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Castro-Ávila AC, Cookson R, Doran T, Shaw R, Brittain J, Sowden S. Are local public expenditure reductions associated with increases in inequality in emergency hospitalisation? Time-series analysis of English local authorities from 2010 to 2017. Emerg Med J 2024; 41:389-396. [PMID: 38871481 DOI: 10.1136/emermed-2022-212845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 04/20/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Reductions in local government funding implemented in 2010 due to austerity policies have been associated with worsening socioeconomic inequalities in mortality. Less is known about the relationship of these reductions with healthcare inequalities; therefore, we investigated whether areas with greater reductions in local government funding had greater increases in socioeconomic inequalities in emergency admissions. METHODS We examined inequalities between English local authority districts (LADs) using a fixed-effects linear regression to estimate the association between LAD expenditure reductions, their level of deprivation using the Index of Multiple Deprivation (IMD) and average rates of (all and avoidable) emergency admissions for the years 2010-2017. We also examined changes in inequalities in emergency admissions using the Absolute Gradient Index (AGI), which is the modelled gap between the most and least deprived neighbourhoods in an area. RESULTS LADs within the most deprived IMD quintile had larger pounds per capita expenditure reductions, higher rates of all and avoidable emergency admissions, and greater between-neighbourhood inequalities in admissions. However, expenditure reductions were only associated with increasing average rates of all and avoidable emergency admissions and inequalities between neighbourhoods in local authorities in England's three least deprived IMD quintiles. For a LAD in the least deprived IMD quintile, a yearly reduction of £100 per capita in total expenditure was associated with a yearly increase of 47 (95% CI 22 to 73) avoidable admissions, 142 (95% CI 70 to 213) all-cause emergency admissions and a yearly increase in inequalities between neighbourhoods of 48 (95% CI 14 to 81) avoidable and 140 (95% CI 60 to 220) all-cause emergency admissions. In 2017, a LAD average population was ~170 000. CONCLUSION Austerity policies implemented in 2010 impacted less deprived local authorities, where emergency admissions and inequalities between neighbourhoods increased, while in the most deprived areas, emergency admissions were unchanged, remaining high and persistent.
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Affiliation(s)
- Ana Cristina Castro-Ávila
- Health Sciences, University of York, York, North Yorkshire, UK
- Carrera de Kinesiologia, Universidad del Desarrollo Facultad de Medicina Clínica Alemana, Santiago, Chile
| | | | - Tim Doran
- Health Sciences, University of York, York, North Yorkshire, UK
| | - Robert Shaw
- NHS England and NHS Improvement London, London, UK
| | | | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
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2
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Mitchell E, O'Reilly D, O'Donovan D, Bradley D. Predictors and Consequences of Homelessness: Protocol for a Cohort Study Design Using Linked Routine Data. JMIR Res Protoc 2023; 12:e42404. [PMID: 37498664 PMCID: PMC10415948 DOI: 10.2196/42404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/28/2023] [Accepted: 04/05/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Homelessness is a global burden, estimated to impact more than 100 million people worldwide. Individuals and families experiencing homelessness are more likely to have poorer physical and mental health than the general population. Administrative data is being increasingly used in homelessness research. OBJECTIVE The objective of this study is to combine administrative health care data and social housing data to better understand the consequences and predictors associated with being homeless. METHODS We will be linking health and social care administrative databases from Northern Ireland, United Kingdom. We will conduct descriptive analyses to examine trends in homelessness and investigate risk factors for key outcomes. RESULTS The results of our analyses will be shared with stakeholders, reported at conferences and in academic journals, and summarized in policy briefing notes for policymakers. CONCLUSIONS This study will aim to identify predictors and consequences of homelessness in Northern Ireland using linked housing, health, and social care data. The findings of this study will examine trends and outcomes in this vulnerable population using routinely collected health and social care administrative data. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42404.
