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McCabe R, Pollack R, Broadbent P, Thomson RM, Igelström E, Pearce A, Bambra C, Bennett DL, Alexandros A, Daras K, Taylor-Robinson D, Barr B, Katikireddi SV. Implications of child poverty reduction targets for public health and health inequalities in England: a modelling study between 2024 and 2033. J Epidemiol Community Health 2024:jech-2024-222313. [PMID: 39107099 DOI: 10.1136/jech-2024-222313] [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: 04/09/2024] [Accepted: 06/20/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND We investigated the potential impacts of child poverty (CP) reduction scenarios on population health and health inequalities in England between 2024 and 2033. METHODS We combined aggregate local authority-level data with published and newly created estimates on the association between CP and the rate per 100 000 of infant mortality, children (aged <16) looked after, child (aged <16) hospitalisations for nutritional anaemia and child (aged <16) all-cause emergency hospital admissions. We modelled relative, absolute (per 100 000) and total (per total population) annual changes for these outcomes under three CP reduction scenarios between 2024 and 2033-low-ambition (15% reduction), medium-ambition (25% reduction) and high-ambition (35% reduction)-compared with a baseline CP scenario (15% increase). Annual changes were aggregated between 2024 and 2033 at national, regional and deprivation (IMD tertiles) levels to investigate inequalities. RESULTS All CP reduction scenarios would result in substantial improvements to child health. Meeting the high-ambition reduction would decrease total cases of infant mortality (293; 95% CI 118 to 461), children looked after (4696; 95% CI 1987 to 7593), nutritional anaemia (458, 95% CI 336 to 574) and emergency admissions (32 650; 95% CI 4022 to 61 126) between 2024 and 2033. Northern regions (eg, North East) exhibited the greatest relative and absolute benefit. The most deprived tertile would experience the largest relative, absolute and total benefit; under high-ambition reduction, total infant mortality cases were predicted to fall by 126 (95% CI 51 to 199) in the most deprived tertile compared with 71 (95% CI 29 to 112) in the least between 2024 and 2033. CONCLUSIONS Achieving reductions in CP could substantially improve child health and reduce health inequalities in England.
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Affiliation(s)
- Ronan McCabe
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Roxana Pollack
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Philip Broadbent
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rachel M Thomson
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Erik Igelström
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anna Pearce
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University Institute for Health and Society, Newcastle upon Tyne, UK
| | | | | | | | | | - Benjamin Barr
- Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
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Sartorius V, Philibert M, Klungsoyr K, Klimont J, Szamotulska K, Drausnik Z, Velebil P, Mortensen L, Gissler M, Fresson J, Nijhuis J, Zhang WH, Källén K, Rihs TA, Tica V, Matthews R, Smith L, Zeitlin J. Neonatal Mortality Disparities by Gestational Age in European Countries. JAMA Netw Open 2024; 7:e2424226. [PMID: 39110462 PMCID: PMC11307138 DOI: 10.1001/jamanetworkopen.2024.24226] [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: 03/04/2024] [Accepted: 05/28/2024] [Indexed: 08/10/2024] Open
Abstract
Importance There are wide disparities in neonatal mortality rates (NMRs, deaths <28 days of life after live birth per 1000 live births) between countries in Europe, indicating potential for improvement. Comparing country-specific patterns of births and deaths with countries with low mortality rates can facilitate the development of effective intervention strategies. Objective To investigate how these disparities are associated with the distribution of gestational age (GA) and GA-specific mortality rates. Design, Setting, and Participants This was a cross-sectional study of all live births in 14 participating European countries using routine data compiled by the Euro-Peristat Network. Live births with a GA of 22 weeks or higher from 2015 to 2020 were included. Data were analyzed from May to October 2023. Exposures GA at birth. Main Outcomes and Measures The study investigated excess neonatal mortality, defined as a rate difference relative to the pooled rate in the 3 countries with the lowest NMRs (Norway, Sweden, and Finland; hereafter termed the top 3). The Kitagawa method was used to divide this excess into the proportion explained by the GA distribution of births and by GA-specific mortality rates. A sensitivity analysis was conducted among births 24 weeks' GA or greater. Results There were 35 094 neonatal deaths among 15 123 428 live births for an overall NMR of 2.32 per 1000. The pooled NMR in the top 3 was 1.44 per 1000 (1937 of 1 342 528). Excess neonatal mortality compared with the top 3 ranged from 0.17 per 1000 in the Czech Republic to 1.82 per 1000 in Romania. Excess deaths were predominantly concentrated among births less than 28 weeks' GA (57.6% overall). Full-term births represented 22.7% of the excess deaths in Belgium, 17.8% in France, 40.6% in Romania and 17.3% in the United Kingdom. Heterogeneous patterns were observed when partitioning excess mortality into the proportion associated with the GA distribution vs GA-specific mortality. For example, these proportions were 9.2% and 90.8% in France, 58.4% and 41.6% in the United Kingdom, and 92.9% and 7.1% in Austria, respectively. These associations remained stable after removing births under 24 weeks' GA in most, but not all, countries. Conclusions and Relevance This cohort study of 14 European countries found wide NMR disparities with varying patterns by GA. This knowledge is important for developing effective strategies to reduce neonatal mortality.
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Affiliation(s)
- Victor Sartorius
- CRESS, Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPe, INSERM, INRA, Université Paris Cité, Paris, France
- Department of Neonatal Intensive Care, AP-HP, Hôpital Necker Enfants-Malades, Paris, France
| | - Marianne Philibert
- CRESS, Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPe, INSERM, INRA, Université Paris Cité, Paris, France
| | - Kari Klungsoyr
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jeannette Klimont
- Unit Demography and Health, Directorate Social Statistics, Statistics Austria, Vienna, Austria
| | - Katarzyna Szamotulska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
| | - Zeljka Drausnik
- Division of Public Health, Croatian Institute of Public Health, Zagreb, Croatia
| | - Petr Velebil
- Department of Obstetrics and Gynecology, Institute for the Care of Mother and Child, Prague, Czech Republic
- Department of Obstetrics and Gynecology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Laust Mortensen
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - Jeanne Fresson
- CRESS, Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPe, INSERM, INRA, Université Paris Cité, Paris, France
- Direction de la Recherche, des Etudes, de l’Evaluation et des Statistiques (Drees), Paris, France
| | - Jan Nijhuis
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, MUMC+, Maastricht, the Netherlands
| | - Wei-Hong Zhang
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Karin Källén
- Swedish National Board of Health and Welfare, Department of Analysis, Stockholm, Sweden
| | - Tonia A. Rihs
- Federal Statistical Office (FSO), Neuchâtel, Switzerland
| | - Vlad Tica
- Faculty of Medicine, East European Institute for Reproductive Health, Academy of Romanian Scientists, University ‘Ovidius’ Constanţa, Constanța, Romania
| | - Ruth Matthews
- Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Lucy Smith
- Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Jennifer Zeitlin
- CRESS, Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPe, INSERM, INRA, Université Paris Cité, Paris, France
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Esan OB, Norman P, McHale P, Hargreaves D, Creese H, Melendez-Torres GJ, Taylor-Robinson D. Intersecting ethnic and socioeconomic inequalities in infant mortality in England, 2007-2019. Arch Dis Child 2024:archdischild-2023-326619. [PMID: 38950906 DOI: 10.1136/archdischild-2023-326619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/03/2024]
Affiliation(s)
- Oluwaseun B Esan
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
- NIHR School for Public Health Research, Newcastle upon Tyne, UK
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
| | - Philip McHale
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
| | - Dougal Hargreaves
- NIHR School for Public Health Research, Newcastle upon Tyne, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Hanna Creese
- NIHR School for Public Health Research, Newcastle upon Tyne, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - G J Melendez-Torres
- NIHR School for Public Health Research, Newcastle upon Tyne, UK
- Medical School, University of Exeter, Exeter, UK
| | - David Taylor-Robinson
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
- NIHR School for Public Health Research, Newcastle upon Tyne, UK
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Hiam L. Action is urgently needed on the social determinants of health in the UK. BMJ 2024; 385:q1422. [PMID: 38936854 DOI: 10.1136/bmj.q1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
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Evensen M, Klitkou ST, Tollånes MC, Júlíusson PB, Kravdal Ø. Parental income gradients in child and adolescent mortality: Norwegian trends over half a century. Scand J Public Health 2024; 52:402-409. [PMID: 36785495 PMCID: PMC11179307 DOI: 10.1177/14034948231151990] [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: 04/19/2022] [Revised: 11/14/2022] [Accepted: 01/04/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Child mortality has declined rapidly over the last century in many high-income countries. However, little is known about the socio-economic differences in this decline and whether these vary across causes of death. METHODS We used register data that included all Norwegian births between 1968 and 2010 (2.1 million), and we analysed how all-cause and cause-specific child (0-4 years) and adolescent (5-20 years) mortality rates vary with relative parental income the year before the birth. RESULTS Child and adolescent all-cause mortality decreased with increasing parental relative income within all birth cohorts. Among children aged 0-4 years, the socio-economic gradient in all-cause mortality and in mortality due to external causes, sudden infant deaths and perinatal factors declined over the period, while there was no systematic decline in mortality from congenital malformations. Among children aged 5-20 years, the gradient did not weaken similarly, although there were indications of declines in the socio-economic gradient related to all-cause deaths and deaths because of suicides and other external causes. While the absolute differences in mortality declined over time, the relative differences remained stable. CONCLUSIONS Although children of low-income parents still have elevated mortality, there has been a large reduction in child mortality in all socio-economic groups across 50 years for all causes combined and most of the groups of specific causes of death.
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Affiliation(s)
| | - Søren Toksvig Klitkou
- Clinical Trials Unit, Oslo University Hospital, Norway
- Department for Disease Burden, Norwegian Institute of Public Health, Norway
| | - Mette Christophersen Tollånes
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Norway
- Department for Global Public Health and Primary Care, University of Bergen, Norway
| | - Pétur Benedikt Júlíusson
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Norway
- Department of Clinical Science, University of Bergen, Norway
- Children and Youth Clinic, Haukeland University Hospital, Norway
| | - Øystein Kravdal
- Centre for Fertility and Health, Norwegian Institute of Public Health, Norway
- Department of Economics, University of Oslo, Norway
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Cánepa ET, Berardino BG. Epigenetic mechanisms linking early-life adversities and mental health. Biochem J 2024; 481:615-642. [PMID: 38722301 DOI: 10.1042/bcj20230306] [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: 02/19/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/15/2024]
Abstract
Early-life adversities, whether prenatal or postnatal exposure, have been linked to adverse mental health outcomes later in life increasing the risk of several psychiatric disorders. Research on its neurobiological consequences demonstrated an association between exposure to adversities and persistent alterations in the structure, function, and connectivity of the brain. Consistent evidence supports the idea that regulation of gene expression through epigenetic mechanisms are involved in embedding the impact of early-life experiences in the genome and mediate between social environments and later behavioral phenotypes. In addition, studies from rodent models and humans suggest that these experiences and the acquired risk factors can be transmitted through epigenetic mechanisms to offspring and the following generations potentially contributing to a cycle of disease or disease risk. However, one of the important aspects of epigenetic mechanisms, unlike genetic sequences that are fixed and unchangeable, is that although the epigenetic markings are long-lasting, they are nevertheless potentially reversible. In this review, we summarize our current understanding of the epigenetic mechanisms involved in the mental health consequences derived from early-life exposure to malnutrition, maltreatment and poverty, adversities with huge and pervasive impact on mental health. We also discuss the evidence about transgenerational epigenetic inheritance in mammals and experimental data suggesting that suitable social and pharmacological interventions could reverse adverse epigenetic modifications induced by early-life negative social experiences. In this regard, these studies must be accompanied by efforts to determine the causes that promote these adversities and that result in health inequity in the population.
