHS referral to a commercial weight loss programme in the UK and results are comparable with other options for weight loss available through primary care."
A team from Sweden offers a cost comparison between standard ante-natal care and care with additional weight gain restriction for obese women who are pregnant. There's also a qualitative study of a UK community based prevention and management programme for maternal obesity.

North - South divide at the heart of the matter (again)

Examining Clinical and Health Outcomes Knowledge Base data from 2009 on coronary heart disease (CHD) mortality, cholesterol charity Heart UK has found a marked divide in between North and South. While this is not exactly news, it's the basis of Heart UK's new Heart Hotspots campaign and is supported by a survey conducted by ICS that suggests that even people with cardiovascular disease symptoms like high blood pressure or high cholesterol are not overly concerned about heart health. As well as the North-South divide, the data also shows wide variations within cities, even in the South. A study in from a team at the University of Oxford's Public Health Department confirms the survey view insofar as it links unhealthy lifestyle with CHD mortality when examining small geographic areas (ward level). The same team has also looked at how far relative deprivation is associated with CHD mortality, finding that "income inequality of an area has an impact on individual-level health outcome."

Picture of Britain

There's a snapshot of the health of the nation in a chapter from the latest issue of Social Trends from the Office of National Statistics (ONS). Data on health covers health expenditure and life expectancy, self-reported health, use of services, mortality, cancer, healthy living and mental health. Most data is from 2008-9.

The early bird ...

Graham Allen's second report on early intervention has been published by the Cabinet Office. Early Intervention: Smart Investment, Massive Savings focuses, as its title suggests, on how to expedite and pay for early intervention programmes, in better targeting of existing funds (Allen suggests theming the next Comprehensive Spending Review around early intervention) and in attracting financing from elsewhere (social impact bonds from the Big Society Bank). According to the Guardian, Allen's plea for immediate funding to set up his proposed Early Intervention Foundation was turned down by the Government. A formal government response is due in the Autumn.

It really works

A useful summary from DH sets out the evidence for the effectiveness of the Family Nurse Partnership (FNP) , a preventive programme for young mothers, covering its origins in the US and the developing English evidence base. The final reporting for the initial 10 pilots groups has now been published, but we are still awaiting results from a Randomised Controlled Trial (RCT) of a futher 18 sites, due to complete in 2013, which will compare FNP with other services.

Learning disabilities and healthcare: what do we need to know?

A report from the Learning Disabilities Observatory maps the data collected on the health and healthcare of people with learning disabilities. As its name suggests (NHS Data Gaps for Learning Disabilities), the report also describes the gaps in knowledge needed to plan for and assess healthcare provided for people with learning disabilities. The report proposes some changes to data collection that would offer huge improvements, including introducing additional samples of people with learning disabilites in the Health Survey for England, making more effective use of QOF data and a national audit of GP healthchecks for people with learning disabilites.

Postcode lottery again

More research on cancer inequalities, this time from the Roy Castle Foundation, which has looked at lung cancer treatment in England. Along with significant geographical variation, the report identifies socio-economic derived inequalities: people living in deprived areas are less likely to receive chemotherapy. Survival rates for lung cancer are not associated with socio-economic deprivation, but they are with breast cancer, according to a report from the National Cancer Intelligence Network. In this study of breast cancers diagnosed in 2007, poorer women who presented with cancer symptoms had noticeably worse 5-year survival rates than more affluent women, while there was only a slight difference between most and least deprived women whose cancer had been diagnosed via screening.

Power of persuasion

Some interesting pieces of research about behaviour change and technology: firstly a meta-analysis of online social marketing behaviour change interventions, which concludes that the web works for this kind of thing: "Given the high reach and low cost of online technologies, the stage may be set for increased public health campaigns that blend interpersonal online systems with mass-media outreach." Another study by some of the same researchers looked at the potential for smartphones to deliver alcohol use behaviour change and the availability (or otherwise) of apps for that.
A more recent trial of smoking cessation help delivered by text message also gained positive results. This large UK trial, text2stop, found "significantly improved" smoking cessation levels amongst the recipients of texts.

But is it worth it?

More to help the hard-pressed commissioner work out what works. The National Social Marketing Centre (NSMC), in collaboration with NICE, has developed a set of tools to help commissioners work out whether their social marketing and behaviour change interventions are cost effective. Currently there are 5 of the Excel-based Value for Money toolkits, covering: tobacco control, breastfeeding, obesity, bowel cancer, harmful and hazardous drinking and brief alcohol interventions. NSMC is also running a series of training events to support the tools.

Smoothing things out

Spearhead groups were set up in 2001 to help England's most deprived areas in achieving health inequalities targets. By just over halfway through the programme, it became clear that these targets were not going to be reached and that progress was uneven amongst the Spearhead groups. A report from SDO NIHR looks at the reasons behind the inequalities in results and draws some conclusions on effective ways to tackle inequalities in health, looking in detail at cardiovascular disease, teenage pregnancy and cancer. Unusually, the report's authors used qualitative comparative analysis (QCA), which its authors suggest is better at analysing complex causal patterns, as are found in health inequalities.

