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Luo L, Zhang R, Zhuo M, Shan R, Yu Z, Li W, Wu P, Sun X, Wang Q. Medical Resource Management in Emergency Hierarchical Diagnosis and Treatment Systems: A Research Framework. Healthcare (Basel) 2024; 12:1358. [PMID: 38998892 PMCID: PMC11241035 DOI: 10.3390/healthcare12131358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/18/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
The occurrence of major public health crises, like the COVID-19 epidemic, present significant challenges to healthcare systems and the management of emergency medical resources worldwide. This study, by examining the practices of emergency medical resource management in select countries during the COVID-19 epidemic, and reviewing the relevant literature, finds that emergency hierarchical diagnosis and treatment systems (EHDTSs) play a crucial role in managing emergency resources effectively. To address key issues of emergency resource management in EHDTSs, we examine the features of EHDTSs and develop a research framework for emergency resource management in EHDTSs, especially focusing on the management of emergency medical personnel and medical supplies during evolving epidemics. The research framework identifies key issues of emergency medical resource management in EHDTSs, including the sharing and scheduling of emergency medical supplies, the establishment and sharing of emergency medical supply warehouses, and the integrated dispatch of emergency medical personnel. The proposed framework not only offers insights for future research but also can facilitate better emergency medical resource management in EHDTSs during major public health emergencies.
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Affiliation(s)
- Li Luo
- Business School, Sichuan University, Chengdu 610065, China
| | - Renshan Zhang
- Business School, Sichuan University, Chengdu 610065, China
| | - Maolin Zhuo
- School of Finance and Trade Management, Chengdu Industry & Trade College, Chengdu 611731, China
| | - Renbang Shan
- Business School, Sichuan University, Chengdu 610065, China
- School of Management, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Zhoutianqi Yu
- Business School, Sichuan University, Chengdu 610065, China
| | - Weimin Li
- West China Hospital, Sichuan University, Chengdu 610041, China
| | - Peng Wu
- Business School, Sichuan University, Chengdu 610065, China
| | - Xin Sun
- West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qingyi Wang
- Business School, Sichuan University, Chengdu 610065, China
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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 PMCID: PMC11228196 DOI: 10.1136/emermed-2022-212845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [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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Eshun E, Burke O, Do F, Maciver A, Mathur A, Mayne C, Mohamed Jemseed AA, Novak L, Siddique A, Smith E, Tapia-Stocker D, FitzGerald A. Exploring the Role of Rehabilitation Medicine within an Inclusion Health Context: Examining a Population at Risk from Homelessness and Brain Injury in Edinburgh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:769. [PMID: 38929015 PMCID: PMC11203637 DOI: 10.3390/ijerph21060769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
People experiencing homelessness are at risk from a number of comorbidities, including traumatic brain injury, mental health disorders, and various infections. Little is known about the rehabilitation needs of this population. This study took advantage of unique access to a specialist access GP practice for people experiencing homelessness and a local inclusion health initiative to explore the five-year period prevalence of these conditions in a population of people experiencing homelessness through electronic case record searches and to identify barriers and facilitators to healthcare provision for this population in the context of an interdisciplinary and multispecialist inclusion health team through semi-structured interviews with staff working in primary and secondary care who interact with this population. The five-year period prevalence of TBI, infections, and mental health disorders was 9.5%, 4%, and 22.8%, respectively. Of those who had suffered a brain injury, only three had accessed rehabilitation services. Themes from thematic analysis of interviews included the impact of psychological trauma, under-recognition of the needs of people experiencing homelessness, resource scarcity, and the need for collaborative and adaptive approaches. The combination of quantitative and qualitative data suggests a potential role for rehabilitation medicine in inclusion health initiatives.
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Affiliation(s)
- Edwin Eshun
- Department of Rehabilitation Medicine, Astley Ainslie Hospital, NHS Lothian, 133 Grange Loan, Edinburgh EH9 2HL, UK;
- Edinburgh Medical School, College of Medicine & Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK (A.A.M.J.)
| | - Orla Burke
- Edinburgh Medical School, College of Medicine & Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK (A.A.M.J.)
| | - Florence Do
- Edinburgh Medical School, College of Medicine & Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK (A.A.M.J.)
| | - Angus Maciver
- Edinburgh Medical School, College of Medicine & Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK (A.A.M.J.)
| | - Anushka Mathur
- Edinburgh Medical School, College of Medicine & Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK (A.A.M.J.)
| | - Cassie Mayne
- Edinburgh Medical School, College of Medicine & Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK (A.A.M.J.)
| | - Aashik Ahamed Mohamed Jemseed
- Edinburgh Medical School, College of Medicine & Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK (A.A.M.J.)
| | - Levente Novak
- Edinburgh Medical School, College of Medicine & Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK (A.A.M.J.)
| | - Anna Siddique
- Edinburgh Medical School, College of Medicine & Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK (A.A.M.J.)
| | - Eve Smith
- Edinburgh Medical School, College of Medicine & Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK (A.A.M.J.)
| | - David Tapia-Stocker
- Edinburgh Medical School, College of Medicine & Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK (A.A.M.J.)
| | - Alasdair FitzGerald
- Department of Rehabilitation Medicine, Astley Ainslie Hospital, NHS Lothian, 133 Grange Loan, Edinburgh EH9 2HL, UK;
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Matthews J, Dobra R, Wilson G, Allen L, Bossley C, Brendell R, Brugha R, Brown D, Brown S, Cadiente S, Cameron L, Davies G, Dawson C, Elborn S, Hughes D, Longmate J, Macedo P, Pappas L, Pao C, Round C, Ruiz G, Saunders C, Shafi N, Simmonds N, Waller M, Watson D, Davies JC. Levelling the playing field through the London Network of the UK clinical trials accelerator platform. Contemp Clin Trials Commun 2024; 39:101301. [PMID: 38711836 PMCID: PMC11070816 DOI: 10.1016/j.conctc.2024.101301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 05/08/2024] Open
Abstract
Cystic fibrosis (CF) is a multisystem, genetic disease with a significantly reduced life expectancy. Despite substantial progress in therapies in the last 10-15 years, there is still no cure. There are dozens of drugs in the development pipeline and multiple clinical trials are being conducted across the globe. The UK Cystic Fibrosis Trust's (CFT) Clinical Trials Accelerator Platform (CTAP) is a national initiative bringing together 25 UK based CF centres to support the CF community in accessing and participating in CF clinical trials. CTAP enables more CF centres to run a broader portfolio of trials and increases the range of CF studies available for UK patients. There are four large specialist CF centres based in London, all within a small geographical region as well as two smaller centres which deliver CF care. At the launch of CTAP, these centres formed a sub-network in a consortium-style collaboration. The purpose of the network was to ensure equity of access to trials for patients across the UK's capital, and to share experience and knowledge. Four years into the programme we have reviewed our practices through working group meetings and an online survey. We sought to identify strengths and areas for improvement. We share our findings here, as we believe they are relevant to others delivering research in regions outside of London and in other chronic diseases.
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Affiliation(s)
- Jessie Matthews
- Royal Brompton Hospital, Part of Guy's & St Thomas' Trust, London, UK
| | - Rebecca Dobra
- Royal Brompton Hospital, Part of Guy's & St Thomas' Trust, London, UK
| | - Gemma Wilson
- Royal Brompton Hospital, Part of Guy's & St Thomas' Trust, London, UK
| | | | - Cara Bossley
- King's College Hospital, NHS Foundation Trust, London, UK
| | | | - Rossa Brugha
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Danielle Brown
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Sarah Brown
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | | | - Gwyneth Davies
- Royal London Hospital, Barts Health NHS Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Charlotte Dawson
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | | | - Dominic Hughes
- King's College Hospital, NHS Foundation Trust, London, UK
| | | | | | | | - Caroline Pao
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Gary Ruiz
- King's College Hospital, NHS Foundation Trust, London, UK
| | - Clare Saunders
- Royal Brompton Hospital, Part of Guy's & St Thomas' Trust, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
- European CF Society Lung Clearance Index Central Overreading Centre, UK
| | - Nadia Shafi
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Nicholas Simmonds
- Royal Brompton Hospital, Part of Guy's & St Thomas' Trust, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Michael Waller
- King's College Hospital, NHS Foundation Trust, London, UK
| | - Danie Watson
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Jane C. Davies
- Royal Brompton Hospital, Part of Guy's & St Thomas' Trust, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
- European CF Society Lung Clearance Index Central Overreading Centre, UK
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Beaumont JD, Ioannou E, Harish K, Elewendu N, Corrigan N, Nield L. "We're one small piece of the puzzle": evaluating the impact of short-term funding for tier two weight management services. Front Public Health 2024; 12:1381079. [PMID: 38841679 PMCID: PMC11150676 DOI: 10.3389/fpubh.2024.1381079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Overweight and obesity are a global health epidemic and many attempts have been made to address the rising prevalence. In March 2021 the UK government announced £100 million of additional funding for weight management provisions. Of this, £30.5 million was split across local authorities in England to support the expansion of tier two behavioural weight management services for adults. The present work aimed to explore how this funding was used within the Yorkshire and Humber region to consolidate learning, collate best practice, and provide recommendations for future funding use. Method One-hour semi-structured interviews were conducted with 11 weight management service commissioners representing 9 of the 15 local authorities in the region. Interviews were recorded, transcribed and analysed using an established health inequality framework. From this, recommendations were co-developed with the commissioner group to establish best practice for future funding use. Results Commissioners recognised that targeted weight management services were only one small piece of the puzzle for effectively managing obesity. Therefore, recommendations include targeting underserved communities, focussing on early prevention, addressing weight management in a whole systems context, and embracing innovative and holistic approaches to weight management. Discussion Current short-term funding and restrictive commissioning processes of tier two services prevents sustainable and innovative weight management practice which is detrimental to patients, falls short of addressing health inequalities and negatively impacts staff health and wellbeing.
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Affiliation(s)
- Jordan D. Beaumont
- College of Business, Technology and Engineering, Sheffield Hallam University, Sheffield, United Kingdom
| | - Elysa Ioannou
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Krishna Harish
- College of Business, Technology and Engineering, Sheffield Hallam University, Sheffield, United Kingdom
| | - Nnedinma Elewendu
- College of Social Sciences and Arts, Sheffield Hallam University, Sheffield, United Kingdom
| | - Nicola Corrigan
- Office for Health Improvement and Disparities, Department of Health and Social Care, Blenheim House, Leeds, United Kingdom
| | - Lucie Nield
- College of Business, Technology and Engineering, Sheffield Hallam University, Sheffield, United Kingdom
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6
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Melianova E, Morris TT, Leckie G, Manley D. Local government spending and mental health: Untangling the impacts using a dynamic modelling approach. Soc Sci Med 2024; 348:116844. [PMID: 38615613 DOI: 10.1016/j.socscimed.2024.116844] [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: 09/06/2023] [Revised: 02/15/2024] [Accepted: 03/26/2024] [Indexed: 04/16/2024]
Abstract
This study investigated the impact of local government spending on mental health in England between 2013 and 2019. Guided by the "Health in All Policies" vision, which encourages the integration of health in all decision-making areas, we explored how healthcare and multiple nonmedical budgeting decisions related to population mental health. We used random curve general cross-lagged modelling to dynamically partition effects into the short-run (from t to t + 1) and long-run (from t to t + 2) impacts, account for unobserved area-level heterogeneity and reverse causality from health outcomes to financial investments, and comprehensive modelling of budget items as an interconnected system. Our findings revealed that spending in adult social care, healthcare, and law & order predicted long-term mental health gains (0.004-0.081 SDs increase for each additional 10% in expenditure). However, these sectors exhibited negative short-term impulses (0.012-0.077 SDs decrease for each additional 10% in expenditure), markedly offsetting the long-term gains. In turn, infrastructural and environmental spending related to short-run mental health gains (0.005-0.031 SDs increase for each additional 10% in expenditure), while the long-run effects were predominantly negative (0.005-0.028 SDs decrease for each additional 10% in expenditure). The frequent occurrence of short-run and long-run negative links suggested that government resources may not be effectively reaching the areas that are most in need. In the short-term, negative effects could also imply temporary disruptions to service delivery largely uncompensated by later mental health improvements. Nonetheless, some non-health spending policies, such as law & order and infrastructure, can be related to long-lasting positive mental health impacts.