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Affiliation(s)
- Eileen Mitchell
- Centre for Public Health, Queen's University, Belfast, United Kingdom
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University, Belfast, United Kingdom
| | | | - Declan Bradley
- Centre for Public Health, Queen's University, Belfast, United Kingdom
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3
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Guise A, Burridge S, Annand P, Burrows M, Platt L, Rathod SD, Hosseini P, Cornes M. Why were COVID-19 infections lower than expected amongst people who are homeless in London, UK in 2020? Exploring community perspectives and the multiple pathways of health inequalities in pandemics. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100038. [PMID: 35036989 PMCID: PMC8744008 DOI: 10.1016/j.ssmqr.2021.100038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 01/12/2023]
Abstract
High rates of COVID-19 infections and deaths amongst people who are homeless in London, UK were feared. Rates however stayed much lower than expected throughout 2020; an experience that compares to other settings globally. This study sought a community level perspective to explore this rate of infections, and through this explore relationships between COVID-19 and existing health inequalities. Analyses are reported from ongoing qualitative studies on COVID-19 and homeless health service evaluation in London, UK. Repeated in-depth telephone interviews were implemented with people experiencing homelessness in London (n=17; 32 interviews in total) as well as street outreach workers, nurses and hostel staff (n=10) from September 2020 to early 2021. Thematic analysis generated three themes to explore peoples' experiences of, and perspectives on, low infections: people experiencing homelessness following, creating and breaking social distancing and hygiene measures; social distancing in the form of social exclusion as a long-running feature of life; and a narrative of 'street immunity' resulting from harsh living conditions. Further study is needed to understand how these factors combine to prevent COVID-19 and how they relate to different experiences of homelessness. This community perspective can ensure that emerging narratives of COVID-19 prevention success don't ignore longer running causes of homelessness and reinforce stigmatising notions of people who are homeless as lacking agency. Our findings aid theorisation of how health inequalities shape pandemic progression: severe exclusion may substantially delay epidemics in some communities, although with considerable other non-COVID-19 impacts.
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Affiliation(s)
- Andy Guise
- King's College London, Guy's Campus, London, SE1 3UZ, UK,Corresponding author. King's College London, 5th Floor, Addison House, Guy's Campus, London, SE1 3UZ, UK
| | | | - P.J. Annand
- King's College London, Guy's Campus, London, SE1 3UZ, UK
| | - Martin Burrows
- Groundswell, St Matthews, Brixton Hill, London, SW2 1JF, UK
| | - Lucy Platt
- London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1X 9SH, UK
| | - Sujit D. Rathod
- London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1X 9SH, UK
| | - Paniz Hosseini
- London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1X 9SH, UK
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4
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Alexiou A, Fahy K, Mason K, Bennett D, Brown H, Bambra C, Taylor-Robinson D, Barr B. Local government funding and life expectancy in England: a longitudinal ecological study. LANCET PUBLIC HEALTH 2021; 6:e641-e647. [PMID: 34265265 PMCID: PMC8390384 DOI: 10.1016/s2468-2667(21)00110-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/24/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022]
Abstract
Background Since 2010, large reductions in funding for local government services have been introduced in England. These reductions in funding have potentially led to reduced provision of health-promoting public services. We aimed to investigate whether areas that showed a greater decline in funding also had more adverse trends in life expectancy and premature mortality. Methods In this longitudinal ecological study, we linked annual data from the Ministry of Housing, Communities, and Local Government on local government revenue expenditure and financing to 147 upper-tier local authorities in England between 2013 and 2017 with data from Public Health England, on male and female life expectancy at birth, male and female life expectancy at age 65 years, and premature (younger than 75 years) all-cause mortality rate for male and female individuals. Local authorities were excluded if their populations were too small or if changes in boundaries meant consistent data were not available. Using multivariable fixed-effects panel regression models, and controlling for local socioeconomic conditions, we estimated whether changes in local funding from 2013 were associated with changes in life expectancy and premature mortality. We included a set of alternative model specifications to test the robustness of our findings. Findings Between 2013 and 2017, mean per-capita central funding to local governments decreased by 33% or £168 per person (range –£385 to £1). Each £100 reduction in annual per person funding was associated over the study period 2013–17 with an average decrease in life expectancy at birth of 1·3 months (95% CI 0·7–1·9) for male individuals and 1·2 months (0·7–1·7) for female individuals; for life expectancy at age 65 years, the results show a decrease of 0·8 months (0·3–1·3) for male individuals and 1·1 months (0·7–1·5) for female individuals. Funding reductions were greater in more deprived areas and these areas had the worst changes in life expectancy. We estimated that cuts in funding were associated with an increase in the gap in life expectancy between the most and least deprived quintiles by 3% for men and 4% for women. Overall reductions in funding during this period were associated with an additional 9600 deaths in people younger than 75 years in England (3800–15 400), an increase of 1·25%. Interpretation Our findings indicate that cuts in funding for local government might in part explain adverse trends in life expectancy. Given that more deprived areas showed greater reductions in funding, our analysis suggests that inequalities have widened. Since the pandemic, strategies to address these adverse trends in life expectancy and reduce health inequalities could prioritise reinvestment in funding for local government services, particularly within the most deprived areas of England. Funding National Institute for Health Research (NIHR) School for Public Health Research, NIHR Applied Research Collaboration North East and North Cumbria, NIHR Applied Research Collaboration North West Coast and Medical Research Council.