Simple but effective

Finding ways to engage with people who are hard to reach was the aim of the Adults facing Chronic Exclusion (ACE) pilots. The ACE programme was a joint undertaking between healthcare, housing, employment and other agencies. It looked at interventions for people whose lives were "chaotic or isolated" and for whom local services were inaccessible or unaccessed, often because of homelessness prostitution or durg and alcohol misuse. The twelve pilot programmes have now ended and the report on their achievements has been published by the Department for Communities and Local Government: the emphasis is on local solutions, most of which were comparatively inexpensive. The most noticeable healthcare impact was a reduction in use of emergency services, with a shift instead towards primary care. However, the clearest message from the final report is that a key part of any success is "the consistent, trusted adult" who helps clients in accessing existing services in an appropriate way.

Low income Britain

A report from the Joseph Rowntree Foundation takes a long, hard look at government policy on place, poverty and welfare. The Living Through Change in Challenging Neighbourhoods project is the result of 3 years’ research in six low income neighbourhoods across the country. The report focuses on community cohesion, encouraging localism, community regeneration and enhancing opportunities to enter the labour market. A team from Durham University has also been looking at regeneration, here in the context of former coalfield communities. A key insight from this research is the way that its authors consider the relationship between well-being, community resilience and health, as an interview on their departmental blog underlines.

Weight management and physical activity

A review in the International Journal of Obesity looks at the evidence for lifestyle interventions for weight management and concludes that multi-component, longer-term tend to be more effective. The National Obesity Observatory's (NOO) own survey of the subject concurs, but also suggests that brief interventions can work, at least in the short term, if they focus on both diet and activity and incorporate behavioural techniques, including motivational interviewing. How to make physical activity and weight loss programmes work for older obese adults is the subject of a study from the US, while a team from UCL has looked at what enlightenment the Health Survey for England has to offer as regards physical activity levels of South Asians in the UK. NOO also takes a look at data from a variety of surveys, including Health Survey for England and the British Social Attitudes Survey, to examine attitudes to physical activity and healthy eating amongst adults and children and young people. Meanwhile a study in Social Science and Medicine considers the relationship between friendship networks and physical activity amongst children and young people, possibly using spatial autoregressive modelling to analyse jumpers for goalposts...

Child obesity

You can now view child obesity data for England at Local Authority, PCT and Middle Super Output Area (smaller population groups of around 7200) in the e-atlases available from the National Obesity Observatory (NOO). The maps use data from the National Child Measurement Programme and allow for comparison of obesity indictors with deprivation scores, amongst other indicators. NOO also provides a useful set of Powerpoint slides with clear graphics and charts for presenting child and adult obesity information. There are also a couple of surveys of the relationship between obesity and ethnicity and mental health.

Down the hatch

The UK's drinking behaviour is again under the spotlight with the release of the latest statistics on alcohol use from NHS Information Centre. Alcohol-related hospital admissions in 2009-10 had risen by 12% from the previous year and had topped 1 million. The government's alcohol strategy is due out later this year.

Cancer survival rates

The King's Fund considers the UK's record on cancer survival and the government's Cancer outcomes strategy. The report looks at variations in survival rates, where there remains a notable north-south divide and significant variations for some ethnic groups. However one particularly strong variation is in the survival rates of older people, where the UK lags significantly behind other European countries, especially for lung, ovarian and colorectal cancer. Focus for improvement, the report stresses, should be on reducing delays in diagnosis and improving access to radiotherapy and surgery, as well as primary prevention. Tackling health inequalities and addressing cancer care for older people will also improve cancer outcomes.

Location, location, location

The importance of green space in urban environments has been much studied in recent years. A systematic review from a team at the University of Sheffield assesses the evidence for health benefits of green space. They find that while most studies find in favour of green space, causal relationships are more elusive. Another environmental truism, that the countryside is a healthier place to live, is challenged by a study on mortality differences from the Public Health Observatory Wales. Another study from Durham University finds that living in rural areas is associated with better overall mental health, although notes that in rural areas there deeper divisions between those who are in the workforce and those who are not.

Just so you know

Messages for Munro documents the views of children and young people in care who contributed evidence to the Munro review of the child protection system. The Justice Department has also published a short thematic review of the care of looked after children in custody. It has also been announced that responsibility for commissioning health services for children and young people in secure settings passes to the NHS, in line with Young Offender Institutions. Prior to this, Secure Children's Home and Secure Training Centre commissioned their own healthcare independently, funded by the Ministry of Justice.

Peeling the onion

... is the title of a report from the thinktank the Centre for Public Scrutiny (CfPS), looking at the role of scrutiny and accountability in tackling health inequalities. It draws on projects in 10 areas over the last two years, reviewing thematic interventions (such as alcohol pricing or early intervention for mental health problems) or geographic health inequalities.