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Affiliation(s)
| | - Tim T Morris
- Centre for Longitudinal Studies, Social Research Institute, University College London, UK.
| | - George Leckie
- Centre for Multilevel Modelling and School of Education, University of Bristol, UK.
| | - David Manley
- School of Geographical Sciences, University of Bristol, UK.
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Warwick-Giles L, Hutchinson J, Checkland K, Hammond J, Bramwell D, Bailey S, Sutton M. Exploring whether primary care networks can contribute to the national goal of reducing health inequalities: a mixed-methods study. Br J Gen Pract 2024; 74:e290-e299. [PMID: 38164529 PMCID: PMC11060797 DOI: 10.3399/bjgp.2023.0258] [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: 05/26/2023] [Accepted: 11/01/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Significant health inequalities exist in England. Primary care networks (PCNs), comprised of GP practices, were introduced in England in 2019 with funding linked to membership. PCNs have been tasked with tackling health inequalities. AIM To consider how the design and introduction of PCNs might influence their ability to tackle health inequalities. DESIGN AND SETTING A sequential mixed-methods study of PCNs in England. METHOD Linear regression of annual PCN-allocated funding per workload-weighted patient on income deprivation score from 2019-2023 was used. Qualitative interviews and observations of PCNs and PCN staff were undertaken across seven PCN sites in England (July 2020-March 2022). RESULTS Across 1243 networks in 2019-2020, a 10% higher level of income deprivation resulted in £0.31 (95% confidence interval [CI] = £0.25 to £0.37), 4.50%, less funding per weighted patient. In 2022-2023, the same difference in deprivation resulted in £0.16 (95% CI = £0.11 to £0.21), 0.60%, more funding. Qualitative interviews highlighted that, although there were requirements for PCNs to tackle health inequalities, the policy design, and PCN internal relationships and maturity, shaped and sometimes restricted how PCNs approached this task locally. CONCLUSION Allocated PCN funding has become more pro-poor over time, suggesting that the need to account for deprivation within funding models is understood by policymakers. The following additional approaches have been highlighted that could support PCNs to tackle inequalities: better management support; encouragement and support to redistribute funding internally to support practices serving more deprived populations; and greater specificity in service requirements.
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Affiliation(s)
- Lynsey Warwick-Giles
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester
| | - Joseph Hutchinson
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester
| | - Kath Checkland
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester
| | - Jonathan Hammond
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester
| | - Donna Bramwell
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester
| | - Simon Bailey
- Centre for Health Services Studies, University of Kent, Canterbury
| | - Matt Sutton
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester
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Tan L, Wang J, Han J, Sainsbury C, Denniston AK, Crowe FL, Toulis KA, Karamat MA, Yao M, Nirantharakumar K. Socioeconomic Deprivation and the Risk of Sight-Threatening Diabetic Retinopathy: A Population-Based Cohort Study in the U.K. Diabetes Care 2024; 47:844-848. [PMID: 38387082 DOI: 10.2337/dc23-1626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To evaluate the associations between socioeconomic deprivation and sight-threatening diabetic retinopathy (STDR) in individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Data from 175,628 individuals with diabetes in the Health Improvement Network were used to assess the risk of STDR across Townsend Deprivation Index quantiles using Cox proportional hazard regression. RESULTS Among individuals with T1D, the risk of STDR was three times higher (adjusted hazard ratio [aHR] 2.67, 95% CI 1.05-7.78) in the most deprived quintile compared with the least deprived quintile. In T2D, the most deprived quintile had a 28% higher risk (aHR 1.28; 95% CI 1.15-1.43) than the least deprived quintile. CONCLUSIONS Increasing socioeconomic deprivation is associated with a higher risk of developing STDR in people with diabetes. This underscores persistent health disparities linked to poverty, even within a country offering free universal health care. Further research is needed to address health equity concerns in socioeconomically deprived regions.
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Affiliation(s)
- Luyuan Tan
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | - Jingya Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | - Jieun Han
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | | | - Alastair K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, U.K
- National Institute for Health Research Birmingham Biomedical Research Centre, Birmingham, U.K
| | - Francesca L Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | | | - Muhammad Ali Karamat
- Diabetes and Endocrinology Specialist Training Committee, Health Education West Midlands, Birmingham, U.K
| | - Mi Yao
- Department of General Practice, Peking University First Hospital, Beijing, China
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Gkiouleka A, Wong G, Sowden S, Kuhn I, Moseley A, Manji S, Harmston RR, Siersbaek R, Bambra C, Ford JA. Reducing health inequalities through general practice: a realist review and action framework. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-104. [PMID: 38551093 DOI: 10.3310/ytww7032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Background Socio-economic inequalities in health have been in the public agenda for decades. General practice has an influential role to play in mitigating the impact of inequalities especially regarding chronic conditions. At the moment, general practice is dealing with serious challenges in relation to workforce shortages, increasing workload and the impact of the COVID-19 pandemic. It is important to identify effective ways so that general practice can play its role in reducing health inequalities. Objectives We explored what types of interventions and aspects of routine care in general practice decrease or increase inequalities in health and care-related outcomes. We focused on cardiovascular disease, cancer, diabetes and/or chronic obstructive pulmonary disease. We explored for whom these interventions and aspects of care work best, why, and in what circumstances. Our main objective was to synthesise this evidence into specific guidance for healthcare professionals and decision-makers about how best to achieve equitable general practice. Design Realist review. Main outcome measures Clinical or care-related outcomes by socio-economic group, or other PROGRESS-Plus criteria. Review methods Realist review based on Pawson's five steps: (1) locating existing theories, (2) searching for evidence, (3) selecting articles, (4) extracting and organising data and (5) synthesising the evidence. Results Three hundred and twenty-five studies met the inclusion criteria and 159 of them were selected for the evidence synthesis. Evidence about the impact of general practice interventions on health inequalities is limited. To reduce health inequalities, general practice needs to be: • connected so that interventions are linked and coordinated across the sector; • intersectional to account for the fact that people's experience is affected by many of their characteristics; • flexible to meet patients' different needs and preferences; • inclusive so that it does not exclude people because of who they are; • community-centred so that people who receive care engage with its design and delivery. These qualities should inform action across four domains: structures like funding and workforce distribution, organisational culture, everyday regulated procedures involved in care delivery, interpersonal and community relationships. Limitations The reviewed evidence offers limited detail about the ways and the extent to which specific interventions increase or decrease inequalities in general practice. Therefore, we focused on the underpinning principles that were common across interventions to produce higher-level, transferrable conclusions about ways to achieve equitable care. Conclusions Inequalities in general practice result from complex processes across four different domains that include structures, ideas, regulated everyday procedures, and relationships among individuals and communities. To achieve equity, general practice needs to be connected, intersectional, flexible, inclusive and community-centred. Future work Future work should focus on how these five essential qualities can be better used to shape the organisational development of future general practice. Study registration This trial is registered as PROSPERO CRD42020217871. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130694) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Anna Gkiouleka
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences and Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Isla Kuhn
- University of Cambridge Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Annie Moseley
- Patient and Public Involvement Representative, Norwich, UK
| | - Sukaina Manji
- Department of Educational Research, Lancaster University, Lancaster, UK
| | | | - Rikke Siersbaek
- Health System Foundations for Sláintecare Implementation, Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John A Ford
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Gaffney AW, Himmelstein DU, Woolhandler S, Kahn JG. Hospital Expenditures Under Global Budgeting and Single-Payer Financing: An Economic Analysis, 2021-2030. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2023; 53:548-556. [PMID: 36714974 DOI: 10.1177/27551938231152750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
U.S. hospitals provide large amounts of low-value care and devote inordinate resources to administration, while some hospitals leverage market power to realize large profits. Meanwhile, many rural and safety net hospitals are financially distressed. The coexistence of waste and want suggests that U.S. hospital financing is neither efficient nor equitable. We model the economic consequences of adopting the mode of hospital payment used in Canada and the U.S. Veterans Health Administration and proposed in the leading congressional single-payer Medicare-for-All bill: global budgeting. Our models assume increased utilization due to expanded and upgraded coverage; gradual reductions in administrative costs from simplified payment; and the elimination of hospital profits, with hospital capital expenditures funded by explicit grants rather than from profits or borrowing. We estimate that non-federal hospital operating budgets will total $17.2 trillion between 2021 and 2030 under current law versus $14.7 trillion under single-payer with global budgeting. This difference reflects $520 billion in foregone profits and $1,984 billion in reduced expenditures on hospital administration; expenditures on clinical operating budgets, however, would be higher than under current law, funded out of profits.
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Affiliation(s)
- Adam W Gaffney
- Cambridge Health Alliance/Harvard Medical School, Boston, Massachusetts, USA
| | - David U Himmelstein
- Cambridge Health Alliance/Harvard Medical School, Boston, Massachusetts, USA
- City University of New York at Hunter College, New York, New York, USA
| | - Steffie Woolhandler
- Cambridge Health Alliance/Harvard Medical School, Boston, Massachusetts, USA
- City University of New York at Hunter College, New York, New York, USA
| | - James G Kahn
- University of California San Francisco School of Medicine, San Francisco, California, USA
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Currie J, Schilling HT, Evans L, Boyce T, Lester N, Greene G, Little K, Humphreys C, Huws D, Yeoman A, Lewis S, Paranjothy S. Contribution of avoidable mortality to life expectancy inequalities in Wales: a decomposition by age and by cause between 2002 and 2020. J Public Health (Oxf) 2023; 45:762-770. [PMID: 36423922 DOI: 10.1093/pubmed/fdac133] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 08/17/2022] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To explore the contribution of avoidable mortality to life expectancy inequalities in Wales during 2002-2020. DESIGN Observational study. SETTING Wales, 2002-20, including early data from the COVID-19 pandemic. METHODS We used routine statistics for 2002-2020 on population and deaths in Wales stratified by age, sex, deprivation quintile and cause of death. We estimated the contribution of avoidable causes of death and specific age-categories using the Arriaga decomposition method to highlight priorities for action. RESULTS Life expectancy inequalities rose 2002-20 amongst both sexes, driven by serial decreases in life expectancy amongst the most deprived quintiles. The contributions of amenable and preventable mortality to life expectancy inequalities changed relatively little between 2002 and 2020, with larger rises in non-avoidable causes. Key avoidable mortality conditions driving the life expectancy gap in the most recent period of 2018-2020 for females were circulatory disease, cancers, respiratory disease and alcohol- and drug-related deaths, and also injuries for males. CONCLUSIONS Life expectancy inequalities widened during 2002-20, driven by deteriorating life expectancy in the most deprived quintiles. Sustained investment in prevention post-COVID-19 is needed to address growing health inequity in Wales; there remains a role for the National Health Service in ensuring equitable healthcare access to alongside wider policies that promote equity.