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Affiliation(s)
- Eduardo T Cánepa
- Laboratorio de Neuroepigenética y Adversidades Tempranas, Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires and IQUIBICEN, CONICET, Buenos Aires, Argentina
| | - Bruno G Berardino
- Laboratorio de Neuroepigenética y Adversidades Tempranas, Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires and IQUIBICEN, CONICET, Buenos Aires, Argentina
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Hiam L, Klaber B, Sowemimo A, Marmot M. NHS and the whole of society must act on social determinants of health for a healthier future. BMJ 2024; 385:e079389. [PMID: 38604669 DOI: 10.1136/bmj-2024-079389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Affiliation(s)
| | - Bob Klaber
- Research, Innovation, Imperial College Healthcare NHS Trust, London, UK
- School of Public Health, Imperial College London, London, UK
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de Souza Sá ÁR, Santos Branco DK. Social fund and infant mortality: Evidence from an anti-poverty policy in Northeast Brazil. HEALTH ECONOMICS 2024; 33:674-695. [PMID: 38148733 DOI: 10.1002/hec.4785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 12/28/2023]
Abstract
This paper evaluates the effects of a social fund that meets the needs of the poor in Northeast Brazil, the Fundos Estaduais de Combate e Erradicação da Pobreza (FECEP). The program could have improved infant health by reducing poverty and improving access to health care, sanitation, food, and housing. Using a difference-in-differences approach robust to heterogeneous treatment effects, we confirm that the program has effectively reduced poverty in treated areas. Furthermore, we document that this poverty reduction is associated with a significant decline in infant mortality. These findings provide consistent evidence that targeted public investments can improve living conditions in vulnerable regions.
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Kraemer S. Decline in child health in the UK is a national scandal. BMJ 2024; 384:q553. [PMID: 38443088 DOI: 10.1136/bmj.q553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
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Odd DE, Stoianova S, Williams T, Odd D, Edi-osagie N, McClymont C, Fleming P, Luyt K. Race and Ethnicity, Deprivation, and Infant Mortality in England, 2019-2022. JAMA Netw Open 2024; 7:e2355403. [PMID: 38345821 PMCID: PMC10862146 DOI: 10.1001/jamanetworkopen.2023.55403] [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: 07/20/2023] [Accepted: 12/18/2023] [Indexed: 02/15/2024] Open
Abstract
Importance England has one of the highest infant mortality rates in Europe. Much of the variation in infant mortality rates between races and ethnicities may be due to socioeconomic factors, but how deprivation and race and ethnicity are associated with infant mortality is unclear. Objectives To investigate the association of infant race and ethnicity with the infant mortality rate in England, adjusted for preterm birth and level of deprivation. Design, Setting, and Participants This cohort study included children who died younger than 1 year of age, born at or after 22 weeks' gestation, occurring from April 1, 2019, to March 31, 2022, in England. Characteristics of the infant were derived from death notifications. Exposures The racial and ethnic groups were derived from National Health Service data and were reported by the parents and characterized using the Office of National Statistics classification: Asian or Asian British (Bangladeshi, Chinese, Indian, Pakistani, or any other Asian background), Black or Black British (African, Caribbean, or any other Black background), multiracial (White and Asian, White and Black African, White and Black Caribbean, or any other multiracial background), White or White British (British, Irish, any other White background, or Gypsy or Irish Traveler), and other (Arab or any other racial or ethnic group). Main Outcomes and Measures Risk of death for all racial and ethnic groups and relative risk of death compared with the reference group (White) were calcuated. Analyses were repeated, adjusting for deprivation, gestational age of infants, and region of England. Results A total of 5621 infants who died younger than 1 year of age were reported to the National Child Mortality Database. A total of 2842 of 5130 infants (55.4%) were male; the median gestational age was 33 weeks (IQR, 25-38 weeks); of 5149 infants, 927 (18.0%) were Asian, 448 (8.7%) were Black, 3318 (64.4%) were White, 343 (6.7%) were multiracial, and 113 (2.2%) were from other racial and ethnic groups; and the median deprivation score was 4 (IQR, 3-5). In the unadjusted analysis, the relative risk of death compared with White infants was higher for Black (1.93 [95% CI, 1.75-2.13]) and Asian (1.67 [95% CI, 1.55-1.80]) infants. The population attributable risk fraction for all mortality rates among infants who were not White was 12.0% (95% CI, 10.3%-13.8%) (unadjusted), 9.8% (95% CI, 8.0%-11.7%) (adjusted for deprivation), 7.7% (95% CI, 5.9%-9.5%) (adjusted for gestational age at birth), and 12.8% (95% CI, 11.0%-14.5%) (adjusted for region of England). Conclusions and Relevance This cohort study suggests that the proportion of infants who died before 1 year of age is associated with race and ethnicity, with a population attributable risk fraction of 12.0%. An overconservative adjustment for deprivation did not explain the overall patterns seen. Approximately half the population attributable risk fraction may be due to increased risk of preterm birth in Asian and Black communities. Work is needed to identify what can be done to reduce this incidence of infant mortality.
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Affiliation(s)
- David E. Odd
- Division of Population Medicine, School of Medicine, University of Cardiff, Cardiff, United Kingdom
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
| | - Sylvia Stoianova
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
| | - Tom Williams
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
| | - Dawn Odd
- School of Health and Social Wellbeing, University of the West of England, Blackberry Hill, Bristol, United Kingdom
| | - Ngozi Edi-osagie
- Newborn Intensive Care Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | - Peter Fleming
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
| | - Karen Luyt
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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de la Rasilla P, Stamos I, Proietti P, Siragusa A. Closing the Loop: Enhancing Local Monitoring of Child Poverty to Leave No Child Behind. CHILDREN (BASEL, SWITZERLAND) 2024; 11:67. [PMID: 38255380 PMCID: PMC10813958 DOI: 10.3390/children11010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/29/2023] [Accepted: 01/01/2024] [Indexed: 01/24/2024]
Abstract
Research on the Leave No One Behind principle of the Sustainable Development Goals (SDGs) within the context of the Agenda 2030 is currently prevalent; however, research on monitoring child poverty at the sub-national (local) level is still limited. This paper addresses this gap by examining indicators developed for monitoring the phenomenon at different territorial levels (global, European, and national) and assessing their territorial transposition locally, using the city of Cadiz, Spain, as a case study. Interviews with local stakeholders reveal that despite the availability and access to related indicators and data, relevant actors must enhance their efforts to utilize such indicators effectively. Based on desktop research and qualitative analysis, the paper delivers recommendations for improving local monitoring of child poverty in Europe and inducing policy changes. This knowledge can inform targeted interventions, policy formulation, and resource allocation to tackle child poverty and promote equitable and inclusive societies.
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Affiliation(s)
| | - Iraklis Stamos
- Territorial Development Unit, Joint Research Centre, European Commission, 41092 Seville, Spain;
| | - Paola Proietti
- Territorial Development Unit, Joint Research Centre, European Commission, 21027 Ispra, Italy;
| | - Alice Siragusa
- Territorial Development Unit, Joint Research Centre, European Commission, 41092 Seville, Spain;
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Bell Z, Scott S, Visram S, Rankin J, Bambra C, Heslehurst N. Children's nutritional health and wellbeing in food insecure households in Europe: A qualitative meta-ethnography. PLoS One 2023; 18:e0292178. [PMID: 37773922 PMCID: PMC10540950 DOI: 10.1371/journal.pone.0292178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
Since the 2008 global financial crisis, there has been a rise in the number of people experiencing food insecurity. Particularly vulnerable are households with children. This systematic review and meta-ethnography of qualitative studies focuses on families' perceptions of food insecurity and how it affects children's nutritional health and wellbeing. Six electronic databases (Medline, Scopus, Web of Science, EMBASE, CINAHL and ASSIA), were searched for studies from European high-income countries between January 2008-July 2021, and supplemented by searches of grey literature databases, relevant websites, examination of reference lists and citation searches. We adhered to PRISMA and eMERGe guidelines to improve the completeness and clarity of meta-ethnographic reporting. Methodological quality of the studies were assessed using the Critical Appraisal Skills Programme qualitative checklist. We identified 11,596 records; we included 19 publications involving 813 participants in total. Data were synthesised according to Noblit & Hare's seven phases of meta-ethnography. We identified four key themes-food and eating practices, awareness, fragility, and networks of care-comprising five sub-themes. Our meta-ethnography provides a progressive 'storyline' of the children's experiences of food insecurity from both caregivers and children's perspectives. We found that children are aware of their family's limited resources and are often active in trying to help their families cope, and that food insecurity adversely impacts children's physical, psychological, and social experiences. Our analysis highlights gaps in knowledge about how food insecurity impacts children's nutritional health and wellbeing. It suggests that future research should prioritise minoritised ethnic communities, children living in temporary accommodation and caregivers of very young children.
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Affiliation(s)
- Zoë Bell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Steph Scott
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Shelina Visram
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Hailemeskel HS, Dagnaw FT, Demis S, Birhane BM, Azanaw MM, Chanie ES, Asferie WN, Fetene MT, Mose A, Belay DM, Kefale D, Kassaw A, Tiruneh M, Tesfaw A, Tilaye BA, Arage G, Kebede AB, Tiruneh SA. Neonatal outcomes of preterm neonates and its predictors in Ethiopian public hospitals: Multicenter prospective follow-up study. Heliyon 2023; 9:e18534. [PMID: 37576212 PMCID: PMC10412993 DOI: 10.1016/j.heliyon.2023.e18534] [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: 03/01/2022] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Preterm birth remains the most significant clinical and public health encounter. Preterm infant outcomes pose key evidence for clinicians and policymakers and are extensively used to set clinical and policy verdicts to improve services. It is necessary to conduct the outcomes of neonates frequently, as it varies from place to place and even from time to time in a similar place. There is limited literature in Ethiopia about preterm neonates' outcomes and their predictors. Objective This study aimed to assess the neonatal outcomes of preterm neonates and their predictors in South Gondar zone public hospitals, Northwest Ethiopia, 2021. Methods A prospective observational study was employed on 462 preterm neonates in South Gondar Zone Public Hospitals. The data were entered into Epidata 4.6 and analyzed using STATA version 16/MP software. A parametric log-normal survival model was used to identify possible predictors for preterm neonate death. Statistical significance was declared at a P-value less than 0.05. Result The overall preterm survival rate was 71.1% (95% CI: 66.7, 75.1). Thirty-six percent of preterm neonates were diagnosed with sepsis. One-fourth of the neonates had respiratory distress syndrome. Gestational age greater than 34 weeks (β = 1.04; 95% CI: 0.53, 1.56), respiratory distress syndrome (β = 0.85; 95% CI: 0.49, 1.22), body mass index (β = -1.34; 95% CI: -1.87, -0.80), non-union marital status (β = -0.71; 95% CI: -1.34, -0.09), multiple pregnancies (β = -0.66; 95% CI: -0.99-0.32), multiparous (β = 0.35; 95% CI: 0.01, 0.69), hypothermia (β = -1.19; 95% CI: -1.76, -0.62), Kangaroo Mother Care (β = -1.9; 95% CI: -2.34, -1.41) and non-cephalic presentation (β = -1.23; 95% CI: -1.99,-0.46) were significant predictors. Conclusion In this study, the preterm survival rate was low. Gestational age greater than 34 weeks, no respiratory distress syndrome, and multiparous mothers were positively associated with the survival of preterm neonates. Though, high pre-pregnancy maternal body mass index, non-union marital status of mothers, multiple pregnancies, hypothermia, Kangaroo mother care is not given, and non-cephalic presentation were negatively associated. A significant focus should be given to implementing WHO recommendations on preventing and caring for preterm births.