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Affiliation(s)
- Alexandros Alexiou
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK.
| | - Katie Fahy
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
| | - Kate Mason
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
| | - Davara Bennett
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
| | - Heather Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David Taylor-Robinson
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
| | - Benjamin Barr
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
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5
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Huijts T. Examining the impact of cuts to local government spending on Sure Start Children's Centres on childhood obesity: a commentary. J Epidemiol Community Health 2021; 75:813-814. [PMID: 34376586 DOI: 10.1136/jech-2021-217190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tim Huijts
- Research Centre for Education and the Labour Market, Maastricht University, Maastricht, The Netherlands .,Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
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6
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Walsh D, McCartney G, Minton J, Parkinson J, Shipton D, Whyte B. Changing mortality trends in countries and cities of the UK: a population-based trend analysis. BMJ Open 2020; 10:e038135. [PMID: 33154048 PMCID: PMC7646340 DOI: 10.1136/bmjopen-2020-038135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Previously improving life expectancy and all-cause mortality in the UK has stalled since the early 2010s. National analyses have demonstrated changes in mortality rates for most age groups and causes of death, and with deprived populations most affected. The aims here were to establish whether similar changes have occurred across different parts of the UK (countries, cities), and to examine cause-specific trends in more detail. DESIGN Population-based trend analysis. PARTICIPANTS/SETTING Whole populations of countries and selected cities of the UK. PRIMARY AND SECONDARY OUTCOME MEASURES European age-standardised mortality rates (calculated by cause of death, country, city, year (1981-2017), age group, sex and-for all countries and Scottish cities-deprivation quintiles); changes in rates between 5-year periods; summary measures of both relative (relative index of inequality) and absolute (slope index of inequality) inequalities. RESULTS Changes in mortality from around 2011/2013 were observed throughout the UK for all adult age groups. For example, all-age female rates decreased by approximately 4%-6% during the 1980s and 1990s, approximately 7%-9% during the 2000s, but by <1% between 2011/2013 and 2015/2017. Equivalent figures for men were 4%-7%, 8%-12% and 1%-3%, respectively. This later period saw increased mortality among the most deprived populations, something observed in all countries and cities analysed, and for most causes of death: absolute and relative inequalities therefore increased. Although similar trends were seen across all parts of the UK, particular issues apply in Scotland, for example, higher and increasing drug-related mortality (with the highest rates observed in Dundee and Glasgow). CONCLUSIONS The study presents further evidence of changing mortality in the UK. The timing, geography and socioeconomic gradients associated with the changes appear to support suggestions that they may result, at least in part, from UK Government 'austerity' measures which have disproportionately affected the poorest.