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Affiliation(s)
- Jonny Currie
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF10 3QN, UK
| | - Hayden T Schilling
- Centre for Marine Science & Innovation, University of New South Wales, Sydney, NSW 2052, Australia
- Sydney Institute of Marine Science, Mosman, NSW 2088, Australia
| | - Lloyd Evans
- NHS Wales Health Collaborative, Cardiff CF10 4BZ, UK
| | - Tammy Boyce
- Institute of Health Equity, Department for Epidemiology & Public Health, University College London, London WC1E 6BT, UK
| | - Nathan Lester
- Public Health Data, Knowledge and Research Directorate, Public Health Wales, Cardiff CF10 4BZ, UK
| | - Giles Greene
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK & Swansea University Medical School, Swansea SA2 8PP, UK
| | - Kirsty Little
- Public Health Data, Knowledge and Research Directorate, Public Health Wales, Cardiff CF10 4BZ, UK
| | - Ciarán Humphreys
- Wider Determinants of Health Unit, Public Health Wales, Cardiff CF10 4BZ, UK
| | - Dyfed Huws
- Public Health Data, Knowledge and Research Directorate, Public Health Wales, Cardiff CF10 4BZ, UK
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK & Swansea University Medical School, Swansea SA2 8PP, UK
| | - Andrew Yeoman
- Gwent Liver Unit, Royal Gwent Hospital, Newport NP20 2UB, UK
| | - Sally Lewis
- Value in Health, NHS Wales, Pencoed, Wales CF10 3NQ, UK
| | - Shantini Paranjothy
- Aberdeen Health Data Science Centre, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
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12
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Nari F, Park J, Kim N, Kim DJ, Jun JK, Choi KS, Suh M. Impact of health disparities on national breast cancer screening participation rates in South Korea. Sci Rep 2023; 13:13172. [PMID: 37580427 PMCID: PMC10425442 DOI: 10.1038/s41598-023-40164-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/05/2023] [Indexed: 08/16/2023] Open
Abstract
Socioeconomic barriers to cancer screening exist at a regional level. The deprivation index is used to estimate socioeconomic gradients and health disparities across different geographical regions. We aimed to examine the impact of deprivation on breast cancer screening participation rates among South Korean women. Municipal breast cancer screening participation rates in women were extracted from the National Cancer Screening Information System and linked to the Korean version of the deprivation index constructed by the Korea Institute for Health and Social Affairs. A generalised linear mixed model was employed to investigate the association between the deprivation index and age-standardised breast cancer screening participation rates in 2005, 2012, and 2018. Participation rates increased gradually across all age groups from 2005 to 2018. Participants in their 60 s consistently had one of the highest participation rates (2005: 30.37%, 2012: 61.57%, 2018: 65.88%). In 2005, the most deprived quintile had a higher estimate of breast cancer screening participation than the least deprived quintile (2nd quintile; estimate: 1.044, p = 0.242, 3rd quintile; estimate: 1.153, p = 0.192, 4th quintile; estimate: 3.517, p = 0.001, 5th quintile; estimate: 6.913, p = < 0.0001). In 2012, the participation rate also increased as the level of deprivation increased. There were no statistically meaningful results in 2018. Regions with high deprivation have a higher participation rate in breast cancer screening. The role of health disparities in determining cancer outcomes among women in Korea requires further examination.
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Affiliation(s)
- Fatima Nari
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
| | - Juwon Park
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
| | - Nayeon Kim
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
| | - Dong Jin Kim
- Center for Health Policy Research, Korea Institute for Health and Social Affairs, Sejong City, 30147, Republic of Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea.
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Republic of Korea.
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13
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Vodden A, Holdroyd I, Bentley C, Marshall L, Barr B, Massou E, Ford J. Evaluation of the national governmental efforts between 1997 and 2010 in reducing health inequalities in England. Public Health 2023; 218:128-135. [PMID: 37019028 DOI: 10.1016/j.puhe.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 02/05/2023] [Accepted: 02/27/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES The pandemic has compounded existing inequalities. In the UK, there have been calls for a new cross-government health inequalities strategy. This study aims to evaluate the effectiveness of national governmental efforts between 1997 and 2010, referred to as the National Health Inequalities Strategy (NHIS). STUDY DESIGN population-based observational study. METHODS Using Global Burden of Disease data, age-standardised years of life lost due to premature mortality (YLL) rates per 10,000 were extracted for 150 Upper Tier Local Authority (UTLA) regions in England for every year between 1990 and 2019. The slope index of inequality was calculated using YLL rates for all causes, individual conditions, and risk factors. Joinpoint regression was used to assess the trends of any changes which arose before, during or after the NHIS. RESULTS Absolute inequalities in YLL rates for all causes remained stable between 1990 and 2000, before decreasing over the following 10 years. After 2010, improvements slowed. A similar trend can be observed amongst inequalities in YLLs for individual causes, including ischaemic heart disease, stroke, breast cancer and lung cancer amongst females, and ischaemic heart disease stroke, diabetes and self-harm amongst males. This trend was also observed amongst certain risk factors, notably blood pressure, cholesterol, tobacco and dietary risks. Inequalities were generally greater in males than in females; however, trends were similar across both sexes. The NHIS coincided with significant reductions in inequalities in YLLs due to ischaemic heart disease and lung cancer. CONCLUSIONS The findings suggest that the NHIS coincided with a reduction in health inequalities in England. Policy makers should consider a new cross-government strategy to tackle health inequalities drawing from the success of the previous NHIS.
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Affiliation(s)
- A Vodden
- University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - I Holdroyd
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK
| | - C Bentley
- Independent Population Health Consultant, UK
| | - L Marshall
- The Health Foundation, 8 Salisbury Square, London EC4Y 8AP, UK
| | - B Barr
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, L693GB, UK
| | - E Massou
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK
| | - J Ford
- Wolfson Institute of Population Health, Queen Mary University of London, London, EC1M 6BQ, UK.
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14
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Bambra C. Levelling up: Global examples of reducing health inequalities. Scand J Public Health 2022; 50:908-913. [PMID: 34148458 PMCID: PMC9578091 DOI: 10.1177/14034948211022428] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 12/31/2022]
Abstract
There are significant inequalities in health by socio-economic status, race/ethnicity, gender, neighbourhood deprivation and other axes of social inequality. Reducing these health inequalities and improving health equity is arguably the 'holy grail' of public health. This article engages with this quest by presenting and analysing historical examples of when sizeable population-level reductions in health inequalities have been achieved. Five global examples are presented ranging from the 1950s to the 2000s: the Nordic social democratic welfare states from the 1950s to the 1970s; the Civil Rights Acts and War on Poverty in 1960s USA; democratisation in Brazil in the 1980s; German reunification in the 1990s; and the English health inequalities strategy in the 2000s. Welfare state expansion, improved health care access, and enhanced political incorporation are identified as three commonly held 'levellers' whereby health inequalities can be reduced - at scale. The article concludes by arguing that 'levelling up' population health through reducing health inequalities requires the long-term enactment of macro-level policies that aggressively target the social determinants of health.
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Affiliation(s)
- Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK
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15
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Davey F, McGowan V, Birch J, Kuhn I, Lahiri A, Gkiouleka A, Arora A, Sowden S, Bambra C, Ford J. Levelling up health: A practical, evidence-based framework for reducing health inequalities. PUBLIC HEALTH IN PRACTICE 2022; 4:100322. [PMID: 36164497 PMCID: PMC9494865 DOI: 10.1016/j.puhip.2022.100322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022] Open
Abstract
There are substantial inequalities in health across society which have been exacerbated by the COVID-19 pandemic. The UK government have committed to a programme of levelling-up to address geographical inequalities. Here we undertake rapid review of the evidence base on interventions to reduce such health inequalities and developed a practical, evidence-based framework to 'level up' health across the country. This paper overviews a rapid review undertaken to develop a framework of guiding principles to guide policy. To that end and based on an initial theory, we searched one electrotonic database (MEDLINE) from 2007 to July 2021 to identify published umbrella reviews and undertook an internet search to identify relevant systematic reviews, primary studies, and grey literature. Titles and abstracts were screened according to the eligibility criteria. Key themes were extracted from the included studies and synthesised into an overarching framework of guiding principles in consultation with an expert panel. Included studies were cross checked with the initial theoretical domains and further searching undertaken to fill any gaps. We identified 16 published umbrella reviews (covering 667 individual studies), 19 grey literature publications, and 15 key systematic reviews or primary studies. Based on these studies, we develop a framework applicable at national, regional and local level which consisted of five principles - 1) healthy-by-default and easy to use initiatives; 2) long-term, multi-sector action; 3) locally designed focus; 4) targeting disadvantaged communities; and 5) matching of resources to need. Decision-makers working on policies to level up health should be guided by these five principles.
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Affiliation(s)
- Fiona Davey
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Vic McGowan
- NIHR School for Public Health Research, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom
- NIHR Applied Research Collaboration North East and North Cumbria, United Kingdom
| | - Jack Birch
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Isla Kuhn
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Anwesha Lahiri
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Anna Gkiouleka
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Ananya Arora
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Sarah Sowden
- NIHR School for Public Health Research, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom
- NIHR Applied Research Collaboration North East and North Cumbria, United Kingdom
| | - Clare Bambra
- NIHR School for Public Health Research, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom
- NIHR Applied Research Collaboration North East and North Cumbria, United Kingdom
| | - John Ford
- Cambridge Public Health, University of Cambridge, United Kingdom
- NIHR School for Public Health Research, United Kingdom
- NIHR Applied Research Collaboration East of England, United Kingdom
- Corresponding author. Cambridge Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, United Kingdom.
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16
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Aiello E, Perera K, Ade M, Sordé-Martí T. A case study on the use of Public Narrative as a leadership development approach for Patient Leaders in the English National Health Service. Front Public Health 2022; 10:926599. [PMID: 36187684 PMCID: PMC9521407 DOI: 10.3389/fpubh.2022.926599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/15/2022] [Indexed: 01/24/2023] Open
Abstract
Background In 2016 the National Health Service (NHS) England embraced the commitment to work for maternity services to become safer, more personalized, kinder, professional and more family-friendly. Achieving this involves including a service users' organizations to co-lead and deliver the services. This article explores how Public Narrative, a framework for leadership development used across geographical and cultural settings worldwide, can enhance the confidence, capability and skills of service-user representatives (or Patient Leaders) in the National Health Service (NHS) in England. Specifically, we analyse a pilot initiative conducted with one cohort of Patient Leaders, the Chairs of local Maternity Voices Partnerships (MVPs), and how they have used Public Narrative to enhance their effectiveness in leading transformation in maternity services as part of the NHS Maternity Transformation Programme. Methods Qualitative two-phase case study of a pilot training and coaching initiative using Public Narrative with a cohort of MVP Chairs. Phase 1 consisted of a 6-month period, during which the standard framework was adapted in co-design with the MVP Chairs. A core MVP Chair Co-Design Group underwent initial training and follow-up coaching in Public Narrative. Phase 2 consisted of qualitative data collection and data analysis. Results The study of this pilot initiative suggests two main ways in which Public Narrative can enhance the effectiveness of Patient Leaders in service improvement in general and maternity services in specific. First, training and coaching in the Public Narrative framework enables Patient Leaders to gain insight into, articulate and then craft their lived experience of healthcare services in a way that connects with and activates the underlying values of others ("shared purpose"), such that those experiences become an emotional resource on which Patient Leaders can draw to influence future service design and decision-making processes. Second, Public Narrative provides a simple and compelling structure through which Patient Leaders can enhance their skills, confidence and capability as "healthcare leaders," both individually and collectively. Conclusions The Public Narrative framework can significantly enhance the confidence, capability and skills of Patient Leaders, both to identify and coalesce around shared purpose and to advance genuine co-production in the design and improvement of healthcare services in general and maternity services in specific.