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Affiliation(s)
- Habtamu Shimels Hailemeskel
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fentaw Teshome Dagnaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Binyam Minuye Birhane
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Melkalem Mamuye Azanaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferie
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Ayenew Mose
- Department of Midwifery, Wolkite University, Wolkite, Ethiopia
| | - Demeke Mesfin Belay
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Demewoz Kefale
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulu Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aragaw Tesfaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Birara Aychew Tilaye
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Arage
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Alemwork Baye Kebede
- Neonatal Intensive Care Unit, Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia
| | - Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Lisboa CS, Guimarães NS, Ferreira AJF, Silva KBBD, Alves FJO, Rocha ADS, Ortelan N, Texeira CSS, Falcão IR, Silva NDJ, Ribeiro-Silva RDC, Barbosa D, Barreto ML. Impact of cash transfer programs on birth and child growth outcomes: systematic review. CIENCIA & SAUDE COLETIVA 2023; 28:2417-2432. [PMID: 37531548 DOI: 10.1590/1413-81232023288.14082022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/25/2023] [Indexed: 08/04/2023] Open
Abstract
To investigate the impact of cash transfer (CTs) on birth outcomes, including birth weight, low birth weight and prematurity, as well as child physical growth were included, as assessed by anthropometric indices in children under five years of age. Searching was performed using the PubMed/Medline, Embase, LILACS, Cochrane Library, Scopus and Web of Science databases. Quantitative observational, experimental and quasi-experimental. Eleven studies were included in the review. The majority (81.8%) were carried out in low-and middle-income countries and most involved conditional CTs (63.6%). Four were clinical trials and seven were observational studies. Conditional CTs were found to be associated with a reduction in height-for-age (-0.14; 95%CI -0.27, -0.02); (OR 0.85; 95%CI 0.77-0.94); (OR = 0.44; 95%CI 0.19-0.98), a significantly reduced chance of low weight-for-age (OR = 0.16; 95%CI -0.11-0.43), low weight-for-height (OR = -0.68; 95%CI -1.14, -0.21), and low weight-for-age (OR = 0.27; 95%CI 0.10; 0.71). Unconditional CTs were associated with reduced birth weight (RR = 0.71; 95%CI 0.63-0.81; p < 0.0001) and preterm births (RR = 0.76; 95%CI 0.69-0.84; p < 0.0001). Conditional CTs can positively influence birth outcomes and child growth.
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Affiliation(s)
- Cinthia Soares Lisboa
- Universidade Estadual de Feira de Santana, Programa de Pós-Graduação em Saúde Coletiva. Av. Transnordestina s/n, Novo Horizonte. 44036-900 Feira de Santana BA Brasil.
| | | | | | - Karine Brito Beck da Silva
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| | - Flávia Jôse Oliveira Alves
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| | - Aline Dos Santos Rocha
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| | - Naiá Ortelan
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| | - Camila Silveira Silva Texeira
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| | - Ila Rocha Falcão
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| | | | - Rita de Cássia Ribeiro-Silva
- Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas de Minas Gerais. Belo Horizonte MG Brasil
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| | - Djanilson Barbosa
- Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia. Santo Antônio de Jesus BA Brasil
| | - Mauricio Lima Barreto
- Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas de Minas Gerais. Belo Horizonte MG Brasil
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
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15
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McCabe R, Katikireddi SV, Dundas R, Craig P. The health impact of Scotland's Baby Box Scheme: a natural experiment evaluation using national linked health data. Lancet Public Health 2023; 8:e504-e510. [PMID: 37393089 PMCID: PMC10323308 DOI: 10.1016/s2468-2667(23)00121-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/25/2023] [Accepted: 05/23/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Scotland's Baby Box Scheme (SBBS) is a national programme offering a box of essential items to all pregnant women in Scotland intended to improve infant and maternal health. We aimed to evaluate the effect of SBBS on selected infant and maternal health outcomes at population and subgroup levels (maternal age and area deprivation). METHODS Our complete-case, intention-to-treat evaluation used national health data (from the Scottish Morbidity Record [SMR] 01, SMR02, and the Child Health Surveillance Programme-Pre School), linking birth records to postnatal hospitalisation and universal health visitor records in Scotland. We considered maternal-infant pairs of all live-singleton births 2 years either side of SBBS introduction (Aug 17, 2015, to Aug 11, 2019). We estimated step-changes and trend-changes in outcomes (hospital admission and self-reported exclusive breastfeeding, tobacco smoke exposure, and infant sleeping position) by week of birth using segmented Poisson regression, adjusting for over-dispersion and seasonality where necessary. FINDINGS The analysis comprised 182 122 maternal-infant pairs. The prevalence of tobacco smoke exposure reduced after SBBS introduction: step decrease of 10% (prevalence ratio 0·904 [95% CI 0·865-0·946]; absolute decrease of 1·6% 1 month post-introduction) for infants and 9% (0·905 [0·862-0·950]; absolute decrease of 1·9% 1 month post-introduction) for the primary carer. There was no evidence of changes in infant and maternal all-cause hospital admissions or infant sleeping position. Among mothers younger than 25 years, there was a 10% step-increase in breastfeeding prevalence (1·095 [1·004-1·195]; absolute increase of 2·2% 1 month post-introduction) at 10 days and 17% (1·174 [1·037-1·328]) at 6-8 weeks postnatal. Although associations were robust to most sensitivity analyses, for smoke exposure associations were only observed early in the postnatal period. INTERPRETATION SBBS reduced infant and primary carer tobacco smoke exposure, and increased breastfeeding among young mothers in Scotland. However, absolute effects were small. FUNDING Medical Research Council, Scottish Government Chief Scientist Office, and National Records of Scotland.
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Affiliation(s)
- Ronan McCabe
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | | | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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16
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Bandyopadhyay A, Whiffen T, Fry R, Brophy S. How does the local area deprivation influence life chances for children in poverty in Wales: A record linkage cohort study. SSM Popul Health 2023; 22:101370. [PMID: 36891499 PMCID: PMC9986621 DOI: 10.1016/j.ssmph.2023.101370] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 02/25/2023] Open
Abstract
Objectives Children growing up in poverty are less likely to achieve in school and more likely to experience mental health problems. This study examined factors in the local area that can help a child overcome the negative impact of poverty. Design A longitudinal record linkage retrospective cohort study. Participants This study included 159,131 children who lived in Wales and completed their age 16 exams (Key Stage 4 (KS4)) between 2009 and 2016. Free School Meal (FSM) provision was used as an indicator of household-level deprivation. Area-level deprivation was measured using the Welsh Index of Multiple Deprivation (WIMD) 2011. An encrypted unique Anonymous Linking Field was used to link the children with their health- and educational records. Outcome measures The outcome variable 'Profile to Leave Poverty' (PLP) was constructed based on successful completion of age 16 exams, no mental health condition, no substance and alcohol misuse records in routine data. Logistic regression with stepwise model selection was used to investigate the association between local area deprivation and the outcome variable. Results 22% of children on FSM achieved PLP compared to 54.9% of non-FSM children. FSM Children from least deprived areas were significantly more likely to achieve PLP (adjusted odds ratio (aOR) - 2.20 (1.93, 2.51)) than FSM children from most deprived areas. FSM children, living in areas with higher community safety, higher relative income, higher access to services, were more likely to achieve PLP than their peers. Conclusion The findings indicate that community-level improvements such as increasing safety, connectivity and employment might help in child's education attainment, mental health and reduce risk taking behaviours.
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Affiliation(s)
- Amrita Bandyopadhyay
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Wales, SA2 8PP, UK.,Administrative Data Research Unit, Swansea University, Wales, SA2 8PP, UK
| | - Tony Whiffen
- Administrative Data Research Unit, Welsh Government, Wales, CF10CF10 3NQ, UK
| | - Richard Fry
- Administrative Data Research Unit, Swansea University, Wales, SA2 8PP, UK.,Health Data Research UK, Swansea University Medical School, Wales, SA2 8PP, UK
| | - Sinead Brophy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Wales, SA2 8PP, UK.,Administrative Data Research Unit, Swansea University, Wales, SA2 8PP, UK.,Health Data Research UK, Swansea University Medical School, Wales, SA2 8PP, UK
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17
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Boccia D, Maritano S, Pizzi C, Richiardi MG, Lioret S, Richiardi L. The impact of income-support interventions on life course risk factors and health outcomes during childhood: a systematic review in high income countries. BMC Public Health 2023; 23:744. [PMID: 37087420 PMCID: PMC10121417 DOI: 10.1186/s12889-023-15595-x] [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: 10/26/2022] [Accepted: 04/04/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND In high income countries one in five children still lives in poverty, which is known to adversely shape the life course health trajectory of these children. However, much less is understood on whether social and fiscal policies have the capacity to reverse this damage, which intervention is likely to be most effective and when these interventions should be delivered to maximise their impact. This systematic review attempts to address these questions by looking at the impact of income-support interventions, delivered during the first 1,000 days of life, on cardiovascular, metabolic, respiratory and mental health outcomes. METHODS The review was restricted to experimental or quasi experimental studies conducted in high income countries. Studies were retrieved from multidisciplinary databases as well as health, economic, social sciences-specific literature browsers. All papers retrieved through the search strategy were double screened at title, abstract and full text stage. Relevant data of the selected studies were extracted and collected in tables, then summarised via narrative synthesis approach. Robustness of findings was assessed by tabulating impact by health outcome, type of intervention and study design. RESULTS Overall, 16 relevant papers were identified, including 15 quasi-experimental studies and one randomized control trial (RCT). Income-support interventions included were unconditional/conditional cash transfers, income tax credit and minimum wage salary policies. Most studies were conducted in United States and Canada. Overall, the evidence suggested limited effect on mental health indicators but a positive, albeit small, effect of most policies on birth weight outcomes. Despite this, according to few studies that tried to extrapolate the results into public health terms, the potential number of negative outcomes averted might be consistent. CONCLUSIONS Income-support interventions can positively affect some of the health outcomes of interest in this review, including birth weight and mental health. Given the large number of people targeted by these programs, one could infer that - despite small - the observed effect may be still relevant at population level. Nonetheless, the limited generalisability of the evidence gathered hampers firm conclusions. For the future, the breadth and scope of this literature need to be broadened to fully exploit the potential of these interventions and understand how their public health impact can be maximised.