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Affiliation(s)
- David Walsh
- Glasgow Centre for Population Health, Glasgow, Scotland, UK
| | | | - Jon Minton
- Public Health Scotland, Glasgow, Scotland, UK
| | | | | | - Bruce Whyte
- Glasgow Centre for Population Health, Glasgow, Scotland, UK
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7
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Demakakos P, Lewer D, Jackson SE, Hayward AC. Lifetime prevalence of homelessness in housed people aged 55-79 years in England: its childhood correlates and association with mortality over 10 years of follow-up. Public Health 2020; 182:131-138. [PMID: 32298843 PMCID: PMC7294219 DOI: 10.1016/j.puhe.2019.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/06/2019] [Accepted: 12/20/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Since 2010, the number of homeless people in the UK has increased, and homelessness in its different types has become a major public health problem. Housed older people with past experience of homelessness are an understudied population that can provide valuable insight into this problem. For this reason, we examined the lifetime prevalence of homelessness and its associations with childhood adversity and mortality in a national sample of older people. STUDY DESIGN This is a longitudinal cohort study. METHODS We studied 6649 housed individuals aged 55-79 years in 2007 from the English Longitudinal Study of Ageing (ELSA). We used logistic regression to model the association between adverse childhood experiences (ACE) and lifetime experience of homelessness (ever been homeless for ≥1 months) and Cox proportional hazards regression to model the prospective association between lifetime experience of homelessness and mortality. RESULTS We identified 107 participants with lifetime experience of homelessness. We found a strong graded association between the number of ACE and lifetime experience of homelessness; participants with two ACE had 5.35 (95% confidence interval [CI]: 3.17-9.05) times greater odds of having experienced homelessness than those reporting none. Most ACE were individually associated with lifetime homelessness, but fewer remained so in the mutually adjusted model. Participants with lifetime experience of homelessness had 1.55 (95% CI: 1.01-2.37) times greater risk of mortality over a 10-year follow-up and after adjustment for covariates. CONCLUSIONS Exposure to childhood adversity is associated with increased risk of experiencing homelessness. Older housed people with past experience of homelessness are at increased risk of mortality.
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Affiliation(s)
- P Demakakos
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 6BT, UK.
| | - D Lewer
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 6BT, UK; Collaborative Centre for Inclusion Health, University College London, London, NW1 2DA, UK
| | - S E Jackson
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 6BT, UK
| | - A C Hayward
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 6BT, UK; Collaborative Centre for Inclusion Health, University College London, London, NW1 2DA, UK
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8
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McCartney G, Fenton L, Minton J, Fischbacher C, Taulbut M, Little K, Humphreys C, Cumbers A, Popham F, McMaster R. Is austerity responsible for the recent change in mortality trends across high-income nations? A protocol for an observational study. BMJ Open 2020; 10:e034832. [PMID: 31980513 PMCID: PMC7044814 DOI: 10.1136/bmjopen-2019-034832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Mortality rates in many high-income countries have changed from their long-term trends since around 2011. This paper sets out a protocol for testing the extent to which economic austerity can explain the variance in recent mortality trends across high-income countries. METHODS AND ANALYSIS This is an ecological natural experiment study, which will use regression adjustment to account for differences in exposure, outcomes and confounding. All high-income countries with available data will be included in the sample. The timing of any changes in the trends for four measures of austerity (the Alesina-Ardagna Fiscal Index, real per capita government expenditure, public social spending and the cyclically adjusted primary balance) will be identified and the cumulative difference in exposure to these measures thereafter will be calculated. These will be regressed against the difference in the mean annual change in life expectancy, mortality rates and lifespan variation compared with the previous trends, with an initial lag of 2 years after the identified change point in the exposure measure. The role of underemployment and individual incomes as outcomes in their own right and as mediating any relationship between austerity and mortality will also be considered. Sensitivity analyses varying the lag period to 0 and 5 years, and adjusting for recession, will be undertaken. ETHICS AND DISSEMINATION All of the data used for this study are publicly available, aggregated datasets with no individuals identifiable. There is, therefore, no requirement for ethical committee approval for the study. The study will be lodged within the National Health Service research governance system. All results of the study will be published following sharing with partner agencies. No new datasets will be created as part of this work for deposition or curation.
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Affiliation(s)
- Gerry McCartney
- Public Health Observatory, NHS Health Scotland, Glasgow, Scotland, UK
| | - Lynda Fenton
- Public Health Observatory, NHS Health Scotland, Glasgow, Scotland, UK
- Public Health, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Jon Minton
- Public Health Observatory, NHS Health Scotland, Glasgow, Scotland, UK
| | - Colin Fischbacher
- Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, UK
| | - Martin Taulbut
- Public Health Observatory, NHS Health Scotland, Glasgow, Scotland, UK
| | | | | | - Andrew Cumbers
- Adam Smith Business School, University of Glasgow, Glasgow, UK
| | - Frank Popham
- CSO/MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, UK
| | - Robert McMaster
- Adam Smith Business School, University of Glasgow, Glasgow, UK
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9
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Taylor-Robinson D, Barr B, Whitehead M. Stalling life expectancy and rising inequalities in England. Lancet 2019; 394:2238-2239. [PMID: 31868623 DOI: 10.1016/s0140-6736(19)32610-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Affiliation(s)
- David Taylor-Robinson
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GL, UK; Section of Epidemiology, Copenhagen University, Copenhagen, Denmark.
