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.