Not so fast

Mining data from the Born in Bradford cohort, researchers examine the relationship between proximity to fast food outlets, deprivation, obesity and ethnicity.  They found that the South Asian women in the study had greater access to fast food outlets but were less likely to be obese (17% with BMI > 30 as compared with 24% amongst non-South Asian women).  The study calls into question the usual assumption that area level deprivation and density of fast food outlets are strongly linked to obesity: other factors are at play, too.  Another UK based study attempts to make some connections between ethnicity density, neighbourhood food and physical activity environments.

Putting healthcare on the spot

Does healthcare help everyone equally? A study from Finland examines socioeconomic equity in amenable mortality (premature deaths that should not occur if effective healthcare is provided).  Researchers, who analysed data from 1992 to 2008, found that the decreasing trend in amenable mortality was notably slower in low income groups.  When comparing the effectiveness of specialist and primary care in reducing inequalities, it was clear that inequities were larger and increased faster in deaths amenable to specialist care, although "primary health care interventions made a greater contribution to overall inequity."  Another study examined mortality data from 14 European countries, assessing whether socioeconomic inequalities in amenable mortality reflected access to or quality of healthcare (neither, was the verdict).  A paper in the European Journal of Health Economics does the math, comparing avoidable mortality with healthcare spending in 14 western countries between 1996 and 2006.

The long view

Analysis of ethnic group differences in self-reported limiting long term illness maps the changing situation in the UK population during the 1990s.  While all ethnic groups reported a higher prevalence in 2001 than in 1991, the rise was largest amongst the White Irish, Pakistani and Bangladeshi groups.  Early analysis of data from the GP Patient Survey, which for the first time included health-related quality of life questions, reveals significant geographical and socioeconomic variation, particularly as regards long term conditions.

Trouble shooting

Louise Casey's report for  the Department of Communities and Local Government, Listening to Troubled Families,  suggests above all that long term problems need long term solutions.  Based on interviews with 16 such families, Louise Casey stresses that "the traditional approach of services reaching individual family members, at crisis point or after, and trying to fix single issues such as 'drug use', 'non-attendance at school' or 'domestic violence' in these families is most often destined to fail."  In this way it endorses the government's commitment to Family Intervention Projects and to the payment by results Troubled Families Programme.  Critics of the approach, such as those who contributed  a recent BMJ editorial, suggest that evidence for the effectiveness of Family Intervention Projects is poor, however.

Culturally aware?

A review of interventions to increase takeup of breast and cervical cancer screening amongst Asian women takes a look at what works, finding that there's no quick fix, although a combination of multiple strategies, such as cultural awareness training for healthcare staff and use of outreach workers, is most effective.  There was little evidence for cost effectiveness or long-term sustainability of any of the programmes.  Another review assesses interventions to improve patient participation in the cancer treatment process for culturally and linguistically diverse groups.

What are the chances?

A team from Cardiff University assesses the state of learning on the association between social inequality and infant health, covering adverse birth events, low birth weight, premature birth, stillbirth, neonatal mortality and post-neonatal mortality.  In all of these categories, there is a clear association between deprivation and poor outcomes: only failure to thrive shows no evidence of association.  Latest ONS (Office for National Statistics) figures on births and deaths in England and Wales show a small rise in stillbirths, along with a rising fertility rate and a continuance of the trend of rising average age of mothers, now at 29.7 years.  Age-standardised mortality rates in 2011 were the lowest ever recorded for England and Wales, at 6,172 deaths per million population for males and 4,402 deaths per million population for females.  More detail in infant mortality (this time for 2009) is also provided by ONS in the Birth Cohort Tables.  This release caught the media's attention, particularly as regards the higher early death risk in multiple births ("twins are five times more likely to  die before their first birthday").  NHS Choices Behind the Headlines site separates the data from the terror and also puts some more alarming figures under the spotlight.  The ONS analysis also shows that mothers aged under 20 have the highest infant mortality rate for both single and multiple births and that the infant mortality rate for mothers born outside of the UK was greater than for UK born mothers.  Meanwhile, first data from the 2011 census shows the largest ever population for England and Wales at 56.1 million;  an animated data visualisation maps the changes over the past century.

5 a day

How effective are targeted schemes to improve access to fruit and vegetables for deprived populations? A study from Norfolk evaluates the effectiveness of a mobile fruit and vegetable store, selling cost-price produce in targeted communities.  This intervention succeeded in its basic aim of improving fruit and vegetable consumption in the areas, but it was a small scale study (255 users).  A study from Australia examines perceptions of affordability and availability of fruit and vegetables amongst women in deprived areas.

The heart of the matter

Coronary heart disease (CHD) mortality in England fell by about 6% every year between 2000 and 2007, yet inequalities between socioeconomic groups widened during this period.  A study published in PLOS Medicine tries to assess the reasons behind this development, concluding that trends in major risk factors for CHD, which vary considerably by socioeconomic group, are the root of the inequality.  While medical treatment has made a major contribution to lowering mortality, this effort is undercut by the effects of rising BMI and diabetes prevalence, particularly marked in lower socioeconomic groups.  A study from the Netherlands looks at how far inequalities in mortality from acute myocardial infarction (AMI) persist amongst the elderly. 

How to do well

Home-based provision of welfare rights advice to economically disadvantaged older people is being trialled in the North east of England in the Do-Well study.  In this qualitative study, participants will be recruited from general practice registers.  Research from Denmark looks at the effectiveness of a preventive home visit programme for older people, finding that although takeup by people from lower socioeconomic groups was less good, more proactive invitation could improve this.  Data from the Uppsala Birth Cohort Study is used to consider the impact of mid-life income and retirement income on mortality.