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Affiliation(s)
- Delia Boccia
- Faculty of Population and Health Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK
- Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin, Italy
| | - Silvia Maritano
- Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin, Italy.
- University School for Advanced Studies IUSS Pavia, Pavia, Italy.
| | - Costanza Pizzi
- Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin, Italy
| | - Matteo G Richiardi
- Centre for Microsimulation and Policy Analysis, Institute for Social and Economic Research, University of Essex, Colchester, UK
| | | | - Lorenzo Richiardi
- Centre for Microsimulation and Policy Analysis, Institute for Social and Economic Research, University of Essex, Colchester, UK
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18
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Lee AR, Kingdon CC, Davie M, Hawcutt D, Sinha IP. Child poverty and health inequalities in the UK: a guide for paediatricians. Arch Dis Child 2023; 108:94-101. [PMID: 35680401 DOI: 10.1136/archdischild-2021-323671] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/12/2022] [Indexed: 01/24/2023]
Abstract
One in three children in the UK lives in relative poverty. There are clear and consistent links between child poverty and paediatric morbidity and mortality. In this review, we discuss drivers for family poverty in the UK, and how this leads to poor child health outcomes. We present a framework for healthcare professionals and institutions to consider interventions and strategies relating to socioeconomic health inequalities. We will focus on approaches to mitigate the effects of child poverty on children using our services at a local level and outline the importance of healthcare workers advocating for structural and high-level policy change to address the deep-rooted societal problems that cause child poverty.
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Affiliation(s)
- Alice R Lee
- Lab to Life Child Health Applied Data Centre, Department of Innovation, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | | | - Max Davie
- Community Paediatrics, Mary Sheridan Centre, Evelina London Children's Hospital, London, UK
| | - Daniel Hawcutt
- National Institute for Health Research, Alder Hey Clinical Research Facility, Alder Hey Children's Hospital, Liverpool, UK.,Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Ian P Sinha
- Lab to Life Child Health Applied Data Centre, Department of Innovation, Alder Hey Children's NHS Foundation Trust, Liverpool, UK .,University of Liverpool, Liverpool, UK
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19
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Hiam L, Dorling D, McKee M. When experts disagree: interviews with public health experts on health outcomes in the UK 2010-2020. Public Health 2023; 214:96-105. [PMID: 36528937 PMCID: PMC9754903 DOI: 10.1016/j.puhe.2022.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To ascertain the views of public health experts on adverse trends in life expectancy across England and Wales over the past decade, causal factors, possible solutions, and their opinions about how the prepandemic situation influenced the UK's COVID-19 response. STUDY DESIGN Semistructured, in-depth interviews. METHODS Nineteen public health experts were identified by purposeful sampling and invited to take part via e-mail. Sixty-three percent responded and participated (n = 12), six females and six males. Interviews took place via Microsoft Teams between November 2021 and January 2022. Interviews were transcribed and analysed using thematic content analysis. RESULTS There was no consensus on the significance of the stalling and, at some ages, reversal of previous improvements in life expectancy between 2010 and 2020. Explanations offered included data misinterpretation, widening health inequalities, and disinvestment in public services, as well as some disease-specific causes. Those accepting that the decline was concerning linked it to social factors and suggested solutions based on increased investment and implementing existing evidence on how to reduce health inequalities. These interviewees also pointed to the same factors playing a role in the UK's poor COVID-19 response, highlighting the need to understand and address these underlying issues as part of pandemic preparedness. CONCLUSIONS There was no consensus among a group of influential public health experts in the UK on the scale, nature, and explanations of recent trends in life expectancy. A majority called for implementation of existing evidence on reducing inequalities, especially in the wake of COVID-19. However, without agreement on what the problem is, action is likely to remain elusive.
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Affiliation(s)
- Lucinda Hiam
- School of Geography and the Environment, South Parks Road, Oxford OX1 3QY, UK,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK,Corresponding author. School of Geography and the Environment, South Parks Road, Oxford OX1 3QY, UK. Tel.: +44 1865 285070
| | - Danny Dorling
- School of Geography and the Environment, South Parks Road, Oxford OX1 3QY, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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20
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Odd D, Stoianova S, Williams T, Odd D, Kurinczuk JJ, Wolfe I, Luyt K. What is the relationship between deprivation, modifiable factors and childhood deaths: a cohort study using the English National Child MortalityDatabase. BMJ Open 2022; 12:e066214. [PMID: 36600341 PMCID: PMC9743372 DOI: 10.1136/bmjopen-2022-066214] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The aim of this analysis is to identify the patterns of social deprivation and childhood mortality; and identify potential points where public health, social and education interventions, or health policy may be best targeted. DESIGN Decile of deprivation and underlying population distribution was derived using Office for National Statistics data. The risk of death was then derived using a Poisson regression model, calculating the increasing risk of death for each increasing deprivation decile. SETTING England. PARTICIPANTS 2688 deaths before 18 years of age reviewed between April 2019 and March 2020. MAIN OUTCOME MEASURES The relationship between deprivation and risk of death; for deaths with, and without modifiable factors. RESULTS There was evidence of increasing mortality risk with increase in deprivation decile, with children in the least deprived areas having a mortality of 13.25 (11.78-14.86) per 100 000 person-years, compared with 31.14 (29.13-33.25) in the most deprived decile (RR 1.08 (95% CI 1.07 to 1.10)); with the gradient of risk stronger in children who died with modifiable factors than those without (RR 1.12 (95% CI 1.09 to 1.15)) vs (RR 1.07 (95% CI 1.05 to 1.08)). Deprivation subdomains of employment, adult education, barriers to housing and services, and indoor living environments appeared to be the most important predictors of child mortality CONCLUSIONS: There is a clear gradient of increasing child mortality across England as measures of deprivation increase; with a striking finding that this varied little by area, age or other demographic factor. Over one-fifth of all child deaths may be avoided if the most deprived half of the population had the same mortality as the least deprived. Children dying in more deprived areas may have a greater proportion of avoidable deaths. Adult employment, and improvements to housing, may be the most efficient place to target resources to reduce these inequalities.
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Affiliation(s)
- David Odd
- Division of Population Medicine, Cardiff University, Cardiff, UK
- National Child Mortality Database, University of Bristol, Bristol, UK
| | - Sylvia Stoianova
- National Child Mortality Database, University of Bristol, Bristol, UK
| | - Tom Williams
- National Child Mortality Database, University of Bristol, Bristol, UK
| | - Dawn Odd
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | | | - Ingrid Wolfe
- Department of Women's and Children's Health, King's College London, London, UK
| | - Karen Luyt
- National Child Mortality Database, University of Bristol, Bristol, UK
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21
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Johansson N, Sarkadi A, Feldman I, Price AMH, Goldfeld S, Salonen T, Wijk K, Isaksson D, Kolic E, Stenquist S, Elg M, Lönn E, Wennelin J, Lindström L, Medina M, Åberg S, Viklund J, Warner G. Ameliorating Child poverty through Connecting Economic Services with child health Services (ACCESS): study protocol for a randomised controlled trial of the healthier wealthier families model in Sweden. BMC Public Health 2022; 22:2181. [PMID: 36434580 PMCID: PMC9701015 DOI: 10.1186/s12889-022-14424-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Sweden is often held up as an example of a country with low child deprivation; yet, rates of relative deprivation are rising. Every municipality in Sweden is required to provide free, timely and accessible budget and debt counselling under the Social Services Act. The services have been encouraged to perform preventative practice with families; however, this has not been realised. The Healthier Wealthier Families (HWF) model embeds universal screening for economic hardship into child health services and creates a referral pathway to economic support services. Given the universal child health system in Sweden, which is freely available and has excellent coverage of the child population, implementation of the HWF model has potential to support families to access the freely available municipal budget and debt counselling and ultimately improve rates of child deprivation in Sweden. METHODS/DESIGN We will conduct a two-arm randomised waitlist-control superiority trial to examine the effectiveness and cost-effectiveness of the HWF model in the Sweden. A longitudinal follow-up with the cohort will explore whether any effects are maintained in the longer-term. DISCUSSION HWF is a collaborative and sustainable model that could maximise the effectiveness of current services to address child deprivation in Sweden. The study outlined in this protocol is the first effectiveness evaluation of the HWF model in Sweden and is a crucial step before HWF can be recommended for national implementation within the child health services. TRIAL REGISTRATION Clinicaltrials.gov; NCT05511961. Prospectively registered on 23 August 2022. https://clinicaltrials.gov/ct2/show/NCT05511961.
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Affiliation(s)
- Nina Johansson
- grid.8993.b0000 0004 1936 9457Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Sarkadi
- grid.8993.b0000 0004 1936 9457Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Inna Feldman
- grid.8993.b0000 0004 1936 9457Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anna M. H. Price
- grid.416107.50000 0004 0614 0346Centre for Community Child Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC Australia
| | - Sharon Goldfeld
- grid.416107.50000 0004 0614 0346Centre for Community Child Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC Australia
| | - Tapio Salonen
- grid.32995.340000 0000 9961 9487Department of Social Work, Malmö University, Malmö, Sweden
| | - Katarina Wijk
- grid.8993.b0000 0004 1936 9457Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Centre for Research and Development, Uppsala University, Gävle, Region Gävleborg Sweden ,grid.69292.360000 0001 1017 0589Faculty of Health and Occupational Studies, Department of Occupational Health Sciences and Psychology, University of Gavle, Gävle, Sweden
| | - David Isaksson
- grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
| | - Emir Kolic
- Konsument Gästrikland Budget and Debt Counselling Service, Gävle, Sweden
| | - Sara Stenquist
- Konsument Gästrikland Budget and Debt Counselling Service, Gävle, Sweden
| | - Maria Elg
- Sandviken Municipality, Sandviken, Sweden
| | - Ewa Lönn
- Sandviken Municipality, Sandviken, Sweden
| | | | | | | | | | | | - Georgina Warner
- grid.8993.b0000 0004 1936 9457Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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22
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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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23
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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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24
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Voit FAC, Kajantie E, Lemola S, Räikkönen K, Wolke D, Schnitzlein DD. Maternal mental health and adverse birth outcomes. PLoS One 2022; 17:e0272210. [PMID: 36044423 PMCID: PMC9432739 DOI: 10.1371/journal.pone.0272210] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/14/2022] [Indexed: 11/20/2022] Open
Abstract
Recent research in economics emphasizes the role of in utero conditions for the health endowment at birth and in early childhood and for social as well as economic outcomes in later life. This paper analyzes the relation between maternal mental health during pregnancy and birth outcomes of the child. In particular, we analyze the relationship between maternal mental health during pregnancy and the probability of giving birth preterm (PT), having a newborn at low birth weight (LBW) or being small for gestational age (SGA). Based on large population-representative data from the German Socio-Economic Panel (SOEP) and cohort data from the National Educational Panel Study (NEPS), we present extensive descriptive evidence on the relationship between maternal mental health and preterm birth by carrying out OLS estimates controlling for a wide range of socioeconomic characteristics. In addition, we apply matching estimators and mother fixed effects models, which bring us closer toward a causal interpretation of estimates. In summary, the results uniformly provide evidence that poor maternal mental health is a risk factor for preterm birth and low birth weight in offspring. In contrast, we find no evidence for an relationship between maternal mental health and small for gestational age at birth.