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Affiliation(s)
- Emilia Aiello
- Department of Sociology, Autonomous University of Barcelona, Cerdanyola del Vallés, Barcelona, Spain,*Correspondence: Emilia Aiello
| | - Kathryn Perera
- National Health Service (NHS) Horizons, London, United Kingdom
| | - Mo Ade
- Maternity Voices Partnership (MVP) Chair and Patient Public Voice, National Health Service, Ashford, United Kingdom
| | - Teresa Sordé-Martí
- Department of Sociology, Autonomous University of Barcelona, Cerdanyola del Vallés, Barcelona, Spain
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17
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Holdroyd I, Vodden A, Srinivasan A, Kuhn I, Bambra C, Ford JA. Systematic review of the effectiveness of the health inequalities strategy in England between 1999 and 2010. BMJ Open 2022; 12:e063137. [PMID: 36134765 PMCID: PMC9472114 DOI: 10.1136/bmjopen-2022-063137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The purpose of this systematic review is to explore the effectiveness of the National Health Inequality Strategy, which was conducted in England between 1999 and 2010. DESIGN Three databases (Ovid Medline, Embase and PsycINFO) and grey literature were searched for articles published that reported on changes in inequalities in health outcomes in England over the implementation period. Articles published between January 1999 and November 2021 were included. Title and abstracts were screened according to an eligibility criteria. Data were extracted from eligible studies, and risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool. RESULTS The search strategy identified 10 311 unique studies, which were screened. 42 were reviewed in full text and 11 were included in the final review. Six studies contained data on inequalities of life expectancy or mortality, four on disease-specific mortality, three on infant mortality and three on morbidities. Early government reports suggested that inequalities in life expectancy and infant mortality had increased. However, later publications using more accurate data and more appropriate measures found that absolute and relative inequalities had decreased throughout the strategy period for both measures. Three of four studies found a narrowing of inequalities in all-cause mortality. Absolute inequalities in mortality due to cancer and cardiovascular disease decreased, but relative inequalities increased. There was a lack of change, or widening of inequalities in mental health, self-reported health, health-related quality of life and long-term conditions. CONCLUSIONS With respect to its aims, the strategy was broadly successful. Policymakers should take courage that progress on health inequalities is achievable with long-term, multiagency, cross-government action. TRIAL REGISTRATION NUMBER This study was registered in PROSPERO (CRD42021285770).
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Affiliation(s)
- Ian Holdroyd
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alice Vodden
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Akash Srinivasan
- Imperial College London Faculty of Medicine, South Kensington Campus, London, UK
| | - Isla Kuhn
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Clare Bambra
- Newcastle University Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - John Alexander Ford
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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18
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Alderwick H, Hutchings A, Mays N. A cure for everything and nothing? Local partnerships for improving health in England. BMJ 2022; 378:e070910. [PMID: 35788447 PMCID: PMC9273030 DOI: 10.1136/bmj-2022-070910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Collaboration between local agencies is no replacement for national policy and investment, argue Hugh Alderwick, Andrew Hutchings, and Nicholas Mays
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Affiliation(s)
| | | | - Nicholas Mays
- London School of Hygiene and Tropical Medicine, London, UK
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19
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Exarchakou A, Kipourou DK, Belot A, Rachet B. Socio-economic inequalities in cancer survival: how do they translate into Number of Life-Years Lost? Br J Cancer 2022; 126:1490-1498. [PMID: 35149855 PMCID: PMC9090931 DOI: 10.1038/s41416-022-01720-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/15/2022] [Accepted: 01/26/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We aimed to investigate the impact of socio-economic inequalities in cancer survival in England on the Number of Life-Years Lost (NLYL) due to cancer. METHODS We analysed 1.2 million patients diagnosed with one of the 23 most common cancers (92.3% of all incident cancers in England) between 2010 and 2014. Socio-economic deprivation of patients was based on the income domain of the English Index of Deprivation. We estimated the NLYL due to cancer within 3 years since diagnosis for each cancer and stratified by sex, age and deprivation, using a non-parametric approach. The relative survival framework enables us to disentangle death from cancer and death from other causes without the information on the cause of death. RESULTS The largest socio-economic inequalities were seen mostly in adults <45 years with poor-prognosis cancers. In this age group, the most deprived patients with lung, pancreatic and oesophageal cancer lost up to 6 additional months within 3 years since diagnosis than the least deprived. For most moderate/good prognosis cancers, the socio-economic inequalities widened with age. CONCLUSIONS More deprived patients and particularly the young with more lethal cancers, lose systematically more life-years than the less deprived. To reduce these inequalities, cancer policies should systematically encompass the inequities component.
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Affiliation(s)
- Aimilia Exarchakou
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Dimitra-Kleio Kipourou
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Aurélien Belot
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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21
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Griffith GJ, Davey Smith G, Manley D, Howe LD, Owen G. Interrogating structural inequalities in COVID-19 mortality in England and Wales. J Epidemiol Community Health 2021; 75:1165-1171. [PMID: 34285096 PMCID: PMC8295019 DOI: 10.1136/jech-2021-216666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/24/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Numerous observational studies have highlighted structural inequalities in COVID-19 mortality in the UK. Such studies often fail to consider the hierarchical, spatial nature of such inequalities in their analysis, leading to the potential for bias and an inability to reach conclusions about the most appropriate structural levels for policy intervention. METHODS We use publicly available population data on COVID-19-related mortality and all-cause mortality between March and July 2020 in England and Wales to investigate the spatial scale of such inequalities. We propose a multiscale approach to simultaneously consider three spatial scales at which processes driving inequality may act and apportion inequality between these. RESULTS Adjusting for population age structure and number of local care homes we find highest regional inequality in March and June/July. We find finer grained within region inequality increased steadily from March until July. The importance of spatial context increases over the study period. No analogous pattern is visible for non-COVID-19 mortality. Higher relative deprivation is associated with increased COVID-19 mortality at all stages of the pandemic but does not explain structural inequalities. CONCLUSIONS Results support initial stochastic viral introduction in the South, with initially high inequality decreasing before the establishment of regional trends by June and July, prior to reported regionality of the 'second-wave'. We outline how this framework can help identify structural factors driving such processes, and offer suggestions for a long-term, locally targeted model of pandemic relief in tandem with regional support to buffer the social context of the area.
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Affiliation(s)
- Gareth J Griffith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - David Manley
- School of Geographical Sciences, University of Bristol, Bristol, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Gwilym Owen
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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22
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Röding D, Walter U, Dreier M. Long-Term Effects of Integrated Strategies of Community Health Promotion on Diabetes Mellitus Mortality: a Natural Policy Experiment Based on Aggregated Longitudinal Secondary Data. J Urban Health 2021; 98:791-800. [PMID: 34799821 PMCID: PMC8688653 DOI: 10.1007/s11524-021-00590-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 10/28/2022]
Abstract
Integrated strategies of community health promotion (ISCHP) are based on intersectoral collaborations using the Health in All Policies approach to address determinants of health. While effects on health determinants have been shown, evidence on the effectiveness of ISCHP on health outcomes is scarce. The aim of this study is to assess the long-term effects of ISCHP on diabetes mellitus mortality (DMM) in German communities. A nonrandomized evaluation based on secondary county-level official data (1998-2016) was performed. In April 2019, 149 communities in Germany with ISCHP out of 401 were identified. Communities with < 5 measurements of DMM, starting before 1999 or after 2015, were excluded. Analyses included 65 communities with ISCHP (IG) and 124 without ISCHP (CG). ISCHP ran for a mean of 5.6 years. Fixed effects (FE) models were used to estimate effects of ISCHP and duration on DMM taking into account the time-varying average age. The FE estimator for DMM is b = - 2.48 (95% CI - 3.45 to - 1.51) for IG vs. CG and b = - 0.30 (95% CI - 0.46 to - 0.14) for ISCHP duration (0-16 years). In the first year of an ISCHP, a reduction of the annual DMM of 0.3 per 100,000 population (1%), and in the 16th year of 4.8 (14%) was achieved. This study provides preliminary evidence of the effectiveness of ISCHP in Germany. Limitations include inaccuracies to classify IG and CG and possible selection bias. Longitudinal county-level data may be an efficient data source to evaluate complex interventions, thereby contributing to further strengthen evidence-based integrated health promotion.
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Affiliation(s)
- Dominik Röding
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
| | - Ulla Walter
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Maren Dreier
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg Str. 1, 30625, Hannover, Germany
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Griffith GJ, Davey Smith G, Manley D, Howe LD, Owen G. Interrogating structural inequalities in COVID-19 mortality in England and Wales. J Epidemiol Community Health 2021. [PMID: 34285096 DOI: 10.1101/2021.02.15.21251771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Numerous observational studies have highlighted structural inequalities in COVID-19 mortality in the UK. Such studies often fail to consider the hierarchical, spatial nature of such inequalities in their analysis, leading to the potential for bias and an inability to reach conclusions about the most appropriate structural levels for policy intervention. METHODS We use publicly available population data on COVID-19-related mortality and all-cause mortality between March and July 2020 in England and Wales to investigate the spatial scale of such inequalities. We propose a multiscale approach to simultaneously consider three spatial scales at which processes driving inequality may act and apportion inequality between these. RESULTS Adjusting for population age structure and number of local care homes we find highest regional inequality in March and June/July. We find finer grained within region inequality increased steadily from March until July. The importance of spatial context increases over the study period. No analogous pattern is visible for non-COVID-19 mortality. Higher relative deprivation is associated with increased COVID-19 mortality at all stages of the pandemic but does not explain structural inequalities. CONCLUSIONS Results support initial stochastic viral introduction in the South, with initially high inequality decreasing before the establishment of regional trends by June and July, prior to reported regionality of the 'second-wave'. We outline how this framework can help identify structural factors driving such processes, and offer suggestions for a long-term, locally targeted model of pandemic relief in tandem with regional support to buffer the social context of the area.
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Affiliation(s)
- Gareth J Griffith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - David Manley
- School of Geographical Sciences, University of Bristol, Bristol, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Gwilym Owen
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Johnston BM, Burke S, Kavanagh PM, O'Sullivan C, Thomas S, Parker S. Moving beyond formulae: a review of international population-based resource allocation policy and implications for Ireland in an era of healthcare reform. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13453.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Population-based resource allocation is a specific approach to population health planning that is used to address differences in population need to promote equity and efficiency in health and health system outcomes. However, while previous studies have described this type of funding model, they have not compared how such policies and practices have been implemented across jurisdictions. This research examined the impacts and outcomes of population-based resource allocation across six high-income countries, with a view to informing strategic decision-making as Ireland progresses its universal healthcare reform agenda. Methods: A concurrent multi-method approach was employed to examine the experiences of six jurisdictions selected for analysis: Australia (New South Wales), Canada (Alberta), England, New Zealand, Scotland and Sweden (Stockholm). A documentary analysis of key policy, strategy and planning publications was combined with a narrative rapid review of peer-reviewed and grey literature (n = 8) to determine how population-based resource allocation is specified and implemented. The findings were checked and verified by national experts. Results: Notable differences were observed across countries in terms of the stated objectives and descriptions of models as well as the criteria for choosing variables and the variables ultimately used in funding formulae. While population-based resource allocation can help improve equity related to healthcare outcomes and access, a number of tensions were revealed between the need to ensure alignment between policy goals and model design; transition between models; support regionalisation policies; and develop robust governance and monitoring mechanisms to maximise outcomes. Conclusions: The review progresses ‘thinking’ about population-based resource allocation beyond the technical aspects of model or formulae construction. Population-based resource allocation should be viewed as just one lever of large-scale health system reform that can be thoughtfully developed, monitored and adjusted in a way that supports the goals of Sláintecare and the delivery of universal healthcare.
