Driving My Life Away? Essays examining the impact of commuting on income and well-being

Commuting is an important and increasing component of time use. In 1995/97, the average worker in Britain commuted for 48 minutes per day; by 2012 this had increased to 56 minutes, c. 12% of a standard fulltime working week (Department of Transport National Travel Survey (NTS), 2013). Since commuting is viewed as an economic bad, rational individuals should only undertake longer commutes if they are compensated for doing so. This compensation can be monetary (e.g. higher pay) and non-monetary (e.g. better housing). Because of this compensation, people with longer commutes should not report lower levels of subjective well-being (SWB) - a proxy for utility - than people with shorter commutes. The principle aim of this thesis is to examine commuting behaviour against a number of different outcomes. Chapter 2 uses data from the Annual Survey of Hours and Earnings (ASHE) to investigate the causal relationship between commuting distance and pay. Specifically, we focus on exogenous shocks to commuting, similar to the papers by Mulalic et al (2010, 2013). We find evidence of a positive and significant relationship between commuting distance and income, suggesting that individuals receive financial compensation for longer commutes. Chapter 3 considers commuting and social capital, specifically in the presence of congestion charging. Using unique data, we analyse the impact that the Western Extension Zone (WEZ) had on an individual's stock of social capital. Following Putnam (2000), we proxy social capital by the frequency of visiting friends and family. Using difference-in-difference (D-i-D) techniques, we find that the WEZ did lead to lower levels of social capital. Chapters 4 and 5 then look at the relationship between commuting and well-being using data from the British Household Panel Survey. In chapter 4 we show that there is an insignificant relationship between commuting time and life satisfaction for individuals, albeit there is a relationship between the General Health Questionnaire (GHQ) score and commuting for women. In chapter 5, we then consider the couple as the unit of analysis. Again we find no evidence of a negative relationship between commuting time and SWB. This is robust to including spousal commuting information. We conclude that commuting further increases individuals' pay. However, we find no evidence of a significant relationship between commuting and SWB, which is a broader measure of individual utility. This may be due to commuting being associated with lower levels of social capital, which cancels out the effect of income on well-being

Estimating the additional costs of living with a disability in the United Kingdom between 2013 and 2016

In the United Kingdom, more than 20% of the population live with a disability. Past evidence shows that being disabled is associated with functional limitations that often cause social exclusion and poverty. Therefore, it is necessary to analyse the connection between disability and poverty. This paper examines whether households with disabled members face extra costs of living to attain the same standard of living as their peers without disabled members. The modelling framework is based on the standard of living approach which estimates the extra income required to close the gap between households with and without disabled members. We apply an ordered logit regression to data from the Family Resources Survey between 2013 and 2016 to analyse the relationship between standard of living, income, and disability, conditional on other explanatory variables. We find that households with disabled members face considerable extra costs that go beyond the transfer payment of the government. The average household with disabled members saw their weekly extra costs continually increase from £293 in 2013 to £326 in 2016 [2020 prices]. Therefore, the government needs to adjust welfare policies to address the problem of extra costs faced by households with disabled members

A prospective cohort study measuring cost-benefit analysis of the Otago Exercise Programme in Community Dwelling Adults with Rheumatoid Arthritis

Det er en sammenheng mellom bachelorstudentenes karakterpoeng fra videregående skole og resultater til eksamen i anatomi, fysiologi, biokjemi (AFB). Enkelte studenter med lavere opptakskarakterer enn landsgjennomsnittet oppnådde bedre eksamensresultat enn det nasjonale gjennomsnittsresultatet i AFB for 2016. Hensikten med studien var å undersøke hvordan bachelorstudenter i sykepleie med lave opptakspoeng og gode eksamensresultater i AFB lærte og tilegnet seg emnet. Studien har et kvalitativ forskningsdesign og det ble gjennomført semistrukturerte intervju av 12 bachelorstudenter i sykepleie, som ble analysert ved hjelp av innholdsanalyse. Funnene er beskrevet ut fra tre hovedkategorier: A) Relevansen til sykepleieryrket styrker læring, B) tilhørighet har betydning for læring, og C) læring skjer i samarbeid med andre. Vi fant at studentene lærte AFB mer inngående i samhandling med andre studenter. Samlinger på campus er viktig for studenters læring, til tross for at det er stort fokus på fleksible utdanninger og digitale pedagogiske metoder. Selvstendig arbeid kombinert med læring i et sosialt studentfellesskap, oppgis som motivasjonsfaktorer til målrettet arbeid med studiene. Studentene erfarer mestringsforventning, i et miljø som preges av anerkjennelse og samtidig gir opplevelse av tilhørighet. Studentene vektlegger studienes relevans sett i lys av det profesjonsyrket som de utdanner seg til, som en betydningsfull motivasjonsfaktor for læring.publishedVersio

How can healthcare organisations improve the social determinants of health for their local communities? Findings from realist-informed case studies among secondary healthcare organisations in England