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Affiliation(s)
- Falk A. C. Voit
- Institute of Labour Economics, Leibniz Universität Hannover, Hannover, Germany
- * E-mail:
| | - Eero Kajantie
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Clinical and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway
| | - Sakari Lemola
- Fakultät für Psychologie und Sportwissenschaft, Universität Bielefeld, Bielefeld, Germany
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Katri Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Daniel D. Schnitzlein
- Institute of Labour Economics, Leibniz Universität Hannover, Hannover, Germany
- IZA Institute of Labor Economics, Bonn, Germany
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25
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Norman P, Exeter D, Shelton N, Head J, Murray E. (Un-) healthy ageing: Geographic inequalities in disability-free life expectancy in England and Wales. Health Place 2022; 76:102820. [PMID: 35690019 DOI: 10.1016/j.healthplace.2022.102820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/08/2022] [Accepted: 05/03/2022] [Indexed: 11/04/2022]
Abstract
Health expectancies are an indicator of healthy ageing that reflect quantity and quality of life. Using limiting long term illness and mortality prevalence, we calculate disability-free life expectancy for small areas in England and Wales between 1991 and 2011 for males and females aged 50-74, the life stage when people may be changing their occupation from main career to retirement or alternative work activities. We find that inequalities in disability-free life expectancy are deeply entrenched, including former coalfield and ex-industrial areas and that areas of persistent (dis-) advantage, worsening or improving deprivation have health change in line with deprivation change. A mixed health picture for rural and coastal areas requires further investigation as do the demographic processes which underpin these area level health differences.
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Affiliation(s)
- Paul Norman
- School of Geography, University of Leeds, UK.
| | - Dan Exeter
- School of Population Health, University of Auckland, New Zealand
| | - Nicola Shelton
- Research Department of Epidemiology and Public Health, University College London, UK
| | - Jenny Head
- Research Department of Epidemiology and Public Health, University College London, UK
| | - Emily Murray
- Research Department of Epidemiology and Public Health, University College London, UK
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26
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Trinh NT, de Visme S, Cohen JF, Bruckner T, Lelong N, Adnot P, Rozé JC, Blondel B, Goffinet F, Rey G, Ancel PY, Zeitlin J, Chalumeau M. Recent historic increase of infant mortality in France: A time-series analysis, 2001 to 2019. Lancet Reg Health Eur 2022; 16:100339. [PMID: 35252944 PMCID: PMC8891691 DOI: 10.1016/j.lanepe.2022.100339] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The infant mortality rate (IMR) serves as a key indicator of population health. Methods We used data from the French National Institute of Statistics and Economic Studies on births and deaths during the first year of life from 2001 to 2019 to calculate IMR aggregated by month. We ran joinpoint regressions to identify inflection points and assess the linear trend of each segment. Exploratory analyses were performed for overall IMR, as well as by age at death subgroups (early neonatal [D0-D6], late neonatal [D7-27], and post-neonatal [D28-364]), and by sex. We performed sensitivity analyses by excluding deaths at D0 and using other time-series modeling strategies. Results Over the 19-year study period, 53,077 infant deaths occurred, for an average IMR of 3·63/1000 (4·00 in male, 3·25 in female); 24·4% of these deaths occurred during the first day of life and 47·8% during the early neonatal period. Joinpoint analysis identified two inflection points in 2005 and 2012. The IMR decreased sharply from 2001 to 2005 (slope: -0·0167 deaths/1000 live births/month; 95%CI: -0·0219 to -0·0116) and then decreased slowly between 2005 and 2012 (slope: -0·0041; 95%CI: -0·0065 to -0·0016). From 2012 onwards, a significant increase in IMR was observed (slope: 0·0033; 95%CI: 0·0011 to 0·0056). Subgroup analyses indicated that these trends were driven notably by an increase in the early neonatal period. Sensitivity analyses provided consistent results. Interpretation The recent historic increase in IMR since 2012 in France should prompt urgent in-depth investigation to understand the causes and prepare corrective actions. Funding No financial relationships with any organizations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.
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27
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Coughlan CH, Ruzangi J, Neale FK, Nezafat Maldonado B, Blair M, Bottle A, Saxena S, Hargreaves D. Social and ethnic group differences in healthcare use by children aged 0-14 years: a population-based cohort study in England from 2007 to 2017. Arch Dis Child 2022; 107:32-39. [PMID: 34244166 PMCID: PMC8685637 DOI: 10.1136/archdischild-2020-321045] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/20/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe social and ethnic group differences in children's use of healthcare services in England, from 2007 to 2017. DESIGN Population-based retrospective cohort study. SETTING/PATIENTS We performed individual-level linkage of electronic health records from general practices and hospitals in England by creating an open cohort linking data from the Clinical Practice Research Datalink and Hospital Episode Statistics. 1 484 455 children aged 0-14 years were assigned to five composite ethnic groups and five ordered groups based on postcode mapped to index of multiple deprivation. MAIN OUTCOME MEASURES Age-standardised annual general practitioner (GP) consultation, outpatient attendance, emergency department (ED) visit and emergency and elective hospital admission rates per 1000 child-years. RESULTS In 2016/2017, children from the most deprived group had fewer GP consultations (1765 vs 1854 per 1000 child-years) and outpatient attendances than children in the least deprived group (705 vs 741 per 1000 child-years). At the end of the study period, children from the most deprived group had more ED visits (447 vs 314 per 1000 child-years) and emergency admissions (100 vs 76 per 1000 child-years) than children from the least deprived group.In 2016/2017, children from black and Asian ethnic groups had more GP consultations than children from white ethnic groups (1961 and 2397 vs 1824 per 1000 child-years, respectively). However, outpatient attendances were lower in children from black ethnic groups than in children from white ethnic groups (732 vs 809 per 1000 child-years). By 2016/2017, there were no differences in outpatient, ED and in-patient activity between children from white and Asian ethnic groups. CONCLUSIONS Between 2007 and 2017, children living in more deprived areas of England made greater use of emergency services and received less scheduled care than children from affluent neighbourhoods. Children from Asian and black ethnic groups continued to consult GPs more frequently than children from white ethnic groups, though black children had significantly lower outpatient attendance rates than white children across the study period. Our findings suggest substantial levels of unmet need among children living in socioeconomically disadvantaged areas. Further work is needed to determine if healthcare utilisation among children from Asian and black ethnic groups is proportionate to need.
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Affiliation(s)
- Charles Hamish Coughlan
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Judith Ruzangi
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Francesca K Neale
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Behrouz Nezafat Maldonado
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Mitch Blair
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Alex Bottle
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Sonia Saxena
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Dougal Hargreaves
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
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28
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Mueller JT. The Poverty Balancing Equation: Expressing Poverty of Place as a Population Process. Demography 2021; 58:2065-2088. [PMID: 34596211 DOI: 10.1215/00703370-9530075] [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: 11/19/2022]
Abstract
The accurate measurement of poverty is essential for the development of effective poverty policy. Unfortunately, approaches that use poverty rates to assess the causes and consequences of poverty do not fully capture the components of change in the poverty population because changes in the conventional poverty rate can occur owing to processes of natural increase, migration, or transitions in and out of poverty. This article presents an accounting framework for changes in poverty within and between places. The framework, termed the poverty balancing equation, generates a series of summary statistics that can be used in place of the conventional poverty rate in future research. The approach is demonstrated using the 2014 panel of the Survey of Income and Program Participation to generate state-level estimates of the poverty components of change for three states in the American South between January and December of 2013. Results show that even when poverty rates remain constant, there is significant dynamism within poor and nonpoor populations. By applying this approach, either completely or in part, researchers can provide more specific and actionable evidence for poverty alleviation policy.
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Affiliation(s)
- J Tom Mueller
- Department of Geography and Environmental Sustainability, University of Oklahoma, Norman, OK, USA
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29
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Wickham S, Fancourt D. Perspective Commentary: The Implementation of Welfare Policies Are Not Held to the Same Ethical Standards as Research: Raising Intergenerational Health Inequality Concerns. Front Public Health 2021; 9:764559. [PMID: 34888286 PMCID: PMC8650605 DOI: 10.3389/fpubh.2021.764559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Over the last 12 years the United Kingdom (UK) has seen the introduction of an austerity programme-a fiscal policy-with the primary goal to reduce the government's budget deficit and the role of the welfare system. Between 2010 and 2015 there was an estimated reduction of £14.5 billion in spending, attributable to decreasing the value of benefits and restricting entitlement to benefit claimants. By 2020, there had been an estimated unprecedented £27 billion less spent on welfare compared with spending in 2010. Whilst fiscally-successful at reducing spending, some implemented welfare policies have had direct consequences for people's health, increasing inequalities which have been heavily criticized. Moreover, there is growing concern that this has an intergenerational effect. In this paper, we describe the ethical principles in human research, how these have been considered in public health policy, and the existing evidence of the direct and intergenerational health and welfare consequences of some recent, nationally-implemented welfare policies. We argue that ethical principles, specifically the ethical principle of safety that is applied in all research, should be applied to all public welfare policies to stop the rising inequalities in health we are seeing across generations. We highlight that initial changes implemented to welfare policies as a response to COVID-19 demonstrate that there can be a political and societal perceived value in going further to support individuals and their families during times of adversity, and consider the ethical implications of this.
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Affiliation(s)
- Sophie Wickham
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Daisy Fancourt
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
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30
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Brown H, Jesurasa A, Bambra C, Rankin J, McNaughton A, Heslehurst N. Assessing the relationship between adverse pregnancy outcomes and area-level deprivation in Wales 2014-2019: a national population-based cross-sectional study. BMJ Open 2021; 11:e052330. [PMID: 34789495 PMCID: PMC8601077 DOI: 10.1136/bmjopen-2021-052330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the relationship between deciles of area-level deprivation and seven adverse pregnancy outcomes in Wales. DESIGN Cross-sectional analysis. SETTING 64 699 live births in Wales from 31 March 2014 to 16 September 2019. PRIMARY OUTCOME VARIABLE We examined each of the following seven adverse pregnancy outcomes: (1) small for gestational age (SGA); (2) large for gestational age; (3) preterm birth; (4) third-degree or fourth-degree perineal tear; (5) major postpartum haemorrhage (MPPH); (6) a lower Apgar score at 5 min and (7) emergency caesarean section. RESULTS There was no significant association between increasing aggregate measures of area-level deprivation and the adverse pregnancy outcomes we studied. Women living in an area with greater access to services are more likely to have a baby that is SGA (1.27, 95% CI 1.11 to 1.49), have a greater likelihood of a perineal tear (1.74, 95% CI 1.15 to 2.61), are significantly less likely to have MPPH (0.79, 95% CI 0.64 to 0.96), have a baby with an Apgar score of 0.26 higher (95% CI 0.22 to 0.29) and are significantly less likely to have an emergency caesarean section (0.81, 95% CI 0.73 to 0.88). Women living in areas with higher employment (0.26, 95% CI 0.19 to 0.36) and better health (0.26, 95% CI 0.19 to 0.35) were less likely to experience perineal tear. CONCLUSIONS There was no clear social-spatial gradient in area-level deprivation and adverse pregnancy outcomes. We found a stronger association for individual-level behavioural risk factors than area-level factors. These findings support the benefits that accessible and holistic person-centred care may bring through addressing individual behavioural risk factors. There is a need for improved data completeness and further individual-level data on risk factors such as employment and income to better understand the role which may be played by population-level policies and their pathways to affecting outcomes.