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25
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McGowan VJ, Buckner S, Mead R, McGill E, Ronzi S, Beyer F, Bambra C. Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review. BMC Public Health 2021; 21:1888. [PMID: 34666742 PMCID: PMC8524206 DOI: 10.1186/s12889-021-11852-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Locally delivered, place-based public health interventions are receiving increasing attention as a way of improving health and reducing inequalities. However, there is limited evidence on their effectiveness. This umbrella review synthesises systematic review evidence of the health and health inequalities impacts of locally delivered place-based interventions across three elements of place and health: the physical, social, and economic environments. METHODS Systematic review methodology was used to identify recent published systematic reviews of the effectiveness of place-based interventions on health and health inequalities (PROGRESS+) in high-income countries. Nine databases were searched from 1st January 2008 to 1st March 2020. The quality of the included articles was determined using the Revised Assessment of Multiple Systematic Reviews tool (R-AMSTAR). RESULTS Thirteen systematic reviews were identified - reporting 51 unique primary studies. Fifty of these studies reported on interventions that changed the physical environment and one reported on changes to the economic environment. Only one primary study reported cost-effectiveness data. No reviews were identified that assessed the impact of social interventions. Given heterogeneity and quality issues, we found tentative evidence that the provision of housing/home modifications, improving the public realm, parks and playgrounds, supermarkets, transport, cycle lanes, walking routes, and outdoor gyms - can all have positive impacts on health outcomes - particularly physical activity. However, as no studies reported an assessment of variation in PROGRESS+ factors, the effect of these interventions on health inequalities remains unclear. CONCLUSIONS Place-based interventions can be effective at improving physical health, health behaviours and social determinants of health outcomes. High agentic interventions indicate greater improvements for those living in greater proximity to the intervention, which may suggest that in order for interventions to reduce inequalities, they should be implemented at a scale commensurate with the level of disadvantage. Future research needs to ensure equity data is collected, as this is severely lacking and impeding progress on identifying interventions that are effective in reducing health inequalities. TRIAL REGISTRATION PROSPERO CRD42019158309.
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Affiliation(s)
- V J McGowan
- Population Health Sciences Institute, Newcastle University, 5th Floor, Ridley 1, Newcastle Upon Tyne, NE1 7RU UK
- Fuse – The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - S. Buckner
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - R. Mead
- Department of Health Research, Lancaster University, Lancaster, UK
- LiLaC – Liverpool and Lancaster Universities Collaboration for Public Health Research, Lancaster, UK
| | - E. McGill
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - S. Ronzi
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - F. Beyer
- Population Health Sciences Institute, Newcastle University, 5th Floor, Ridley 1, Newcastle Upon Tyne, NE1 7RU UK
- Fuse – The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - C. Bambra
- Population Health Sciences Institute, Newcastle University, 5th Floor, Ridley 1, Newcastle Upon Tyne, NE1 7RU UK
- Fuse – The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
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26
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Ford J, Knight J, Brittain J, Bentley C, Sowden S, Castro A, Doran T, Cookson R. Reducing inequality in avoidable emergency admissions: Case studies of local health care systems in England using a realist approach. J Health Serv Res Policy 2021; 27:31-40. [PMID: 34289742 DOI: 10.1177/13558196211021618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE People in disadvantaged areas are more likely to have an avoidable emergency hospital admission. Socio-economic inequality in avoidable emergency hospital admissions is monitored in England. Our aim was to inform local health care purchasing and planning by identifying recent health care system changes (or other factors), as reported by local health system leaders, that might explain narrowing or widening trends. METHODS Case studies were undertaken in one pilot and at five geographically distinct local health care systems (Clinical Commissioning Groups, CCGs), identified as having consistently increasing or decreasing inequality. Local settings were explored through discussions with CCG officials and stakeholders to identify potential local determinants. Data were analysed using a realist evaluation approach to generate context-mechanism-outcome (CMO) configurations. RESULTS Of the five geographically distinct CCGs, two had narrowing inequality, two widening, and one narrowing inequality, which widened during the project. None of the CCGs had designed a large-scale package of service changes with the explicit aim of reducing socio-economic inequality in avoidable emergency admissions, and local decision makers were unfamiliar with their own trends. Potential primary and community care determinants included: workforce, case finding and exclusion, proactive care co-ordination for patients with complex needs, and access and quality. Potential commissioning determinants included: data use and incentives, and targeting of services. Other potential determinants included changes in care home services, national A&E targets, and wider issues - such as public services financial constraints, residential gentrification, and health care expectations. CONCLUSIONS We did not find any bespoke initiatives that explained the inequality trends. The trends were more likely due to an interplay of multiple health care and wider system factors. Local decision makers need greater awareness, understanding and support to interpret, use and act upon inequality indicators. They are unlikely to find simple, cheap interventions to reduce inequalities in avoidable emergency admissions. Rather, long-term multifaceted interventions are required that embed inequality considerations into mainstream decision making.
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Affiliation(s)
- John Ford
- Clinical Lecturer, Department of Public Health and Primary Care, University of Cambridge
| | - Julia Knight
- Public Health Registrar, Leicestershire County Council, UK
| | - John Brittain
- Principal Operational Researcher, NHS England and NHS Improvement, UK
| | | | - Sarah Sowden
- Clinical Lecturer and Honorary Public Health Consultant, Population Health Sciences Institute, University of Newcastle, UK
| | - Ana Castro
- Research Fellow, Health Sciences, University of York, UK
| | - Tim Doran
- Professor, Health Sciences, University of York, UK
| | - Richard Cookson
- Professor, Centre for Health Economics, University of York, UK
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27
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Barlow P, Mohan G, Nolan A, Lyons S. Area-level deprivation and geographic factors influencing utilisation of General Practitioner services. SSM Popul Health 2021; 15:100870. [PMID: 34386571 PMCID: PMC8342788 DOI: 10.1016/j.ssmph.2021.100870] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022] Open
Abstract
Inequities in access to General Practitioner (GP) services are a key policy concern given the role of GPs as gatekeepers to secondary care services. Geographic or area-level factors, including local deprivation and supply of healthcare providers, are important elements of access. In considering how area-level deprivation relates to GP utilisation, two potentially opposing factors may be important. The supply of healthcare services tends to be lower in areas of higher deprivation. However, poorer health status among individuals in deprived areas suggests greater need for healthcare. To explore the relationship of area-level deprivation to healthcare utilisation, we use data from the Healthy Ireland survey, which provided a sample of 6326 respondents to face-to-face interviews. A u-shaped relationship between GP supply and area-level deprivation is observed in the data. Modelling reveals that residing in more deprived communities has a strong, statistically significant positive association with having seen a GP within the last four weeks, controlling for individual characteristics and GP supply. All else equal, residing in an area ranked in the most deprived quintile increases the odds of a respondent having visited the GP in four weeks by 1.43 (95% Confidence Interval: 1.15–1.78), compared to the least deprived quintile (p-value< 0.001). The findings indicate that the level of deprivation in an area may be relevant to decisions about how to allocate primary care resources. GP utilisation is higher amongst those in more deprived areas. GP supply is lower in middle income areas compared to deprived or affluent areas. Differences in GP supply and GP utilisation occur across deprivation quintiles. Other geographic factors are not found to be significant in determining GP utilisation.
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Affiliation(s)
- Peter Barlow
- Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Dublin, Ireland
| | - Gretta Mohan
- Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Dublin, Ireland.,School of Economics, Trinity College, Dublin, Ireland
| | - Anne Nolan
- Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Dublin, Ireland.,School of Economics, Trinity College, Dublin, Ireland
| | - Seán Lyons
- Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Dublin, Ireland.,School of Economics, Trinity College, Dublin, Ireland
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Ford J, Sowden S, Olivera J, Bambra C, Gimson A, Aldridge R, Brayne C. Transforming health systems to reduce health inequalities. Future Healthc J 2021; 8:e204-e209. [PMID: 34286186 PMCID: PMC8285147 DOI: 10.7861/fhj.2021-0018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Never before in history have we had the data to track such a rapid increase in inequalities. With changes imminent in healthcare and public health organisational landscape in England and health inequalities high on the policy agenda, we have an opportunity to redouble efforts to reduce inequalities. In this article, we argue that health inequalities need re-framing to encompass the breadth of disadvantage and difference between healthcare and health outcome inequalities. Second, there needs to be a focus on long-term organisational change to ensure equity is considered in all decisions. Third, actions need to prioritise the fundamental redistribution of resources, funding, workforce, services and power. Reducing inequalities can involve unpopular and difficult decisions. Physicians have a particular role in society and can support evidenced-based change across practice and the system at large. If we do not act now, then when?
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Affiliation(s)
- John Ford
- University of Cambridge, Cambridge, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle-upon-Tyne, UK
| | | | - Clare Bambra
- Population Health Sciences Institute, Newcastle-upon-Tyne, UK
| | - Alex Gimson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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29
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Mourby MJ. 'Leading by Science' through Covid-19: the NHS Data Store & Automated Decision-Making. Int J Popul Data Sci 2021; 5:1099. [PMID: 34164583 PMCID: PMC8189169 DOI: 10.23889/ijpds.v5i4.1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The UK government announced in March 2020 that it would create an NHS Covid-19 ‘Data Store’ from information routinely collected as part of the health service. This ‘Store’ would use a number of sources of population data to provide a ‘single source of truth’ about the spread of the coronavirus in England. The initiative illustrates the difficulty of relying on automated processing when making healthcare decisions under the General Data Protection Regulation (GDPR). The end-product of the store, a number of ‘dashboards’ for decision-makers, was intended to include models and simulations developed through artificial intelligence. Decisions made on the basis of these dashboards would be significant, even (it was suggested) to the point of diverting patients and critical resources between hospitals based on their predictions. How these models will be developed, and externally validated, remains unclear. This is an issue if they are intended to be used for decisions which will affect patients so directly and acutely. We have (by default) a right under the GDPR not to be subject to significant decisions based solely on automated decision-making. It is not obvious, at present, whether resource allocation within the NHS could take place in reliance on this automated modelling. The recent A Level debacle illustrates, in the context of education, the risks of basing life-changing decisions on the national application of a single equation. It is worth considering the potential consequences for the health service if the NHS Data Store is used for resource planning as part of the Covid-19 response.
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Affiliation(s)
- M J Mourby
- Centre for Health, Law and Emerging Technologies, University of Oxford, Ewert House, Oxford, OX2 7DD, UK
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30
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Darlington-Pollock F, Green MA, Simpson L. Why were there 231 707 more deaths than expected in England between 2010 and 2018? An ecological analysis of mortality records. J Public Health (Oxf) 2021; 44:310-318. [PMID: 33765120 PMCID: PMC8083632 DOI: 10.1093/pubmed/fdab023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/03/2020] [Accepted: 01/19/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Policy responses to the Global Financial Crisis emphasized wide-ranging fiscal austerity measures, many of which have been found to negatively impact health outcomes. This paper investigates change in patterns of mortality at local authority level in England (2010-11 to 2017-18) and the relation with fiscal austerity measures. METHODS Data from official local authority administrative records are used to quantify the gap between observed deaths and what was anticipated in the 2010-based subnational population projections. Regression analyses are used to explore the relation between excess deaths, austerity and wider process of population change at local authority level. RESULTS We estimate 231 707 total excess deaths, the majority of which occurred since 2014-15 (89%) across the majority of local authorities (91%). Austerity is positively associated with excess deaths. For working age adults, there is a clear gradient to the impact of austerity, whereas for older adults, the impact is more uniform. CONCLUSIONS Fiscal austerity policies contributed to an excess of deaths for older people and widened social inequalities for younger populations. These results call for an end to all austerity measures and require further research into areas with the highest total excess deaths as a priority following the COVID-19 pandemic.