| | - Ben Barr
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GL, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GL, UK
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10
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Tyler A, Moss AC, Cox S. Understanding women's feelings about safety and hazards of street drinking in London through interpretative phenomenological analysis. Addict Behav 2019; 99:106042. [PMID: 31494453 DOI: 10.1016/j.addbeh.2019.106042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022]
Abstract
AIMS Drinking alcohol in outdoor public places (e.g. streets and parks) and outside of formally organised events is perceived and reported as antisocial behaviour and may be indicative of a problematic relationship with alcohol, and other clinical needs. This paper aims to address a lack of qualitative research on street drinking in the United Kingdom and develop a textured understanding of the lived-experience of how some women engage in street drinking, in the context of one London borough. METHOD The authors collected semi-structured interviews as part of a larger mixed methods study on street drinking from April to August 2018. A sub-set of interviews (n = 3) with women who were accessing local drug and alcohol services and had a history of street drinking behaviour were selected as a case series for triangulating analysis with a smaller, homogenous sample. These data were analysed using Interpretative Phenomenological Analysis with a reflexive, feminist, social constructionist approach. RESULTS The authors developed and named a superordinate theme, Constellations of Safety and Hazards for Women Drinking in Public and Private. Within this, four themes were defined and illustrated from the data: Drinking outdoors to be away from hazards at home; Women's awareness of geo-temporal factors to moderate risk; Women identifying risks of accepting drinks from strangers; and Threats of untreated trauma within histories of heavy drinking. Definitions and illustrations from participants aid explanations of how the texts add detail or disruption to dominant discourses. CONCLUSION The case studies illustrating how these women have experienced alcohol misuse and behaviour change provide reflexive accounts of exercising agency in managing embodied and affective states of vulnerability. This was demonstrated by asserting choice around environmental spaces and friendships, even when still in positions deemed as 'risky'. These three women's decisions around drinking in public, outdoor spaces were shaped by complex interactions of interpersonal, intrapersonal, socio-economic, and cultural structures. Understanding behaviours is improved with data that situates people in contexts where they experience and make sense of their lives.
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Affiliation(s)
- Allan Tyler
- Centre for Addictive Behaviours Research, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom.
| | - Antony C Moss
- Centre for Addictive Behaviours Research, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom
| | - Sharon Cox
- Centre for Addictive Behaviours Research, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom
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11
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Abstract
Purpose
The purpose of this paper is to understand the lived experience of people who have experienced homelessness and street activity, and professional stakeholders’ views about the challenges faced by this client group. The study sought to identify measures to improve the current situation for both individuals experiencing homelessness and professionals working with them.
Design/methodology/approach
Peer researchers with lived experience of multiple and complex needs conducted semi-structured interviews/surveys with 18 participants (eight individuals experiencing homelessness and street activity and ten professional stakeholders). The authors of the paper conducted a thematic analysis of the data.
Findings
This paper offers insights into both the current challenges and assets for people who are or have been homeless in an urban setting. Key findings include the need for a coordinated partnership approach to address pathways to support, and the importance of developing opportunities for meaningful activity and building on local resources including giving homeless people a voice. These findings are discussed within the context of current policy (Housing First) and legislation (Homelessness Reduction Act 2017) and the impact on integrated care for people who have experienced homelessness.
Research limitations/implications
The views explored in this study are specific to one city centre in the West Midlands; thus, generalisability may be limited.
Originality/value
This study presents a participatory research approach with peer researchers exploring the perspective of individuals experiencing homelessness and wider stakeholders. The findings of this research are considered with reference to the provisions of the HRA 2017.