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Affiliation(s)
- Heather Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Clare Bambra
- Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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31
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Marques C, Johansen IC. Health and household surveys in Brazil and England: The National Health Survey and the Health Survey for England. CIENCIA & SAUDE COLETIVA 2021; 26:3943-3954. [PMID: 34586250 DOI: 10.1590/1413-81232021269.02942021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 11/22/2022] Open
Abstract
This paper aims to analyze the characteristics of national health surveys conducted in Brazil and England by their respective Statistics institutes. For Brazil, the National Health Survey (PNS) was considered, and the Health Survey for England (HSE) for England. To this end, we show a preliminary overview of the different population profiles of the two countries. Then, a brief historical background is presented, including the common themes that are addressed in the PNS and HSE that favor comparative analyses. Finally, we compared, for example, the inequalities in access to and use of Brazilian and English health services. The results show several possibilities for comparative analysis on topics such as health perception, tobacco use, alcohol consumption, diabetes, and hypertension. However, the need to consider the specificities of the population profile of each country and the methodological characteristics of the surveys is emphasized.
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Affiliation(s)
- César Marques
- Escola Nacional de Ciências Estatísticas. R. André Cavalcanti 106, Centro. 20231-050 Rio de Janeiro RJ Brasil.
| | - Igor Cavallini Johansen
- Núcleo de Estudos e Pesquisas Ambientais, Universidade Estadual de Campinas. Campinas SP Brasil
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32
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Nath S, Hardelid P, Zylbersztejn A. Are infant mortality rates increasing in England? The effect of extreme prematurity and early neonatal deaths. J Public Health (Oxf) 2021; 43:541-550. [PMID: 32119086 PMCID: PMC8458015 DOI: 10.1093/pubmed/fdaa025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/31/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Infant mortality has been rising in England since 2014. We examined potential drivers of these trends. METHODS We used aggregate data on all live births, stillbirths and linked infant deaths in England in 2006-2016 from the Office for National Statistics. We compared trends in infant mortality rates overall, excluding births at <24 weeks of gestation, by quintile of SES and gestational age. RESULTS Infant mortality decreased from 4.78 deaths/1000 live births in 2006 to 3.54/1000 in 2014 (annual decrease of 0.15/1000) and increased to 3.67/1000 in 2016 (annual increase of 0.07/1000). This rise was driven by increases in deaths at 0-6 days of life. After excluding infants born at <24 weeks of gestation, infant mortality continued to decrease after 2014. The risk of infant death was 94% higher in the most versus least deprived SES quintile, which reduced to a 55% higher risk after adjusting for gestational age. CONCLUSIONS The observed increase in infant mortality rates since 2014 is wholly explained by an increasing number of deaths at 0-6 days of age among babies born at <24 weeks of gestation. Policies focused on improving maternal health to reduce preterm birth could substantially reduce the socio-economic gap in infant survival.
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Affiliation(s)
- Selina Nath
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Pia Hardelid
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Ania Zylbersztejn
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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33
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Satherley RM, Wolfe I, Lingam R. Experiences of healthcare for mothers of children with ongoing illness, living in deprived neighbourhoods health and place. Health Place 2021; 71:102661. [PMID: 34492455 DOI: 10.1016/j.healthplace.2021.102661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE While the association between socioeconomic deprivation and children's poor health is clear, the complex pathways linking socioeconomic deprivation with access to care and health inequalities are less well understood. This analysis sought to understand the root cause of these inequalities by exploring how mothers living in deprived neighborhoods support their sick children, and their experiences with primary care. METHODS Interview transcripts from eight mothers, living in socioeconomically deprived neighborhoods, were analyzed using interpretative phenomenological analysis. RESULTS Participants described their experiences in three distinct themes. Each theme highlights the importance of the mother's agency, voice, and power in supporting their child's health, and the crucial role played by the health system in addressing, maintaining, or reinforcing health inequalities. Participants used several strategies to address these health inequalities, which included fighting against the health system, using past experiences to explain health needs, and support from friends and family. CONCLUSION Although the health system is an essential resource to support families, encounters with primary care may fail to address health inequalities and may therefore exacerbate existing health inequalities for families living in deprived neighborhoods, irrespective of health system financing and ability to pay.
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Affiliation(s)
- Rose-Marie Satherley
- Department of Psychological Interventions, University of Surrey, Guilford, England, UK.
| | - Ingrid Wolfe
- Department of Women's and Children's Health, King's College London, London, England, UK.
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women & Children's Health, University of New South Wales, Sydney, Australia.
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34
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Katikireddi SV, Hainey KJ, Beale S. The impact of COVID-19 on different population subgroups: ethnic, gender and age-related disadvantage. J R Coll Physicians Edinb 2021; 51:S40-S46. [PMID: 34185037 DOI: 10.4997/jrcpe.2021.240] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Against a background of stalling UK life expectancy, the COVID-19 pandemic is a major crisis for public health with impacts differing markedly by ethnicity, gender, and age. Direct health impacts include mortality and long-term harms among survivors. Social disruption and lockdown measures arising from uncontrolled infection have destabilised healthcare and other essential services. The economic crisis resulting from the pandemic is already triggering job losses, which will in turn have their own adverse health effects. These myriad impacts of the pandemic are not affecting everyone equally. Ethnic minorities, men and older people have disproportionately suffered from COVID-19, including their risk of mortality. However, some indirect impacts - including those on mental health and employment - are more likely to affect women and younger people. The health consequences of the pandemic will affect the lives of people in the UK for decades.
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Affiliation(s)
- Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow G3 7HR, UK,
| | - Kirsten Jane Hainey
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London
| | - Sarah Beale
- UCL Research Department of Epidemiology & Public Health, University College London, London
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Harpur A, Minton J, Ramsay J, McCartney G, Fenton L, Campbell H, Wood R. Trends in infant mortality and stillbirth rates in Scotland by socio-economic position, 2000-2018: a longitudinal ecological study. BMC Public Health 2021; 21:995. [PMID: 34044796 PMCID: PMC8155799 DOI: 10.1186/s12889-021-10928-0] [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: 02/21/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As Scotland strives to become a country where children flourish in their early years, it is faced with the challenge of socio-economic health inequalities, which are at risk of widening amidst austerity policies. The aim of this study was to explore trends in infant mortality rates (IMR) and stillbirth rates by socio-economic position (SEP) in Scotland, between 2000 and 2018, inclusive. METHODS Data for live births, infant deaths, and stillbirths between 2000 and 2018 were obtained from National Records of Scotland. Annual IMR and stillbirth rates were calculated and visualised for all of Scotland and when stratified by SEP. Negative binomial regression models were used to estimate the association between SEP and infant mortality and stillbirth events, and to assess for break points in trends over time. The slope (SII) and relative (RII) index of inequality compared absolute and relative socio-economic inequalities in IMR and stillbirth rates before and after 2010. RESULTS IMR fell from 5.7 to 3.2 deaths per 1000 live births between 2000 and 2018, with no change in trend identified. Stillbirth rates were relatively static between 2000 and 2008 but experienced accelerated reduction from 2009 onwards. When stratified by SEP, inequalities in IMR and stillbirth rates persisted throughout the study and were greatest amongst the sub-group of post-neonates. Although comparison of the SII and RII in IMR and stillbirths before and after 2010 suggested that inequalities remained stable, descriptive trends in mortality rates displayed a 3-year rise in the most deprived quintiles from 2016 onwards. CONCLUSION Whilst Scotland has experienced downward trends in IMR and stillbirth rates between 2000 and 2018, the persistence of socio-economic inequalities and suggestion that mortality rates amongst the most deprived groups may be worsening warrants further action to improve maternal health and strengthen support for families with young children.
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Affiliation(s)
- Alice Harpur
- The Usher Institute, The University of Edinburgh, Edinburgh, UK. .,Department of Public Health NHS Lothian, Edinburgh, UK.
| | | | | | | | | | - Harry Campbell
- The Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Rachael Wood
- The Usher Institute, The University of Edinburgh, Edinburgh, UK.,Public Health Scotland, Glasgow, UK
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Valek A, Vitrai J, Erdei L, Branyiczkiné Géczy G, Pászthy B, Szabó A, Szabó M. Investigation of possible causes of increase in Hungarian infant mortality in 2019. Orv Hetil 2021; 162:830-838. [PMID: 34023815 DOI: 10.1556/650.2021.32092] [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: 10/22/2020] [Accepted: 01/08/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: Magyarországon a csecsemőhalandóság 2014 óta folyamatosan javult, azonban 2019-ben az előző évi adathoz képest 11%-kal magasabb érték mutatkozott. Célkitűzés: A vizsgálat célja a 2019. évi kedvezőtlenebb csecsemőhalálozási mutató lehetséges összetevőinek feltárása. Módszer: A 2018. és 2019. évi csecsemőhalálozási adatokat hasonlítottuk össze a csecsemő kora, a halál oka és a gyógyintézeti, illetve nem gyógyintézeti elhalálozás szerint. A vizsgálathoz a Központi Statisztikai Hivatal adatait használtuk. A trendvizsgálatnál 2010-től elemeztük az adatokat. A nem gyógyintézeti haláleseteket 10 évre összevonva járásonként térképesen ábrázoltuk. Eredmények: 2018-ban 304, 2019-ben 335 csecsemő halt meg Magyarországon, a csecsemőhalálozási arányszám 3,4 ezrelékről 3,8 ezrelékre emelkedett. A 2019. évi érték az előző évtizedek trendjére illesztett görbe alapján megfelelt a várható értéknek. 2019-ben a 0-27 napos csecsemőhalálozás alig változott a 2018. évihez képest, a 28-364 napos korban bekövetkezett halálesetek száma viszont növekedett. A vizsgált évben 59%-kal emelkedett a nem gyógyintézeti csecsemőhalálozás. A 2019. évi csecsemőhalálozás növekedéséért 74%-ban a nem gyógyintézeti esetek voltak felelősek. A nem gyógyintézeti halálozás döntő többsége késői csecsemőkorban következett be. A járásonkénti, 10 évre összevont, nem intézményben elhunyt csecsemők számában és 1000 élve születésre vonatkozó arányában ötszörös területi különbségek mutatkoztak. A halálokok közül a perinatalis szakban keletkező bizonyos állapotok miatt meghalt csecsemők száma emelkedett a leginkább, a nem gyógyintézeti halálozás esetében pedig a hirtelen csecsemőhalál szindrómában meghaltaké. Következtetés: 2019-ben kiugróan magas volt a nem gyógyintézeti, késői csecsemőhalálozás száma és részaránya, ezen esetek feltűnő regionális halmozódást mutattak. A csecsemőhalandóság csökkentésének hatásos eszköze lehetne a jövőben minden egyes csecsemőhalál részletes szakmai értékelése. Orv Hetil. 2021; 162(1): 830-838. SUMMARY INTRODUCTION In Hungary, infant mortality has been steadily declining since 2014, but in 2019 it increased by 11% compared to 2018. OBJECTIVE The aim of our study is to explore the possible components of the above increase. METHOD Ten-year trends of infant mortality were analized and compared by age, cause, place of deaths (hospital or non-hospital environment) and location, using Central Statistical Office data. RESULTS There were 304 infant deaths in Hungary in 2018 and 335 in 2019. Infant mortality rate rose from 3.4‰ to 3.8‰, however, it was in line with the expected value based on the curve fitted to the trend of previous decades. In 2019, 0-27-day infant mortality basically did not change compared to 2018, while the number of deaths at 28-364 days of age increased. Non-hospital infant mortality increased by 59% in 2019 and these cases accounted for 74% of the total increase in infant mortality; the vast majority of these deaths occurred in late infancy. There were fivefold regional differences in the number of non-hospital infant deaths. Among the causes of death, the conditions related to the perinatal period and sudden infant death syndrome increased the most. CONCLUSION In Hungary, the number and proportion of non-hospital infant mortality was remarkably high in 2019 compared to previous years. These cases showed a striking regional accumulation. An effective tool for reducing infant mortality could be an appropriate professional assessment of each infant death in the future. Orv Hetil. 2021; 162(21): 830-838.
