Motivating factors

There's been a lot of attention in the literature to uptake of cancer screening, especially uptake of breast cancer screening. A review published in Quality in Primary Care considers poor uptake amongst British South Asian women, as compared with the general UK population. A critical examination of information brochures provided to women about to undergo screening appears in the European Journal of Public Health, looking at brochures issued in Germany, Italy, Spain and France.

Taking the long view

Inequalities in premature mortality in the UK have risen during the first years of the 21st century, in spite of plenty of serious attention and government intervention, a study published in the BMJ asserts. Looking at data from 1921 to 2007, the review's authors note that, although generally life expectancy has continued to rise, the gap between rich and poor areas is also increasing, to the extent that "inequality in mortality is now greater than at any time since comparable records began."

Working out what the numbers mean

Figures showing geographic differences in place of death have been examined by the Natioanl End of Life Care Networks in a report, Variations in Place of Death in England: Inequalities or appropriate consequences of age, gender and cause of death? Analysis indicates that people on low incomes are more likely to die in hospital, which begs the question as to whether this reflects a greater prevalence of diseases requiring hospital care in the terminal stages amongst deprived populations. West Midlands Public Health Observatory has produced a mapping tool to show selected indicators concerning older people, at local authority and regional level.

Message not getting through

A study by the Health Protection Agency reveals that pregnant women from ethnic minority backgrounds are more at risk from listeriosis. Looking at data from 2001 to 2007, the HPA's research also shows that, overall, there were more listeria cases in deprived areas than in the most affluent. One key concern is that the message about avoiding foods that may be contaminated with listeria during pregnancy is not getting through.

Not really news

... especially not good news...The National Audit Office's report, Tackling inequalities in life expectancy in areas with the worst health and deprivation, takes a long, hard look at DH's achievements as regards inequalities. And the verdict? A good effort, but not exactly value for money.
"The Department of Health has made a concerted effort to tackle a very difficult and long-standing problem. However, it was slow to take action and health inequalities were not a top priority for the NHS until 2006. We recognize that this is a very complicated issue and that it took time to develop an evidence base. However, the best, cost-effective interventions have been identified and now must be employed on a larger scale in order to have a greater impact and improve value for money.
"The Department should target its efforts on the most deprived areas of the country and develop costed proposals to maintain or increase investment in preventative interventions to tackle the conditions which lead to health inequalities."
Amyas Morse, head of the National Audit Office, 2 July 2010.

Health Policy Insight casts a wise look back to Julian Tudor Hart's inverse care law.

Unfair distribution

The recently revised NICE guidelines on COPD provide some grim reading. Currently, NICE says that COPD affects between 2% and 4% of the population, but the burden of the disease falls heavily on areas of deprivation: "men aged 20-64 employed in unskilled manual occupations being 14 times more likely to die from chronic obstructive pulmonary disease than those in professional occupations ." At the moment, COPD is the UK's 5th leading cause of death but this is expected to rise, with the condition becoming the 3rd leading cause of mortality worldwide. And it doesn't stop there: NICE's review suggests that this is a substantially under-diagnosed condition, under-represented in death certificates and in primary care prevalence assessments.

More about health budgets

Two recent articles in the BMJ argue that it’s not just about ringfencing health budgets: social welfare and the health of the nation are far more entwined than that. Joan Benach and others look at the international situation, while David Stuckler and colleagues examine the UK perspective in more detail.
Age UK (the name for the merger between Age Concern and Help the Aged) argues that the Autumn spending review should include ringfencing of social care budgets, too. The King’s Fund’s John Appleby also notes ominously that the real extent of cuts will only be made clear in the Autumn spending review and looks at the ripple effect for health of cuts and the Office for Budget Responsibility’s prediction of slower economic growth.