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12
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Stuckler D, Reeves A, Loopstra R, Karanikolos M, McKee M. Austerity and health: the impact in the UK and Europe. Eur J Public Health 2018; 27:18-21. [PMID: 29028245 PMCID: PMC5881725 DOI: 10.1093/eurpub/ckx167] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Austerity measures—reducing social spending and increasing taxation—hurts deprived groups the most. Less is known about the impact on health. In this short review, we evaluate the evidence of austerity’s impact on health, through two main mechanisms: a ‘social risk effect’ of increasing unemployment, poverty, homelessness and other socio-economic risk factors (indirect), and a ‘healthcare effect’ through cuts to healthcare services, as well as reductions in health coverage and restricting access to care (direct). We distinguish those impacts of economic crises from those of austerity as a response to it. Where possible, data from across Europe will be drawn upon, as well as more extensive analysis of the UK’s austerity measures performed by the authors of this review.
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Affiliation(s)
- David Stuckler
- Dondena Research Centre, University of Bocconi, Milan Italy.,Department of Sociology, University of Oxford, Oxford, UK
| | - Aaron Reeves
- Department of Social Inequality, London School of Economics, London, UK
| | | | - Marina Karanikolos
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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13
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Paton D, Wright L. The effect of spending cuts on teen pregnancy. JOURNAL OF HEALTH ECONOMICS 2017; 54:135-146. [PMID: 28558295 DOI: 10.1016/j.jhealeco.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 04/27/2017] [Accepted: 05/15/2017] [Indexed: 06/07/2023]
Abstract
In recent years, English local authorities have been forced to make significant cuts to devolved expenditure. In this paper, we examine the impact of reductions in local expenditure on one particular public health target: reducing rates of teen pregnancy. Contrary to predictions made at the time of the cuts, panel data estimates provide no evidence that areas which reduced expenditure the most have experienced relative increases in teenage pregnancy rates. Rather, expenditure cuts are associated with small reductions in teen pregnancy rates, a result which is robust to a number of alternative specifications and tests for causality. Underlying socio-economic factors such as education outcomes and alcohol consumption are found to be significant predictors of teen pregnancy.
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Affiliation(s)
- David Paton
- Nottingham University Business School, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, United Kingdom.
| | - Liam Wright
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield, S1 4DA, United Kingdom.
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14
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Ruckert A, Labonté R. Health inequities in the age of austerity: The need for social protection policies. Soc Sci Med 2017; 187:306-311. [PMID: 28359581 DOI: 10.1016/j.socscimed.2017.03.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
This commentary assesses the impacts of the global austerity drive on health inequities in the aftermath of the global financial crisis of 2008. In doing so, it first locates the origins of austerity within the 40 year history of neoliberal economic orthodoxy. It then describes the global diffusion of austerity since 2008, and its key policy tenets. It next describes the already visible impacts of austerity-driven welfare reform on trends in health equity, and documents how austerity has exacerbated health inequities in countries with weak social protection policies. We finally identify the components of an alternative policy response to the financial crisis than that of austerity, with specific reference to the need for shifts in national and global taxation policies and public social protection policies and spending. We conclude with a call for a reorientation of public policy towards making human health an overarching global policy goal, and how this aligns with the multilaterally agreed upon Sustainable Development Goals.
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Affiliation(s)
- Arne Ruckert
- University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, 850 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada.
| | - Ronald Labonté
- University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, 850 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada.
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McKee M, Reeves A, Clair A, Stuckler D. Living on the edge: precariousness and why it matters for health. Arch Public Health 2017; 75:13. [PMID: 28270912 PMCID: PMC5335798 DOI: 10.1186/s13690-017-0183-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/23/2017] [Indexed: 11/10/2022] Open
Abstract
The post-war period in Europe, between the late 1940s and the 1970s, was characterised by an expansion of the role of by the state, protecting its citizens from risks of unemployment, poverty, homelessness, and food insecurity. This security began to erode in the 1980s as a result of privatisation and deregulation. The withdrawal of the state further accelerated after the 2008 financial crisis, as countries began pursuing deep austerity. The result has been a rise in what has been termed 'precariousness'. Here we review the development of the concept of precariousness and related phenomena of vulnerability and resilience, before reviewing evidence of growing precariousness in European countries. It describes a series of studies of the impact on precariousness on health in domains of employment, housing, and food, as well as natural experiments of policies that either alleviate or worsen these impacts. It concludes with a warning, drawn from the history of the 1930s, of the political consequences of increasing precariousness in Europe and North America.