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Affiliation(s)
| | - Mark A Green
- Department of Geography and Planning, University of Liverpool, L69 7ZT Liverpool, UK
| | - Ludi Simpson
- Cathie Marsh Institute for Social Research, University of Manchester, M13 9BL, Manchester, UK
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31
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Black M. Vaccination against COVID-19 and inequalities - Avoiding making a bad situation worse. PUBLIC HEALTH IN PRACTICE 2021; 2:100101. [PMID: 33686381 PMCID: PMC7927589 DOI: 10.1016/j.puhip.2021.100101] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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32
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Cookson R, Doran T, Asaria M, Gupta I, Mujica FP. The inverse care law re-examined: a global perspective. Lancet 2021; 397:828-838. [PMID: 33640069 DOI: 10.1016/s0140-6736(21)00243-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 12/11/2022]
Abstract
An inverse care law persists in almost all low-income and middle-income countries, whereby socially disadvantaged people receive less, and lower-quality, health care despite having greater need. By contrast, a disproportionate care law persists in high-income countries, whereby socially disadvantaged people receive more health care, but of worse quality and insufficient quantity to meet their additional needs. Both laws are caused not only by financial barriers and fragmented health insurance systems but also by social inequalities in care seeking and co-investment as well as the costs and benefits of health care. Investing in more integrated universal health coverage and stronger primary care, delivered in proportion to need, can improve population health and reduce health inequality. However, trade-offs sometimes exist between health policy objectives. Health-care technologies, policies, and resourcing should be subjected to distributional analysis of their equity impacts, to ensure the objective of reducing health inequalities is kept in sight.
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Affiliation(s)
- Richard Cookson
- Centre for Health Economics, University of York, York, England.
| | - Tim Doran
- Department of Health Sciences, University of York, York, England
| | - Miqdad Asaria
- Department of Health Policy, London School of Economics, London, England
| | - Indrani Gupta
- Health Policy Research Unit, Institute of Economic Growth, Delhi, India
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33
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Wang Z, Chan KY, Poon AN, Homma K, Guo Y. Construction of an area-deprivation index for 2869 counties in China: a census-based approach. J Epidemiol Community Health 2020; 75:114-119. [PMID: 33037046 DOI: 10.1136/jech-2020-214198] [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: 03/30/2020] [Revised: 06/06/2020] [Accepted: 08/24/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND A paucity of data has made it challenging to construct a deprivation index at the lowest administrative, or county, level in China. An index is required to guide health equity monitoring and resource allocation to regions of greatest need. This study used China's 2010 census data to construct a county-level area-deprivation index (CADI). METHODS Data for 2869 counties from China's 2010 census were used to generate a CADI. Eleven indicators across four domains of deprivation were selected for principal component analysis with standardisation of the first principal component. Sensitivity analysis was used to test whether the population size and weighting method affected the index's robustness. Deprived counties identified by the CADI were then compared with China's official list of poverty-stricken counties. RESULTS The first principal component explained 60.38% of the total variation in the deprivation indicators. The CADI ranged from the least deprived value of -2.71 to the most deprived value of 2.92, with SD of 1. The CADI was found to be robust against county-level population size and different weighting methods. When compared with the official list of poverty-stricken counties in China, the deprived counties identified by the CADI were found to be even more deprived. CONCLUSION Constructing a robust area-deprivation index for China at the county level based on population census data is feasible. The CADI is a potential policy tool to identify China's most deprived areas. In the future, it may support health equity monitoring and comparison at the national and subnational levels.
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Affiliation(s)
- Zhicheng Wang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.,Vanke School of Public Health, Tsinghua University, Beijing, China.,Research Centre for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Kit Yee Chan
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK .,Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Adrienne N Poon
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK.,Department of Medicine, School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
| | - Kirsten Homma
- Department of Medicine, School of Medicine & Health Sciences, George Washington University, Washington, DC, USA.,Department of Medicine, New York Presbyterian - Columbia University, New York, NY, USA
| | - Yan Guo
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
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Thomson K, Berry R, Robinson T, Brown H, Bambra C, Todd A. An examination of trends in antibiotic prescribing in primary care and the association with area-level deprivation in England. BMC Public Health 2020; 20:1148. [PMID: 32741362 PMCID: PMC7397662 DOI: 10.1186/s12889-020-09227-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Internationally, there are growing concerns about antimicrobial resistance. This has resulted in increased scrutiny of antibiotic prescribing trends – particularly in primary care where the majority of prescribing occurs. In England, antibiotic prescribing targets are set nationally but little is known about the local context of antibiotic prescribing. This study aimed to examine trends in antibiotic prescribing (including broad-spectrum), and the association with area-level deprivation and region in England. Methods Antibiotic prescribing data by GP surgery in England were obtained from NHS Business Service Authority for the years 2014–2018. These data were matched with the Index of Multiple Deprivation (IMD) 2015 at the Lower Layer Super Output Area level Lower Layer Super Output Area (LSOA) level. Linear regression methods were employed to explore the relationship between antibiotic use and area-level deprivation as well as region, after controlling for a range of other confounding variables, including health need, rurality, and ethnicity. Results Over time, the amount of antibiotic prescribing significantly reduced from 1.11 items per STAR-PU to 0.96 items per STAR-PU – a reduction of 13.6%. The adjusted models found that, at LSOA level, the most deprived areas of England had the highest levels of antibiotic prescribing (0.03 items per STAR-PU higher). However, broad spectrum antibiotic prescribing exceeding 10% of all antibiotic prescribing within a GP practice was higher in more affluent areas. There were also significant regional differences – with the North East and the East of England having the highest levels of antibiotic prescribing (by 0.16 items per STAR-PU). Conclusion Although antibiotic prescribing has reduced over time, there remains significant variation in by area-level deprivation and region in England – with higher antibiotic prescribing in more deprived areas. Future prescribing targets should account for local factors to ensure the most deprived communities are not inappropriately penalised.
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Affiliation(s)
- Katie Thomson
- Population Heath Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Fuse - the UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Rachel Berry
- NHS County Durham Clinical Commissioning Group, Durham, UK
| | - Tomos Robinson
- Population Heath Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Heather Brown
- Population Heath Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Fuse - the UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Clare Bambra
- Population Heath Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Fuse - the UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Adam Todd
- Population Heath Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK. .,Fuse - the UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK. .,School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK.
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Wraw C, Minton J, Mitchell R, Wyper GMA, Campbell C, McCartney G. Can changes in spending on health and social care explain the recent mortality trends in Scotland? A protocol for an observational study. BMJ Open 2020; 10:e036025. [PMID: 32690513 PMCID: PMC7371127 DOI: 10.1136/bmjopen-2019-036025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION There have been steady reductions in mortality rates in the majority of high-income countries, including Scotland, since 1945. However, reductions in mortality rates have slowed down since 2012-2014 in these nations; and have reversed in some cases. Deaths among those aged 55+ explain a large amount of these changing mortality trends in Scotland. Increased pressures on health and social care services have been suggested as one factor explaining these changes. This paper outlines a protocol for the approach to testing the extent to which health and social care pressures can explain recent mortality trends in Scotland. Although a slower rate of mortality improvements have affected people of all ages, certain ages have been more negatively affected than the others. The current analyses will be run by age-band to test if the service pressure-mortality link varies across age-group. METHODS AND ANALYSIS This will be an observational ecological study based on the Scottish population. The exposures of interest will be the absolute (primary outcome) and percentage (secondary outcome) change in real terms per capita spending on social and healthcare services between 2011 and 2017. The outcome of interest will be the absolute (primary outcome) and percentage (secondary outcome) change in age-standardised mortality rate between 2012 and 2018 for men and women separately. The units of analysis will be the 32 local authorities and the 14 territorial health boards. The analyses will be run for both all age-groups combined and for the following age bands: <1, 1-15, 16-44, 45-64, 65-74, 75-84 and 85+.A series of descriptive analyses will summarise the distribution of health and social care expenditure and mortality trends between 2011 and 2018. Linear regression analysis will be used to investigate the direct association between health care spending and mortality rates. ETHICS AND DISSEMINATION The data used in this study will be publicly available and aggregated and will not be individually identifiable; therefore, ethical committee approval is not needed. This work will not result in the creation of a new data set. On completion, the study will be stored within the National Health Service research governance system. All of the results will be published once they have been shared with partner agencies.
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Affiliation(s)
- Christina Wraw
- Public Health Observatory, NHS Health Scotland, Edinburgh, UK
| | - Jon Minton
- Public Health Observatory, NHS Health Scotland, Glasgow, UK
| | - Rory Mitchell
- Public Health Observatory, NHS Health Scotland, Edinburgh, UK
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Corris V, Dormer E, Brown A, Whitty P, Collingwood P, Bambra C, Newton JL. Health inequalities are worsening in the North East of England. Br Med Bull 2020; 134:63-72. [PMID: 32462181 PMCID: PMC7350410 DOI: 10.1093/bmb/ldaa008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The North of England, particularly the North East (NE), has worse health (e.g. 2 years lower life expectancy) and higher health inequalities compared to the rest of England. SOURCES OF DATA We explore this over time drawing on publicly available data. AREAS OF AGREEMENT AND CONTROVERSY Whilst overall health is improving, within-regional health inequalities are getting worse and the gap between the NE and other regions (particularly the South of England) is worsening. The gap in life expectancy is widening with substantial variation between deprived and affluent areas within the NE. Those living in the NE are more likely to have a shorter lifespan and to spend a larger proportion of their shorter lives in poor health, as well as being more likely to die prematurely from preventable diseases. GROWING POINTS We highlight wide, and in some cases increasing, inequalities in health outcomes between the NE and the rest of England. This health disadvantage and the north-south health divide are recognized; despite this, the situation appears to be worsening over the time. AREAS TIMELY FOR DEVELOPING RESEARCH Research to understand and reduce health inequalities is needed particularly in the NE of England where reductions could have enhanced the impact.
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Affiliation(s)
- Valerie Corris
- NEQOS, North East Quality Observatory Service, 1st Floor, Ridley House, Henry Street, Gosforth, Newcastle upon Tyne NE3 1DQ, UK
| | - Emily Dormer
- School of Economics, Nottingham University, Nottingham NG7 2RD, UK
| | - Andrea Brown
- NEQOS, North East Quality Observatory Service, 1st Floor, Ridley House, Henry Street, Gosforth, Newcastle upon Tyne NE3 1DQ, UK
| | - Paula Whitty
- NEQOS, North East Quality Observatory Service, 1st Floor, Ridley House, Henry Street, Gosforth, Newcastle upon Tyne NE3 1DQ, UK.,NIHR Applied Research Collaborative North East and North Cumbria, Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, The Clocktower Building, St Nicholas Hospital, Gosforth, Newcastle NE3 3XT, UK
| | - Paul Collingwood
- NEQOS, North East Quality Observatory Service, 1st Floor, Ridley House, Henry Street, Gosforth, Newcastle upon Tyne NE3 1DQ, UK
| | - Clare Bambra
- NIHR Applied Research Collaborative North East and North Cumbria, Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, The Clocktower Building, St Nicholas Hospital, Gosforth, Newcastle NE3 3XT, UK.,Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - Julia L Newton
- NIHR Applied Research Collaborative North East and North Cumbria, Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, The Clocktower Building, St Nicholas Hospital, Gosforth, Newcastle NE3 3XT, UK.,Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.,AHSN NENC, Academic Health Science Network for North East North Cumbria, Room 2.13, Biomedical Research Building, Campus for Ageing and Vitality, Nuns' Moor Road, Newcastle upon Tyne NE4 5PL, UK
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Garnett C, Tombor I, Beard E, Jackson SE, West R, Brown J. Changes in smoker characteristics in England between 2008 and 2017. Addiction 2020; 115:748-756. [PMID: 31914486 PMCID: PMC7079121 DOI: 10.1111/add.14882] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/12/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022]
Abstract
AIMS At a time of declining smoking prevalence in England, it is useful to document any changes in the characteristics of smokers. This has implications for targeting tobacco control policies and interventions. This study compared the characteristics of smokers from 2008 to 2017 to assess changes in smoking and quitting patterns and socio-demographic profile. DESIGN AND SETTING Analysis of annual trends in results from repeated cross-sectional surveys of representative samples of the population in England from 2008 to 2017. PARTICIPANTS The study included 208 813 adults aged 16+. MEASUREMENTS Information was gathered on age, sex, social grade and region, cigarette consumption, cigarette dependence as measured by time to first cigarette of the day, daily smoking, smoking roll-your-own cigarettes, attempts to cut down, use of an e-cigarette or nicotine replacement therapy, attempts to cut down or quit, use of support in quit attempts and whether the quit attempt was abrupt. FINDINGS During the period, mean daily cigarette consumption [B = -0.30, 95% confidence interval (CI) = -0.33 to -0.27] and the time to first cigarette score decreased (B = -0.03, 95% CI = -0.03 to -0.02). The proportion of smokers attempting to cut down or quit decreased (odds ratio (OR) range = 0.96-0.97, 95% CI range = 0.95-0.97). Use of behavioural support [odds ratio (OR) = 0.89, 95% CI = 0.86-0.92] or no support decreased (OR = 0.98, 95% CI = 0.96-0.99), while use of pharmacological support, including e-cigarettes, increased (OR = 1.04, 95% CI = 1.02-1.05). There was no significant change in the difference in social grade between smokers and non-smokers comparing 2008 with 2017. Changes in smoking and quitting behaviour were independent of changes in socio-demographic characteristics. CONCLUSIONS Between 2008 and 2017 in England, smokers appear to have become less dependent on cigarettes but less likely to try to quit or cut down. Of those who tried to quit, fewer used behavioural support and more used pharmacological support. The proportion from more disadvantaged backgrounds did not change significantly.
