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.