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Affiliation(s)
- Martin McKee
- ECOHOST, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Aaron Reeves
- London School of Economics and Political Science, London, UK
| | - Amy Clair
- Department of Sociology, University of Oxford, Oxford, UK
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK
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Reeves A, Clair A, McKee M, Stuckler D. Reductions in the United Kingdom's Government Housing Benefit and Symptoms of Depression in Low-Income Households. Am J Epidemiol 2016; 184:421-9. [PMID: 27613659 PMCID: PMC5023793 DOI: 10.1093/aje/kww055] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/01/2016] [Indexed: 11/21/2022] Open
Abstract
Housing security is an important determinant of mental ill health. We used a quasinatural experiment to evaluate this association, comparing the prevalence of mental ill health in the United Kingdom before and after the government's April 2011 reduction in financial support for low-income persons who rent private-sector housing (mean reduction of approximately £1,220 ($2,315) per year). Data came from the United Kingdom's Annual Population Survey, a repeated quarterly cross-sectional survey. We focused our analysis on renters in the private sector, disaggregating data between an intervention group receiving the government's Housing Benefit (n = 36,859) and a control group not receiving the Housing Benefit (n = 142,205). The main outcome was a binary measure of self-reported mental health problems. After controlling for preexisting time trends, we observed that between April 2011 and March 2013, the prevalence of depressive symptoms among private renters receiving the Housing Benefit increased by 1.8 percentage points (95% confidence interval: 1.0, 2.7) compared with those not receiving the Housing Benefit. Our models estimated that approximately 26,000 (95% confidence interval: 14,000, 38,000) people newly experienced depressive symptoms in association with the cuts to the Housing Benefit. We conclude that reducing housing support to low-income persons in the private rental sector increased the prevalence of depressive symptoms in the United Kingdom.
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Affiliation(s)
- Aaron Reeves
- Correspondence to Dr. Aaron Reeves, Department of Sociology, Social Sciences Division, University of Oxford, Manor Road Building, Manor Road, Oxford OX1 3UQ, United Kingdom (e-mail: )
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Schrecker T. Public health policies and politics for uncertain times. J Public Health (Oxf) 2016; 38:411-412. [DOI: 10.1093/pubmed/fdw092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Indexed: 11/13/2022] Open
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Loopstra R, McKee M, Katikireddi SV, Taylor-Robinson D, Barr B, Stuckler D. Austerity and old-age mortality in England: a longitudinal cross-local area analysis, 2007-2013. J R Soc Med 2016; 109:109-16. [PMID: 26980412 PMCID: PMC4794969 DOI: 10.1177/0141076816632215] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective There has been significant concern that austerity measures have negatively impacted health in the UK. We examined whether budgetary reductions in Pension Credit and social care have been associated with recent rises in mortality rates among pensioners aged 85 years and over. Design Cross-local authority longitudinal study. Setting Three hundred and twenty-four lower tier local authorities in England. Main outcome measure Annual percentage changes in mortality rates among pensioners aged 85 years or over. Results Between 2007 and 2013, each 1% decline in Pension Credit spending (support for low income pensioners) per beneficiary was associated with an increase in 0.68% in old-age mortality (95% CI: 0.41 to 0.95). Each reduction in the number of beneficiaries per 1000 pensioners was associated with an increase in 0.20% (95% CI: 0.15 to 0.24). Each 1% decline in social care spending was associated with a significant rise in old-age mortality (0.08%, 95% CI: 0.0006–0.12) but not after adjusting for Pension Credit spending. Similar patterns were seen in both men and women. Weaker associations observed for those aged 75 to 84 years, and none among those 65 to 74 years. Categories of service expenditure not expected to affect old-age mortality, such as transportation, showed no association. Conclusions Rising mortality rates among pensioners aged 85 years and over were linked to reductions in spending on income support for poor pensioners and social care. Findings suggest austerity measures in England have affected vulnerable old-age adults.
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Affiliation(s)
- Rachel Loopstra
- Department of Sociology, Oxford University, Manor Road Building, Manor Road, Oxford OX1 3UQ, UK
| | - Martin McKee
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | | | - David Taylor-Robinson
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3BX, UK
| | - Ben Barr
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3BX, UK
| | - David Stuckler
- Department of Sociology, Oxford University, Manor Road Building, Manor Road, Oxford OX1 3UQ, UK Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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