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Affiliation(s)
- Andrea Valek
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Gyermekgyógyászati Klinika, Neonatológiai Tanszéki Csoport, Budapest, Bókay u. 53., 1083
| | | | - Lilla Erdei
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Gyermekgyógyászati Klinika, Neonatológiai Tanszéki Csoport, Budapest, Bókay u. 53., 1083
| | | | - Bea Pászthy
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Gyermekgyógyászati Klinika, Budapest
| | - Attila Szabó
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Gyermekgyógyászati Klinika, Budapest
| | - Miklós Szabó
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Gyermekgyógyászati Klinika, Neonatológiai Tanszéki Csoport, Budapest, Bókay u. 53., 1083
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McKee M, Dunnell K, Anderson M, Brayne C, Charlesworth A, Johnston-Webber C, Knapp M, McGuire A, Newton JN, Taylor D, Watt RG. The changing health needs of the UK population. Lancet 2021; 397:1979-1991. [PMID: 33965065 PMCID: PMC9751760 DOI: 10.1016/s0140-6736(21)00229-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/22/2020] [Accepted: 01/07/2021] [Indexed: 12/23/2022]
Abstract
The demographics of the UK population are changing and so is the need for health care. In this Health Policy, we explore the current health of the population, the changing health needs, and future threats to health. Relative to other high-income countries, the UK is lagging on many health outcomes, such as life expectancy and infant mortality, and there is a growing burden of mental illness. Successes exist, such as the striking improvements in oral health, but inequalities in health persist as well. The growth of the ageing population relative to the working-age population, the rise of multimorbidity, and persistent health inequalities, particularly for preventable illness, are all issues that the National Health Service (NHS) will face in the years to come. Meeting the challenges of the future will require an increased focus on health promotion and disease prevention, involving a more concerted effort to understand and tackle the multiple social, environmental, and economic factors that lie at the heart of health inequalities. The immediate priority of the NHS will be to mitigate the wider and long-term health consequences of the COVID-19 pandemic, but it must also strengthen its resilience to reduce the impact of other threats to health, such as the UK leaving the EU, climate change, and antimicrobial resistance.
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Affiliation(s)
- Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Michael Anderson
- Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Anita Charlesworth
- The Health Foundation, London, UK; College of Social Sciences, Health Services Management Centre, University of Birmingham, Birmingham, UK
| | | | - Martin Knapp
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Alistair McGuire
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - David Taylor
- UCL School of Pharmacy, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
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38
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FitzRoy FR, Nolan MA. Income Status and Life Satisfaction. JOURNAL OF HAPPINESS STUDIES 2021; 23:233-256. [PMID: 33994845 PMCID: PMC8110693 DOI: 10.1007/s10902-021-00397-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
The importance of both income rank and relative income, as indicators of status, has long been recognised in the literature on life satisfaction and happiness. Recently, several authors have made explicit comparisons of the relative importance of these two measures of income status, and concluded that rank dominates to the extent that reference income becomes insignificant in regressions including both these explanatory variables, and that even absolute or household income, otherwise always positively related to happiness, may lose statistical significance. Here we test this hypothesis with a large UK panel (British Household Panel Survey and Understanding Society) for 1996-2017, split by age and retirement status, and find, contrary to previous results, that rank, household income and reference income are all usually important explanatory variables, but with significant differences between subgroups. This finding holds when rank is in its often-used relative form, and also with absolute rank.
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39
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Cheung R, Shah R, McKeown R, Viner RM. State of child health: how is the UK doing? Arch Dis Child 2021; 106:313-314. [PMID: 32444446 DOI: 10.1136/archdischild-2020-319367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Ronny Cheung
- General Paediatrics, Evelina London Children's Hospital, London, UK
| | - Rakhee Shah
- Community Paediatrics, Chelsea and Westminster Hospital NHS Foundation Trust, London, London, UK
| | - Rachael McKeown
- Health Policy, Royal College of Paediatrics and Child Health, London, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Institute of Child Health, London, UK.,Royal College of Paediatrics and Child Health, London, London, UK
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Thomson K, Moffat M, Arisa O, Jesurasa A, Richmond C, Odeniyi A, Bambra C, Rankin J, Brown H, Bishop J, Wing S, McNaughton A, Heslehurst N. Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis. BMJ Open 2021; 11:e042753. [PMID: 33722867 PMCID: PMC7959237 DOI: 10.1136/bmjopen-2020-042753] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE There has been an unprecedented rise in infant mortality associated with deprivation in recent years in the United Kingdom (UK) and Republic of Ireland. A healthy pregnancy can have significant impacts on the life chances of children. The objective of this review was to understand the association between individual-level and household-level measures of socioeconomic status and adverse pregnancy outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES Nine databases were searched (Medline, Embase, Scopus, ASSIA, CINAHL, PsycINFO, BNI, MIDRIS and Google Scholar) for articles published between 1999 and August 2019. Grey literature searches were also assessed. STUDY SELECTION CRITERIA Studies reporting associations between individual-level or household socioeconomic factors on pregnancy outcomes in the UK or Ireland. RESULTS Among the 82 353 search results, 53 821 titles were identified and 35 unique studies met the eligibility criteria. Outcomes reported were neonatal, perinatal and maternal mortality, preterm birth, birth weight and mode of delivery. Pooled effect sizes were calculated using random-effects meta-analysis. There were significantly increased odds of women from lower levels of occupation/social classes compared with the highest level having stillbirth (OR 1.40, 95% CI 1.23 to 1.59, I298.62%), neonatal mortality (OR 1.39, 95% CI 1.22 to 1.57, I297.09%), perinatal mortality (OR 1.39, 95% CI 1.23 to 1.57, I298.69%), preterm birth (OR 1.41, 95% CI 1.33 to 1.50, I270.97%) and low birth weight (OR 1.40, 95% CI 1.19 to 1.61, I299.85%). Limitations relate to available data, unmeasured confounders and the small number of studies for some outcomes. CONCLUSIONS This review identified consistent evidence that lower occupational status, especially manual occupations and unemployment, were significantly associated with increased risk of multiple adverse pregnancy outcomes. Strategies to improve pregnancy outcomes should incorporate approaches that address wider determinants of health to provide women and families with the best chances of having a healthy pregnancy and baby and to decrease pregnancy-related health inequalities in the general population. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019140893.
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Affiliation(s)
- Katie Thomson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Malcolm Moffat
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Oluwatomi Arisa
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Catherine Richmond
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Adefisayo Odeniyi
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Heather Brown
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Julie Bishop
- Health Improvement Division, Public Health Wales, Cardiff, UK
| | - Susan Wing
- Health Improvement Division, Public Health Wales, Cardiff, UK
| | - Amy McNaughton
- Health Improvement Division, Public Health Wales, Cardiff, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
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Jessiman PE, Powell K, Williams P, Fairbrother H, Crowder M, Williams JG, Kipping R. A systems map of the determinants of child health inequalities in England at the local level. PLoS One 2021; 16:e0245577. [PMID: 33577596 PMCID: PMC7880458 DOI: 10.1371/journal.pone.0245577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/05/2021] [Indexed: 12/03/2022] Open
Abstract
Children and young people in the UK have worse health outcomes than in many similar western countries and child health inequalities are persistent and increasing. Systems thinking has emerged as a promising approach to addressing complex public health issues. We report on a systems approach to mapping the determinants of child health inequalities at the local level in England for young people aged 0-25, and describe the resulting map. Qualitative group concept mapping workshops were held in two contrasting English local authorities with a range of stakeholders: professionals (N = 35); children and young people (N = 33) and carers (N = 5). Initial area maps were developed, and augmented using data from qualitative interviews with professionals (N = 16). The resulting local maps were reviewed and validated by expert stakeholders in each area (N = 9; N = 35). Commonalities between two area-specific system maps (and removal of locality-specific factors) were used to develop a map that could be applied in any English local area. Two rounds of online survey (N = 21; N = 8) experts in public health, local governance and systems science refined the final system map displaying the determinants of child health inequalities. The process created a map of over 150 factors influencing inequalities in health outcomes for children aged 0-25 years at the local area level. The system map has six domains; physical environment, governance, economic, social, service, and personal. To our knowledge this is the first study taking a systems approach to addressing inequalities across all aspects of child health. The study shows how group concept mapping can support systems thinking at the local level. The resulting system map illustrates the complexity of factors influencing child health inequalities, and it may be a useful tool in demonstrating to stakeholders the importance of policies that tackle the systemic drivers of child health inequalities beyond those traditionally associated with public health.
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Affiliation(s)
- Patricia E. Jessiman
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Katie Powell
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Philippa Williams
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Hannah Fairbrother
- Health Sciences School, University of Sheffield, Sheffield, United Kingdom
| | - Mary Crowder
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Joanna G. Williams
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Ruth Kipping
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Bambra C, Albani V, Franklin P. COVID-19 and the gender health paradox. Scand J Public Health 2021; 49:17-26. [PMID: 33308006 PMCID: PMC7859577 DOI: 10.1177/1403494820975604] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/28/2020] [Accepted: 10/29/2020] [Indexed: 01/05/2023]
Abstract
This article examines gender-based health inequalities arising from the COVID-19 pandemic by drawing on insights from research into the 'gender health paradox'. Decades of international research shows that, across Europe, men have shorter life expectancies and higher mortality rates than women, and yet, women report higher morbidity. These gender-based health inequalities also appear to be evident within the pandemic and its aftermath. The article starts by providing an overview of the 'gender health paradox' and the biological, social, economic and political explanations for it. It then outlines the international estimates of gender-based inequalities in COVID-19 morbidity and mortality rates - where emerging data suggests that women are more likely to be diagnosed with COVID-19 but that men have a higher mortality rate. It then explores the longer term consequences for gender-based health inequalities of the aftermath of the COVID-19 pandemic, focusing on the impacts of government policy responses and the emerging economic crisis, suggesting that this might lead to increased mortality amongst men and increased morbidity amongst women. The essay concludes by reflecting on the pathways shaping gender-based health inequalities in the COVID-19 pandemic and the responses needed to ensure that it does not exacerbate gender-based health inequalities into the future.