Objectives Increasingly, healthcare and public health strategists invite us to look at healthcare organisations as not just care providers but as anchor institutions (ie, large community-rooted organisations with significant impact in the local economy, social fabric and overall community well-being). In response, this study explores the mechanisms through which healthcare organisations can impact social determinants of health and communities in their local areas.Design We conducted case studies with interviews and synthesised the findings using a realist approach to produce a set of explanations (programme theory) of how healthcare organisations can have a positive impact on the overall well-being of local communities by operating as anchor institutions.Setting Secondary healthcare organisations in England, including mental health and community services.Participants Staff from case study sites which were directly employed or actively engaged in the organisation’s anchor institution strategy. Data collection took place from early June to the end of August 2023.Results We found four building blocks for effective anchor activity including employment, spending, estates and sustainability. Healthcare organisations—as anchor institutions—can improve the social determinants of health for their local communities through enabling accessible paths for local community recruitment and career progression; empowering local businesses to join supply chains boosting income and wealth; transforming organisational spaces into community assets; and supporting local innovation and technology to achieve their sustainability goals. These blocks need to be integrated across organisations on the basis of a population health approach promoted by supportive leadership, and in collaboration with a diverse range of local partners.Conclusions Healthcare organisations have the potential for a positive impact on the overall well-being of local communities. Policymakers should support healthcare organisations to leverage employment, spending, estates and sustainability to help address the unequal distribution of the social determinants of health

Analysing changes to the flow of public funding within local health and care systems: an adaptation of the System of Health Accounts framework to a local health system in England

Financial flows relating to health care are routinely analysed at national and international level. They have rarely been systematically analysed at local level, despite sub-national variation due to population needs and decisions enacted by local organisations. We illustrate an adaptation of the System of Health Accounts framework to map the flow of public health and care funding within local systems, with an application for Greater Manchester (GM), an area in England which agreed a health and social care devolution deal with the central government in 2016. We analyse how financial flows changed in GM during the four years post-devolution, and whether spending was aligned with local ambitions to move towards prevention of ill-health and integration of health and social care. We find that GM decreased spending on public health by 15%, and increased spending on general practice by 0.1% in real terms. The share of total local expenditure paid to NHS Trusts for general and acute services increased from 70.3% to 71.6%, while that for community services decreased from 11.7% to 10.3%. Results suggest that GM may have experienced challenges in redirecting resources towards their goals. Mapping financial flows at a local level is a useful exercise to examine whether spending is aligned with system goals and highlight areas for further investigation

A prospective cohort study measuring cost-benefit analysis of the Otago Exercise Programme in community dwelling adults with rheumatoid arthritis.

BACKGROUND: Falls are one of the major health problems in adults with Rheumatoid Arthritis (RA). Interventions, such as the Otago Exercise Programme (OEP), can reduce falls in community dwelling adults by up to 35%. The cost-benefits of such a programme in adults with RA have not been studied. The aims of this study were to determine the healthcare cost of falls in adults with RA, and estimate whether it may be cost efficient to roll out the OEP to improve function and prevent falls in adults living with RA. METHODS: Patients with Rheumatoid Arthritis aged ≥18 years were recruited from four rheumatology clinics across the Northwest of England. Participants were followed up for 1 year with monthly fall calendars, telephone calls and self-report questionnaires. Estimated medical cost of a fall-related injury incurred per-person were calculated and compared with OEP implementation costs to establish potential economic benefits. RESULTS: Five hundred thirty-five patients were recruited and 598 falls were reported by 195 patients. Cumulative medical costs resulting from all injury leading to hospital services is £374,354 (US$540,485). Average estimated cost per fall is £1120 (US$1617). Estimated cost of implementing the OEP for 535 people is £116,479 (US$168,504) or £217.72 (US$314.34) per-person. Based on effectiveness of the OEP it can be estimated that out of the 598 falls, 209 falls would be prevented. This suggests that £234,583 (US$338,116) savings could be made, a net benefit of £118,104 (US$170,623). CONCLUSIONS: Implementation of the OEP programme for patients with RA has potentially significant economic benefits and should be considered for patients with the condition

Exploring the mental health effects of Universal Credit: a journey of co-production

This article offers reflections and experiences of public engagement in a National Institute for Health Research funded study about the mental health effects of Universal Credit. PJ’s poem powerfully illustrates his experiences of Universal Credit (UC). In this article, we outline our approach to public involvement and engagement (PIE) in a mixed-method, multi-site study about the mental health effects of UC funded by the National Institute for Health Research (NIHR). Public involvement in research is defined by NIHR as ‘an active partnership between members of the public and researchers in the research process’. We view public engagement as a social practice of dialogue and learning between researchers and the public;1 at its heart is the core value of social justice, shaped by wider societal developments towards realising citizen empowerment.2 We adopted the term PIE in preference to the more commonly used patient and public involvement, given that our study involves citizens/people with experience of UC and staff supporting them. Deciding who our relevant ‘publics’ are, and how we meaningfully involve them in the research is evolving over time. Here, we describe and reflect on the ongoing process of PIE in the context of this four-year research project