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Affiliation(s)
- Claire Garnett
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Ildiko Tombor
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Emma Beard
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Sarah E. Jackson
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Jamie Brown
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
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Love-Koh J, Cookson R, Claxton K, Griffin S. Estimating Social Variation in the Health Effects of Changes in Health Care Expenditure. Med Decis Making 2020; 40:170-182. [PMID: 32065026 PMCID: PMC7430104 DOI: 10.1177/0272989x20904360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/01/2020] [Indexed: 11/17/2022]
Abstract
Background. A common aim of health expenditure is to reduce unfair inequalities in health. Although previous research has attempted to estimate the total health effects of changes in health expenditure, little is known about how changes affect different groups in the population. Methods. We propose a general framework for disaggregating the total health effects of changes in health expenditure by social groups. This can be performed indirectly when the estimate of the total health effect has first been disaggregated by a secondary factor (e.g., disease area) that can be linked to social characteristics. This is illustrated with an application to the English National Health Service. Evidence on the health effects of expenditure across 23 disease areas is combined with data on the distribution of disease-specific hospital utilization by age, sex, and area-level deprivation. Results. We find that the health effects from NHS expenditure changes are produced largely through disease areas in which individuals from more deprived areas account for a large share of health care utilization, namely, respiratory and neurologic disease and mental health. We estimate that 26% of the total health effect from a change in expenditure would accrue to the fifth of the population living in the most deprived areas, compared with 14% to the fifth living in the least deprived areas. Conclusions. Our approach can be useful for evaluating the health inequality impacts of changing health budgets or funding alternative health programs. However, it requires robust estimates of how health expenditure affects health outcomes. Our example analysis also relied on strong assumptions about the relationship between health care utilization and health effects across population groups.
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Affiliation(s)
- James Love-Koh
- Centre for Health Economics, University of York, York, North Yorkshire, UK
| | - Richard Cookson
- Centre for Health Economics, University of York, York, North Yorkshire, UK
| | - Karl Claxton
- />Centre for Health Economics, University of York, York, North Yorkshire, UK
- />Department of Economics and Related Studies, University of York, York, North Yorkshire, UK
| | - Susan Griffin
- Centre for Health Economics, University of York, York, North Yorkshire, UK
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39
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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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Lee JA, Meacock R, Kontopantelis E, Matheson J, Gittins M. Deprivation and primary care funding in Greater Manchester after devolution: a cross-sectional analysis. Br J Gen Pract 2019; 69:e794-e800. [PMID: 31501163 PMCID: PMC6733588 DOI: 10.3399/bjgp19x705545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/10/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In April 2016 Greater Manchester gained control of its health and social care budget, a devolution that aimed to reduce health inequities both within Greater Manchester and between Greater Manchester and the rest of the country. AIM To describe the relationship between practice location deprivation and primary care funding and care quality measurements in the first year of Greater Manchester devolution (2016/2017). DESIGN AND SETTING Cross-sectional analysis of 472 general practices in Greater Manchester in England. METHOD Financial data for each general practice were linked to the area deprivation of the practice location, as measured by the 2015 Index of Multiple Deprivation. Practices were categorised into five quintiles relative to national deprivation. NHS Payments data and indicators of care quality were compared across social deprivation quintiles. RESULTS Practices in areas of greater deprivation did not receive additional funding per registered patient. Practices in less deprived quintiles received higher National Enhanced Services payments from NHS England than practices in the most deprived quintile. A trend was observed towards funding to more deprived practices being supported by Local Enhanced Service payments from clinical commissioning groups, but these represent a small proportion of overall practice income. Practices in less deprived areas had better care quality measurements according to Quality and Outcomes Framework achievement and Care Quality Commission ratings. CONCLUSION Following devolution, primary care practices in Greater Manchester are still reliant on funding from national funding schemes, which poorly reflect its deprivation. The devolved administration's ability to address health inequities at the primary care level seems uncertain.
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Affiliation(s)
| | | | | | - James Matheson
- Hill Top Surgery, Hope Citadel Healthcare, Shared Health Foundation, Oldham
| | - Matthew Gittins
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester
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Sayma M, Tuijt R, Cooper C, Walters K. Are We There Yet? Immersive Virtual Reality to Improve Cognitive Function in Dementia and Mild Cognitive Impairment. THE GERONTOLOGIST 2019; 60:e502-e512. [DOI: 10.1093/geront/gnz132] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background and Objectives
Cognitive training therapies may delay cognitive deterioration in dementia. There is potential to enhance delivery through immersive virtual reality (IVR), as removing potential distractors for cognitively impaired individuals can enhance their experience, resulting in increased engagement. Evidence in this field is emerging and not yet synthesized. We aimed to summarize research investigating the use of IVR in dementia to evaluate the current extent of use, acceptability, feasibility, and potential effectiveness. We also aimed to identify gaps in current research and to create a set of recommendations in utilizing this therapy.
Research Design and Methods
A systematic literature review was conducted. Our review was registered with PROSPERO, registration number: CRD42019122295. We undertook searches of five databases, article references, and citations. Key authors in the field of health care VR were also contacted to identify additional papers. Articles were assessed for inclusion by two researchers independently. Data were extracted using standardized forms.
Results
Our search identified a total of 2,824 citations, following screening for duplicates and application of inclusion and exclusion criteria, five studies were included for analysis. Included studies were heterogeneous, with small sample sizes and mixed outcomes.
Discussion and Implications
We were unable to reach definitive conclusions over the use, acceptability, and effectiveness of IVR for dementia and mild cognitive impairment. Future studies should focus on ensuring their interventions are truly immersive, developing more robust controls and account for the rapid rate of obsolescence in digital technologies.
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Affiliation(s)
- Meelad Sayma
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, UK
| | - Remco Tuijt
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, UK
| | - Claudia Cooper
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, UK
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Taylor-Robinson D, Lai ETC, Wickham S, Rose T, Norman P, Bambra C, Whitehead M, Barr B. Assessing the impact of rising child poverty on the unprecedented rise in infant mortality in England, 2000-2017: time trend analysis. BMJ Open 2019; 9:e029424. [PMID: 31578197 PMCID: PMC6954495 DOI: 10.1136/bmjopen-2019-029424] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine whether there were inequalities in the sustained rise in infant mortality in England in recent years and the contribution of rising child poverty to these trends. DESIGN This is an analysis of trends in infant mortality in local authorities grouped into five categories (quintiles) based on their level of income deprivation. Fixed-effects regression models were used to quantify the association between regional changes in child poverty and regional changes in infant mortality. SETTING 324 English local authorities in 9 English government office regions. PARTICIPANTS Live-born children under 1 year of age. MAIN OUTCOME MEASURE Infant mortality rate, defined as the number of deaths in children under 1 year of age per 100 000 live births in the same year. RESULTS The sustained and unprecedented rise in infant mortality in England from 2014 to 2017 was not experienced evenly across the population. In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100 000 live births per year (95% CI 6 to 42), relative to the previous trend. There was no significant change from the pre-existing trend in the most affluent local authorities. As a result, inequalities in infant mortality increased, with the gap between the most and the least deprived local authority areas widening by 52 deaths per 100 000 births (95% CI 36 to 68). Overall from 2014 to 2017, there were a total of 572 excess infant deaths (95% CI 200 to 944) compared with what would have been expected based on historical trends. We estimated that each 1% increase in child poverty was significantly associated with an extra 5.8 infant deaths per 100 000 live births (95% CI 2.4 to 9.2). The findings suggest that about a third of the increases in infant mortality between 2014 and 2017 can be attributed to rising child poverty (172 deaths, 95% CI 74 to 266). CONCLUSION This study provides evidence that the unprecedented rise in infant mortality disproportionately affected the poorest areas of the country, leaving the more affluent areas unaffected. Our analysis also linked the recent increase in infant mortality in England with rising child poverty, suggesting that about a third of the increase in infant mortality from 2014 to 2017 may be attributed to rising child poverty.
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Affiliation(s)
- David Taylor-Robinson
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Eric T C Lai
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Sophie Wickham
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Tanith Rose
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
| | - Clare Bambra
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Ben Barr
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Robinson T, Brown H, Norman PD, Fraser LK, Barr B, Bambra C. The impact of New Labour's English health inequalities strategy on geographical inequalities in infant mortality: a time-trend analysis. J Epidemiol Community Health 2019; 73:564-568. [PMID: 30890592 DOI: 10.1136/jech-2018-211679] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/16/2019] [Accepted: 02/14/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND The English health inequalities strategy (1999-2010) aimed to reduce health inequalities between the most deprived local authorities and the rest of England. The multifaceted strategy included increased investment in healthcare, the early years, education and neighbourhood renewal. The objective of this study was to investigate whether the strategy was associated with a reduction in geographical inequalities in the infant mortality rate (IMR). METHODS We used segmented regression analysis to measure inequalities in the IMR between the most deprived local authorities and the rest of England before, during and after the health inequalities strategy period. RESULTS Before the strategy was implemented (1983-1998), absolute inequalities in the IMR increased between the most deprived local authorities and the rest of England at a rate of 0.034 annually (95% CI 0.001 to 0.067). Once the strategy had been implemented (1999-2010), absolute inequalities decreased at a rate of -0.116 annually (95% CI -0.178 to -0.053). After the strategy period ended (2011-2017), absolute inequalities increased at a rate of 0.042 annually (95% CI -0.042 to 0.125). Relative inequalities also marginally decreased during the strategy period. CONCLUSION The English health inequalities strategy period was associated with a decline in geographical inequalities in the IMR. This research adds to the evidence base suggesting that the English health inequalities strategy was at least partially effective in reducing health inequalities, and that current austerity policies may undermine these gains.