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Affiliation(s)
- Clare Bambra
- Population Health Sciences Institute,
Newcastle University, UK
| | - Viviana Albani
- Population Health Sciences Institute,
Newcastle University, UK
| | - Paula Franklin
- Population Health Sciences Institute,
Newcastle University, UK
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43
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Bennett DL, Mason KE, Schlüter DK, Wickham S, Lai ET, Alexiou A, Barr B, Taylor-Robinson D. Trends in inequalities in Children Looked After in England between 2004 and 2019: a local area ecological analysis. BMJ Open 2020; 10:e041774. [PMID: 33234654 PMCID: PMC7684833 DOI: 10.1136/bmjopen-2020-041774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To assess trends in inequalities in Children Looked After (CLA) in England between 2004 and 2019, after controlling for unemployment, a marker of recession and risk factor for child maltreatment. DESIGN Longitudinal local area ecological analysis. SETTING 150 English upper-tier local authorities. PARTICIPANTS Children under the age of 18 years. PRIMARY OUTCOME MEASURE The annual age-standardised rate of children starting to be looked after (CLA rate) across English local authorities, grouped into quintiles based on their level of income deprivation. Slope indices of inequality were estimated using longitudinal segmented mixed-effects models, controlling for unemployment. RESULTS Since 2008, there has been a precipitous rise in CLA rates and a marked widening of inequalities. Unemployment was associated with rising CLA rates: for each percentage point increase in unemployment rate, an estimated additional 9 children per 100 000 per year (95% CI 6 to 11) became looked after the following year. However, inequalities increased independently of the effect of unemployment. Between 2007 and 2019, after controlling for unemployment, the gap between the most and least deprived areas increased by 15 children per 100 000 per year (95% CI 4 to 26) relative to the 2004-2006 trend. CONCLUSIONS The dramatic increase in the rate of children starting to be looked after has been greater in poorer areas and in areas more deeply affected by recession. But trends in unemployment do not explain the decade-long rise in inequalities, suggesting that other socioeconomic factors, including rising child poverty and reduced spending on children's services, may be fuelling inequalities. Policies to safely reduce the CLA rate should urgently address the social determinants of child health and well-being.
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Affiliation(s)
- Davara Lee Bennett
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Kate E Mason
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Daniela K Schlüter
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - S Wickham
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Eric Tc Lai
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Alexandros Alexiou
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Ben Barr
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
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Walsh D, McCartney G, Minton J, Parkinson J, Shipton D, Whyte B. Changing mortality trends in countries and cities of the UK: a population-based trend analysis. BMJ Open 2020; 10:e038135. [PMID: 33154048 PMCID: PMC7646340 DOI: 10.1136/bmjopen-2020-038135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Previously improving life expectancy and all-cause mortality in the UK has stalled since the early 2010s. National analyses have demonstrated changes in mortality rates for most age groups and causes of death, and with deprived populations most affected. The aims here were to establish whether similar changes have occurred across different parts of the UK (countries, cities), and to examine cause-specific trends in more detail. DESIGN Population-based trend analysis. PARTICIPANTS/SETTING Whole populations of countries and selected cities of the UK. PRIMARY AND SECONDARY OUTCOME MEASURES European age-standardised mortality rates (calculated by cause of death, country, city, year (1981-2017), age group, sex and-for all countries and Scottish cities-deprivation quintiles); changes in rates between 5-year periods; summary measures of both relative (relative index of inequality) and absolute (slope index of inequality) inequalities. RESULTS Changes in mortality from around 2011/2013 were observed throughout the UK for all adult age groups. For example, all-age female rates decreased by approximately 4%-6% during the 1980s and 1990s, approximately 7%-9% during the 2000s, but by <1% between 2011/2013 and 2015/2017. Equivalent figures for men were 4%-7%, 8%-12% and 1%-3%, respectively. This later period saw increased mortality among the most deprived populations, something observed in all countries and cities analysed, and for most causes of death: absolute and relative inequalities therefore increased. Although similar trends were seen across all parts of the UK, particular issues apply in Scotland, for example, higher and increasing drug-related mortality (with the highest rates observed in Dundee and Glasgow). CONCLUSIONS The study presents further evidence of changing mortality in the UK. The timing, geography and socioeconomic gradients associated with the changes appear to support suggestions that they may result, at least in part, from UK Government 'austerity' measures which have disproportionately affected the poorest.
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Affiliation(s)
- David Walsh
- Glasgow Centre for Population Health, Glasgow, Scotland, UK
| | | | - Jon Minton
- Public Health Scotland, Glasgow, Scotland, UK
| | | | | | - Bruce Whyte
- Glasgow Centre for Population Health, Glasgow, Scotland, UK
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Frank J, Abel T, Campostrini S, Cook S, Lin VK, McQueen DV. The Social Determinants of Health: Time to Re-Think? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5856. [PMID: 32806743 PMCID: PMC7459980 DOI: 10.3390/ijerph17165856] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022]
Abstract
Twelve years have now passed since the influential WHO Report on the Social Determinants of Health (SDoH) in 2008. A group of senior international public health scholars and decision-makers met in Italy in mid-2019 to review the legacy of the SDoH conceptual framework and its adequacy for the many challenges facing our field as we enter the 2020s. Four major categories of challenges were identified: emerging "exogenous" challenges to global health equity, challenges related to weak policy and practice implementation, more fundamental challenges related to SDoH theory and research, and broader issues around modern research in general. Each of these categories is discussed, and potential solutions offered. We conclude that although the SDoH framework is still a worthy core platform for public health research, policy, and practice, the time is ripe for significant evolution.
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Affiliation(s)
- John Frank
- Director of Knowledge Exchange and Research Impact, Usher Institute, University of Edinburgh, Room 1-308, Doorway #1, Teviot Hall, Teviot Place, Edinburgh EH8 9AG, UK
| | - Thomas Abel
- ISPM, University of Bern, 3012 Bern, Switzerland; (T.A.); (D.V.M.)
| | - Stefano Campostrini
- Department of Economics, University Ca’ Foscari Venice, 30121 Venice, Italy;
| | - Sarah Cook
- Director, Institute for Global Development, University of New South Wales, John Goodsell Building, Sydney, NSW 2052, Australia;
| | - Vivian K. Lin
- Executive Associate Dean, Faculty of Medicine, University of Hong Kong, Hong Kong, China;
| | - David V. McQueen
- ISPM, University of Bern, 3012 Bern, Switzerland; (T.A.); (D.V.M.)
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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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Bambra C, Riordan R, Ford J, Matthews F. The COVID-19 pandemic and health inequalities. J Epidemiol Community Health 2020; 74:964-968. [PMID: 32535550 PMCID: PMC7298201 DOI: 10.1136/jech-2020-214401] [Citation(s) in RCA: 621] [Impact Index Per Article: 155.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 11/20/2022]
Abstract
This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics—drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a syndemicpandemic. It then explores the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generations.
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Affiliation(s)
- Clare Bambra
- Population Health Sciences Institute, Newcastle University Institute for Health and Society, Newcastle upon Tyne, UK
| | - Ryan Riordan
- School of Clinical Medicine, Cambridge University, Cambridge, UK
| | - John Ford
- School of Clinical Medicine, Cambridge University, Cambridge, UK
| | - Fiona Matthews
- Population Health Sciences Institute, Newcastle University Institute for Health and Society, Newcastle upon Tyne, UK
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Rajmil L, Hjern A, Spencer N, Taylor-Robinson D, Gunnlaugsson G, Raat H. Austerity policy and child health in European countries: a systematic literature review. BMC Public Health 2020; 20:564. [PMID: 32423441 PMCID: PMC7236143 DOI: 10.1186/s12889-020-08732-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/19/2020] [Indexed: 01/17/2023] Open
Abstract
Background To analyse the impact of austerity measures taken by European governments as a response to the 2008 economic and financial crisis on social determinants on child health (SDCH), and child health outcomes (CHO). Methods A systematic literature review was carried out in Medline (Ovid), Embase, Web of Science, PsycInfo, and Sociological abstracts in the last 5 years from European countries. Studies aimed at analysing the Great Recession, governments’ responses to the crisis, and its impact on SDCH were included. A narrative synthesis of the results was carried out. The risk of bias was assessed using the STROBE and EPICURE tools. Results Fourteen studies were included, most of them with a low to intermediate risk of bias (average score 72.1%). Government responses to the crisis varied, although there was general agreement that Greece, Spain, Ireland and the United Kingdom applied higher levels of austerity. High austerity periods, compared to pre-austerity periods were associated with increased material deprivation, child poverty rates, and low birth weight. Increasing child poverty subsequent to austerity measures was associated with deterioration of child health. High austerity was also related to poorer access and quality of services provided to disabled children. An annual reduction of 1% on public health expenditure was associated to 0.5% reduction on Measles-Mumps-Rubella vaccination coverage in Italy. Conclusions Countries that applied high level of austerity showed worse trends on SDCH and CHO, demonstrating the importance that economic policy may have for equity in child health and development. European governments must act urgently and reverse these austerity policy measures that are detrimental to family benefits and child protection.
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Affiliation(s)
- Luis Rajmil
- Retired, paediatrician and public health and epidemiology specialist, Homer 22 1rst 1, Barcelona, Spain
| | - Anders Hjern
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, SE-106 91, Stockholm, Sweden.
| | - Nick Spencer
- Emeritus Professor of Child Health, Division of Mental Health and Wellbeing, Warwick Medical School University of Warwick, Coventry, CV4 9JD, UK
| | - David Taylor-Robinson
- Clinical Senior Lecturer, Department of Public Health and Policy, Whelan Building University of Liverpool, Liverpool, UK
| | - Geir Gunnlaugsson
- Faculty of Sociology, Anthropology and Folkloristics, University of Iceland, Reykjavik, Iceland
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
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Hiam L, Dorling D, McKee M. Things Fall Apart: the British Health Crisis 2010-2020. Br Med Bull 2020; 133:4-15. [PMID: 32219417 DOI: 10.1093/bmb/ldz041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/04/2019] [Accepted: 12/09/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND A very large number of studies have reported a stalling of health improvements in the UK since 2010. SOURCES OF DATA Almost all relevant data are produced by the Office for National Statistics and other national statistical agencies. AREAS OF AGREEMENT There has been a dramatic slowdown in life expectancy and diverging trends in infant mortality in the UK as a whole and England and Wales, respectively. AREAS OF CONTROVERSY Many commentators are loath to describe the falls in life expectancy as actual falls or to ascribe blame to the political situation in the UK. GROWING POINTS Health trends in the UK are worrying and raise important questions about government policies. AREAS TIMELY FOR DEVELOPING RESEARCH These findings point to a need for greater investment in research on the political determinants of health, on the timely detection and interpretation of evidence of worsening health, and on how political and policy processes respond to such findings.
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Affiliation(s)
- Lucinda Hiam
- School of Geography and the Environment, University of Oxford, South Parks Rd, Oxford OX1 3QY, UK
| | - Danny Dorling
- School of Geography and the Environment, University of Oxford, South Parks Rd, Oxford OX1 3QY, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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50
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The UK's global standing in child and young people's health and how GPs can help. Br J Gen Pract 2020; 70:156-157. [PMID: 32217569 DOI: 10.3399/bjgp20x708905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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