Counting the cost

The Family Resources Survey (FRS) introduced questions about deprivation in its 2004/5 round. DWP has just published a review of the evidence by Stephen McKay, chair in social research at the University of Birmingham. The paper looks at these new questions and at the FRS more generally, considering how far it reflects current ideas of material deprivation and proposing some minor changes to the survey.

Healthy eating round-up

You are what your friends eat, a systematic review of social network analyses of adolescent eating habits and bodyweight, underlines the importance of school friendships in shaping young people's eating behaviours. It also suggests that social network-based health promotion interventions may play well amongst this group. Well, you don't say ...
Another systematic review considers children's attitudes to obesity, body size, shape and weight, finding that children tend to focus on size, rather than health and also that researchers had rarely engaged effectively with their subjects.
Meanwhile DH has published some new material allied with the eatwell plate, a resource designed to show what a healthy, balanced diet should look like.

Going local

Many avowed solutions to health inequalities lie outside of the sphere of influence of public health professionals. So how can local health departments attempt to address inequalities, asks an article in Health and Social Care in the Community? Its authors suggest that the role of social capital is critical. A team from the Netherlands have also published a study about social capital, looking at its relationship with self-reported health and finding that its positive association with health is especially so for people in urban environments

Smoking Cessation

While smoking has declined amongst the UK population, prevalence amongst ethnic minority groups has not reduced at the same rate, a briefing from the Race Equality Foundation observes. As well as setting out the demographics and providing some examples of cessation interventions, the briefing also gives a helpful overview of smokeless tobacco products used by ethnic minority groups in the UK.

Measuring up

Evaluating the impact of health improvement interventions can be challenging and there’s always a new how-to guide in the offing: here’s one from Local Government Improvement and Development. It stems from the Healthy Communities Programme and includes a selection of project evaluation examples from primary care and a variety of information sources for evaluation and data collection and analysis.

An uphill struggle

Something of a cri de coeur from Clare Bambra and others is contained in a comparison of the Black, Acheson and Marmot reports. Looking at the content as well as the political context in which the reports were commissioned and published, the article find similarities in theoretical underpinning and in effects, not to mention the uncanny likeness of circumstances for Black and Marmot. And there's a rather melancholy conclusion: "Looking to the future, researchers may improve the likelihood of their research having a wider policy impact by focusing less on describing the problem and more on ways to solve it." An analysis of the UK approach between 1997 and 2010 from a Dutch academic is similarly bleak.

Counting the cost

Poor diet is the largest contributor to NHS costs amongst the usual group of suspects, an assertion not missed by the press. The British Heart Foundation Health Promotion Research Group has reappraised the economic impact on the NHS of poor diet, physical inactivity, smoking, alcohol and obesity. Looking at data from 2006-7, researchers found that while smoking and alcohol each accounted for £3.3 billion, poor diet cost the NHS £5.8 billion. A team from the Netherlands, meanwhile, has examined the EU-wide economic cost of health inequalities.

Child Protection

Few surprises from the final paper from the Munro Review, with further critical analysis of the “one size fits all” approach and the quantity of red tape in the current child protection system. Acknowledging the importance of early intervention, the report also (in keeping with a theme in health and social care reform at the moment) stresses the need for more local solutions. And there’s an emphasis on accountability, with the recommendation that Local Safeguarding Children Boards should submit annual reports directly to the Chief Executive and Leader of the Council, as well as to the local Police and Crime Commissioner and the chair of the health and wellbeing board. A further indication that the Munro review wants increased visibility for child protection is the recommendation that councils appoint a dedicated children’s services director. Finally, there’s a lot said in support of social workers, both in terms of removing the bureaucratic barriers and encouraging clearer connections between front-line practitioners and local authority managers. However, as the RCPCH and other have observed, the report has been launched into the maelstrom of NHS reforms and local authority budget cuts, which will inevitably impact child protection provision.

In the country

How will the health service reforms affect rural economies, asks the Primary Care Trust Network (part of NHS Confederation)? Differently, it seems, is the answer. In its briefing, the PCT Network warns commissioners and others to pay attention to the particular demographic and geographic challenges in rural locations, especially the older-than-average population and the hard to reach pockets of deprivation. The report also consider the outlook for the health market, suggesting that rural areas have a propensity for market failure in some sectors: any plans for implementation need to be "rural proofed."

Child abuse deaths: not what you'd expect

An interesting and counterintuitive piece of number-crunching from a team at the university of Warwick shows that child deaths from violence fell considerably over recent years. Looking at ONS mortality data and Home Office homicide statistics between 1974 and 2008, researchers found that deaths from assault fell in infants (below 1 year old) and children (between 1 and 14 years old). For adolescents (15-19 year olds), the picture is different: amongst girls, levels have remained static, but there was a substantial jump in deaths caused by violent assault amongst teenaged boys. And depending on which news report you read, this can either mean that the child protection system works (Independent) or that it fails teenage boys (Children and Young People Now). CYPN also notes that figures released by Cardiff University's Violence and Society Research Group showed a rise in numbers of children under 11 being treated in emergency departments and minor injury units in 2008-9.