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.