Learning Disabilities

Some very useful data and interesting reflections in the Learning Disabilities Observatory's latest report. People with Learning Disabilities in England 2010 brings together information from governmental and other sources, covering health, education, adult social care, employment, benefits and carers.

Waiting time

The latest issue of Social Science and Medicine offers two pieces of research that consider inequalities acute care provision. Do the poor cost much more? looks at whether healthcare reform in the UK designed to incentivise reducing waiting lists and length of stay for elective surgery had adversely affected poorer patients (not much, the article's authors suggest). An earlier study in the BMJ made similar findings. Socioeconomic inequalities in the diffusion of health technology takes as an example uptake of coronary procedures in Western Australia. Here, the authors find some evidence that more well-off patients received coronary artery bypass surgery and angiography earlier.

Is nudging good for you?

It's an idea that features strongly amongst policymakers in the UK and the US at the moment ... but can it really work for population health? Theresa Marteau and others, in a review and analysis of the literature in the BMJ, suggests that the evidence isn't great. While welcoming the debate that Nudge and other books have stimulated, the article observes that nudging towards healthier options fails to compete with the level of nudging in the opposite direction. Nudging works, but regulation works better. The Government thinks differently, as the report from its Behavioural Insights Team shows.
Elsewhere, a report from Ipsos Social Research Institute suggests that most people are willing to accept a level of nudging towards healthy living from government. And a review of Nudge by Thaler and Sunstein in the HSJ suggests it is an approach that can work for commissioning management. If the book has captured your imagination, you may also be interested in its accompanying blog. Also worth checking are presentations from the King's Fund event, Nudging Improvements in Public Health, the last in its Big Society series.

Geography

The association of fast food outlets and density of child obesity in the population of Leeds is shown to be positive, according to a recently published study in Health and Place. Researchers also noted a "significant association between fast food outlet density and areas of higher deprivation." Also from Health and Place researchers looked at the relationship between childhood obesity and access to unrban parks and recreational facilities in a longitudinal study in Southern California (where better?).
A team from the University of Michigan has put GoogleEarth to the test as a neighbourhood audit instrument, using Street View to survey areas of Chicago.
Finally, a team from UEA has mapped the UK's recreational physical activity using data from large population studies rather than estimates and modelling.

Sliding Scale

A team from the Universities of Essex and Toronto have analysed national household panel surveys in the UK, Germany, Denmark and the USA, focusing on inequalities in self-related health for working age adults. They were looking at trajectories of self-related health over a seven-year period and how these could be seen to relate to national welfare policies.

Healthy Eating Round-up

Recently published wisdom on the subject includes:
A cost-effectiveness analysis of public policies designed to increase fruit and vegetable consumption in the European Journal of Public Health. Its authors conclude that VAT reductions work better than food stamps in terms of life years saved and that information campaigns are the most cost-effective (no surprises there!). An earlier issue of EJPH also included findings from a panel discusion on monetary incentives in promoting healthy eating.
From New Zealand there's a study on the effects of a free school breakfast programme on attendance, achievement, nutrition and wellbeing.
There's also a protocol for a study in promoting a healthy diet and physical activity in adults with learning disabilities (from BMC).

Children's Centres

The Commission for Rural Communities makes a bid for the value of children's centres in rural areas to be acknowledged. The government has made it clear in the 2010 Spending Review and elsewhere that it wishes the Sure Start programme and Children's Centres to be "refocused on its original purpose of improving the life chances of disadvantaged children." In the light of this, it's not clear how influential this commissioning guide will be with cash-strapped local authorities or other likely commissioners.

Child Poverty

A recent consultation from the Department for Education considers strategies for reducing child poverty in the present economically straightened circumstances. Tackling Child Poverty and Improving Life Chances is informed by two recent independent reviews commissioned by the Coalition Government: Frank Field's review of poverty and life chances (which reported in early December) and Graham Allen's review of early intervention (which reported more recently). However, the whole project is tied to commitments under the Child Poverty Act 2010, which requires government to publish a strategy setting out how it will attempt to tackle this issue.
Responses are due in by 15 February 2011.

Indicators

Recently APHO published health inequality indicators for each English local authority, rather than at PCT level, as had previously been the case. Data covers the period 2005-9 and uses the slope index for inequality (SII) for life expectancy at birth. SII is a single figure which shows the gap between poorest and most well-off in each area. This is based on analysing the relationship between life expectancy and deprivation figures (using the Index of Multiple Deprivation) for the whole local authority. This way of presenting inequalities data at the level was proposed in the Public Health Outcomes Framework. SII has been widely used for sometime and is good at offering clear comparison between health of wealthiest and poorest.

Not a good report

The UK has not scored too well on UNICEF's Innocenti Report Card 9 survey of inequality in child wellbeing amongst the richer countries, The Children Left Behind. Focusing on OECD states, the report looks at health, educational and material wellbeing, and assesses how far the most disadvantaged children have fallen behind those at median level. Using this kind of measure, the UK ranks alongside Hungary, Slovakia and the Czech Republic, in the bottom two- fifths of countries, principally on the basis of a low ranking in material wellbeing.

At the beginning

The Family Nurse Partnership gets another ringing endorsement in a report from DH. Providing "intensive support" for young parents, the scheme has been described as showing "good potential." This is the third evaluation report for the FNP and it follows the first cohort of clients, looking at how the programme supports families where the children are between 12 and 24 months. Andrew Lansley announced in October that the FNP would be doubled in capacity by 2015.