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Affiliation(s)
- Tomos Robinson
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Heather Brown
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lorna K Fraser
- Department of Health Sciences, University of York, York, UK
| | - Ben Barr
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Clare Bambra
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Primary care doctors' understandings of and strategies to tackle health inequalities: a qualitative study. Prim Health Care Res Dev 2019; 20:e20. [PMID: 32800013 PMCID: PMC6536748 DOI: 10.1017/s146342361800052x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim To examine general practitioners’ knowledge of and their role in tackling health inequalities, in relation to their professional responsibilities. Background Primary care is often seen as being in the frontline of addressing health inequalities and the social determinants of health (SDH). Methods A qualitative study with a maximum variety sample of English General Practitioners (GPs). In-depth, semi-structured interviews were held with 13 GPs in various geographical settings; they lasted between 30 and 70 min. Interviews were audio-recorded and transcribed. The analysis involved a constant comparison process undertaken by both authors to reveal key themes. Findings GPs’ understanding of health inequalities reflected numerous perspectives on the SDH and they employ various different strategies in tackling them. This study revealed that GPs’ strategies were changing the nature of (medical) professionalism in primary care. We locate these findings in relation to Gruen’s model of professional responsibility (comprising a distinction between obligation and aspiration, and between patient advocacy, community participation and political involvement). We conclude that these GPs do not exploit the full potential of their contribution to tackling health inequalities. These findings have implication for policy and practice in other practitioners and in other health systems, as they seek to tackle health inequalities.
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du Plessis R, Milton BS, Barr B. Devolution and the regional health divide: a longitudinal ecological study of 14 countries in Europe. J Public Health (Oxf) 2019; 41:3-9. [DOI: 10.1093/pubmed/fdy014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 12/13/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- R du Plessis
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, England
| | - B S Milton
- Department of Public Health and Policy, University of Liverpool, Liverpool, England
| | - B Barr
- Department of Public Health and Policy, University of Liverpool, Liverpool, England
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Currie J, Guzman Castillo M, Adekanmbi V, Barr B, O'Flaherty M. Evaluating effects of recent changes in NHS resource allocation policy on inequalities in amenable mortality in England, 2007-2014: time-series analysis. J Epidemiol Community Health 2018; 73:162-167. [PMID: 30470698 PMCID: PMC6352397 DOI: 10.1136/jech-2018-211141] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Health investment in England post-2010 has increased at lower rates than previously, with proportionally less being allocated to deprived areas. This study seeks to explore the impact of this on inequalities in amenable mortality between local areas. METHODS We undertook a time-series analysis across 324 lower-tier local authorities in England, evaluating the impact of changes in funding allocations to health commissioners from 2007 to 2014 on spatial inequalities in age-standardised under-75 mortality rates for conditions amenable to healthcare for men and women, adjusting for trends in household income, unemployment and time-trends. RESULTS More deprived areas received proportionally more funding between 2007 and 2014, though the reorganisation of commissioning in 2012 stalled this. Funding increases to more deprived local areas accounted for a statistically significant reduction in inequalities in male amenable mortality between local areas of 13 deaths per 100 000 (95% CI 2.5 to 25.9). Funding changes were associated with a reduction in inequalities in female amenable mortality of 7.0 per 100,000, though this finding did not reach significance (p=0.09). CONCLUSION Current National Health Service (NHS) resource allocation policy in England appears to be contributing to a convergence in health outcomes between affluent and deprived areas. However, careful surveillance is needed to evaluate whether diminished allocations to more deprived areas in recent years and reduced NHS investment as a whole is impacting adversely on inequalities between groups.
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Affiliation(s)
| | | | - Victor Adekanmbi
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, University Hospital of Wales, Cardiff, UK
| | - Ben Barr
- Department of Public Health, University of Liverpool, Liverpool, UK
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Lee J, Schram A, Riley E, Harris P, Baum F, Fisher M, Freeman T, Friel S. Addressing Health Equity Through Action on the Social Determinants of Health: A Global Review of Policy Outcome Evaluation Methods. Int J Health Policy Manag 2018; 7:581-592. [PMID: 29996578 PMCID: PMC6037500 DOI: 10.15171/ijhpm.2018.04] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/13/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Epidemiological evidence on the social determinants of health inequity is well-advanced, but considerably less attention has been given to evaluating the impact of public policies addressing those social determinants. Methodological challenges to produce evidence on policy outcomes present a significant barrier to mobilising policy actions for health equities. This review aims to examine methodological approaches to policy evaluation of health equity outcomes and identify promising approaches for future research.
Methods: We conducted a systematic narrative review of literature critically evaluating policy impact on health equity, synthesizing information on the methodological approaches used. We searched and screened records from five electronic databases, using pre-defined protocols resulting in a total of 50 studies included for review. We coded the studies according to (1) type of policy analysed; (2) research design; (3) analytical techniques; (4) health outcomes; and (5) equity dimensions evaluated.
Results: We found a growing number of a wide range of policies being evaluated for health equity outcomes using a variety of research designs. The majority of studies employed an observational research design, most of which were cross-sectional, however, other approaches included experimental designs, simulation modelling, and meta-analysis. Regression techniques dominated the analytical approaches, although a number of novel techniques were used which may offer advantages over traditional regression analysis for the study of distributional impacts of policy. Few studies made intra-national or cross-national comparisons or collected primary data. Despite longstanding challenges of attribution in policy outcome evaluation, the majority of the studies attributed change in physical or mental health outcomes to the policy being evaluated.
Conclusion: Our review provides an overview of methodological approaches to health equity policy outcome evaluation, demonstrating what is most commonplace and opportunities from novel approaches. We found the number of studies evaluating the impacts of public policies on health equity are on the rise, but this area of policy evaluation still requires more attention given growing inequities.
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Affiliation(s)
- Janice Lee
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Ashley Schram
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Emily Riley
- Menzies Centre for Health Policy, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Patrick Harris
- Menzies Centre for Health Policy, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Fran Baum
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Matt Fisher
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Toby Freeman
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Sharon Friel
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
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Mackenbach JP, Hu Y, Artnik B, Bopp M, Costa G, Kalediene R, Martikainen P, Menvielle G, Strand BH, Wojtyniak B, Nusselder WJ. Trends In Inequalities In Mortality Amenable To Health Care In 17 European Countries. Health Aff (Millwood) 2018; 36:1110-1118. [PMID: 28583971 DOI: 10.1377/hlthaff.2016.1674] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Little is known about the effectiveness of health care in reducing inequalities in health. We assessed trends in inequalities in mortality from conditions amenable to health care in seventeen European countries in the period 1980-2010 and used models that included country fixed effects to study the determinants of these trends. Our findings show remarkable declines over the study period in amenable mortality among people with a low level of education. We also found stable absolute inequalities in amenable mortality over time between people with low and high levels of education, but widening relative inequalities. Higher health care expenditure was associated with lower mortality from amenable causes, but not from nonamenable causes. The effect of health care expenditure on amenable mortality was equally strong, in relative terms, among people with low levels of education and those with high levels. As a result, higher health care expenditure was associated with a narrowing of absolute inequalities in amenable mortality. Our findings suggest that in the European context, more generous health care funding provides some protection against inequalities in amenable mortality.
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Affiliation(s)
- Johan P Mackenbach
- Johan P. Mackenbach is a professor of public health and chair of the Department of Public Health, Erasmus University Medical Center, in Rotterdam, the Netherlands
| | - Yannan Hu
- Yannan Hu is a postdoctoral fellow in the Department of Public Health, Erasmus University Medical Center
| | - Barbara Artnik
- Barbara Artnik is on the Faculty of Medicine, Department of Public Health, University of Ljubljana, in Slovenia
| | - Matthias Bopp
- Matthias Bopp is a senior researcher at the Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, in Switzerland
| | - Giuseppe Costa
- Giuseppe Costa is a professor of public health at the Turin University Medical School and chair of the San Luigi Hospital Epidemiology Unit and of the Azienda Sanitaria Locale (Regional Epidemiology Unit) in Turin, Italy
| | - Ramune Kalediene
- Ramune Kalediene is dean of the Faculty of Public Health and head of the Department of Health Management at Lithuanian University of Health Sciences, in Kaunas
| | - Pekka Martikainen
- Pekka Martikainen is a professor of demography in the Department of Sociology, University of Helsinki, in Finland
| | - Gwenn Menvielle
- Gwenn Menvielle is a senior researcher at the Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Institut Nationale de la Santé et de la Recherche Médicale, in Villejuif, France
| | - Bjørn H Strand
- Bjørn H. Strand is a senior researcher in the Division of Epidemiology, Norwegian Institute of Public Health, in Oslo
| | - Bogdan Wojtyniak
- Bogdan Wojtyniak is head of the Department of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, in Warsaw, Poland
| | - Wilma J Nusselder
- Wilma J. Nusselder is an assistant professor in the Department of Public Health, Erasmus University Medical Center
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49
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Phillips RL, Liaw W, Crampton P, Exeter DJ, Bazemore A, Vickery KD, Petterson S, Carrozza M. How Other Countries Use Deprivation Indices-And Why The United States Desperately Needs One. Health Aff (Millwood) 2018; 35:1991-1998. [PMID: 27834238 DOI: 10.1377/hlthaff.2016.0709] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Integrating public health and medicine to address social determinants of health is essential to achieving the Triple Aim of lower costs, improved care, and population health. There is intense interest in the United States in using social determinants of health to direct clinical and community health interventions, and to adjust quality measures and payments. The United Kingdom and New Zealand use data representing aspects of material and social deprivation from their censuses or from administrative data sets to construct indices designed to measure socioeconomic variation across communities, assess community needs, inform research, adjust clinical funding, allocate community resources, and determine policy impact. Indices provide these countries with comparable data and serve as a universal language and tool set to define organizing principles for population health. In this article we examine how these countries develop, validate, and operationalize their indices; explore their use in policy; and propose the development of a similar deprivation index for the United States.
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Affiliation(s)
- Robert L Phillips
- Robert L. Phillips is vice president for research and policy at the American Board of Family Medicine, in Washington, D.C
| | - Winston Liaw
- Winston Liaw is medical director at the Washington, D.C., office of the American Academy of Family Physicians
| | - Peter Crampton
- Peter Crampton is pro-vice-chancellor of the Division of Health Sciences, University of Otago, in Dunedin, New Zealand
| | - Daniel J Exeter
- Daniel J. Exeter is a senior lecturer at the University of Auckland, in New Zealand
| | - Andrew Bazemore
- Andrew Bazemore is director of the Robert Graham Center at the American Academy of Family Physicians
| | - Katherine Diaz Vickery
- Katherine Diaz Vickery is a clinician investigator at Hennepin County Medical Center, in Minneapolis, Minnesota
| | - Stephen Petterson
- Stephen Petterson is research director at the American Academy of Family Physicians
| | - Mark Carrozza
- Mark Carrozza is director of HealthLandscape, in Cincinnati, Ohio
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50
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Giuntella O, Nicodemo C, Vargas-Silva C. The effects of immigration on NHS waiting times. JOURNAL OF HEALTH ECONOMICS 2018; 58:123-143. [PMID: 29477952 DOI: 10.1016/j.jhealeco.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 01/19/2018] [Accepted: 02/01/2018] [Indexed: 06/08/2023]
Abstract
This paper analyzes the effects of immigration on waiting times for the National Health Service (NHS) in England. Linking administrative records from Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in accident and emergency departments (A&E) and elective care. The reduction in outpatient waiting times can be explained by the fact that immigration increases natives' internal mobility and that immigrants tend to be healthier than natives who move to different areas. Finally, we find evidence that immigration increased waiting times for outpatient referrals in more deprived areas outside of London. The increase in average waiting times in more deprived areas is concentrated in the years immediately following the 2004 EU enlargement and disappears in the medium term (e.g., 3-4 years).
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Affiliation(s)
- Osea Giuntella
- University of Pittsburgh, IZA, Department of Economics, Posvar Hall, 230 S Bouquet St, Pittsburgh, PA 15260, USA.
| | - Catia Nicodemo
- University of Oxford, CHSEO, IZA, Department of Economics, Manor Road, OX13UQ Oxford, Oxfordshire, UK.
| | - Carlos Vargas-Silva
- University of Oxford, Centre on Migration, Policy and Society (COMPAS), 58 Banbury Rd, OX26QS Oxford, Oxfordshire, UK.
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