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.