Aversion to health inequality — Pure, income-related and income-caused

We design a novel experiment to identify aversion to pure (univariate) health inequality separately from aversion to income-related and income-caused health inequality. Participants allocate resources to determine health of individuals. Identification comes from random variation in resource productivity and information on income and its causal effect. We gather data (26,286 observations) from a sample of UK adults (n = 337) and estimate pooled and participant-specific social preferences while accounting for noise. The median person has strong aversion to pure health inequality, challenging the health maximisation objective of economic evaluation. Aversion to health inequality is even stronger when it is related to income. However, the median person prioritises health of poorer individuals less than is assumed in the standard measure of income-related health inequality. On average, aversion to that inequality does not become stronger when low income is known to cause ill-health. There is substantial heterogeneity in all three types of inequality aversion.</p

Evaluation of Increased Flexibility for 14 to 16 Year Olds Programme : Outcomes for the Second Cohort - Research Brief

The Increased Flexibility Programme (IFP) was the first national programme which formalised partnership working between post-16 and pre-16 education providers to deliver a broader curriculum for young people at key stage 4. Since its inception, the programme has expanded in the context of a continuing focus on improving the curriculum and qualification routes for 14 to 16 year olds and integrating these into a 14 to 19 framework. The Department for Education and Skills (DfES) commissioned the National Foundation for Educational Research (NFER) to undertake a national evaluation of the first and second cohorts of IFP students, in order to examine the extent to which the aims and objectives of the IFP were being met. This research brief focuses on the outcomes for young people who participated in the programme between 2003 and 2005 (cohort 2) during a time of change in 14 to 19 policy

A European regulatory pathway for Tidepool loop following clearance in the United States?

The recent clearance by the United States Food and Drug Administration of Tidepool Loop sets an important precedent within the medical device landscape. For the first time, an automated insulin delivery mobile application—based on an algorithm initially designed and developed by users —has been recognised as safe and effective by a regulatory body. The aim of this paper is twofold: firstly, we map out the regulatory pathways and processes that were navigated by Tidepool, the non‐profit behind Tidepool Loop, in order to make this landmark moment possible. Secondly, we set out potential approvals processes in the European Union and United Kingdom with a view to examining the challenges to obtaining regulatory clearance for Tidepool Loop in these jurisdictions. In so doing, we highlight the significant differences, not only between the United States and European systems but also between the European Union and Great Britain systems. We conclude by arguing that the complexity encountered when seeking to introduce an innovative solution in different regulatory systems has the potential to act as a disincentive to open source developers from seeking regulatory approvals for such technologies in the future

Open Source Automated Insulin Delivery:Potential Pathways to Regulatory Approval

A note providing a broad overview of the regulatory pathways and processes that may be encountered by those seeking regulatory approvals for Open Source Automated Insulin Delivery apps/software in the United States, the European Union (including Northern Ireland), and Great Britain. It focuses on the distinctions in institutional structure, device classification, and processes for regulatory approval or conformity assessment in the three jurisdictions.The note is based on research presented in Laura Downey, Shane O’Donnell, Tom Melvin, and Muireann Quigley, “A European regulatory pathway for Tidepool loop following clearance in the United States?” Diabetic Medicine 2023;00:e15246. https://doi.org/10.1111/dme.1524

Open Source Automated Insulin Delivery: Potential Pathways to Regulatory Approval

A note note providing a broad overview of the regulatory pathways and processes that may be encountered by those seeking regulatory approvals for Open Source Automated Insulin Delivery apps/software in the United States, the European Union (including Northern Ireland), and Great Britain. It focuses on the distinctions in institutional structure, device classification, and processes for regulatory approval or conformity assessment in the three jurisdictions.The note is based on research presented in Laura Downey, Shane O’Donnell, Tom Melvin, and Muireann Quigley, “A European regulatory pathway for Tidepool loop following clearance in the United States?” Diabetic Medicine 2023;00:e15246. https://doi.org/10.1111/dme.1524

Health and Inequality

__Abstract__ We examine the relationship between income and health with the purpose of establishing the extent to which the distribution of health in a population contributes to income inequality and is itself a product of that inequality. The evidence supports a significant and substantial impact of ill-health on income mainly operating through employment, although it is difficult to gauge the magnitude of the contribution this makes to income inequality. Variation in exposure to health risks early in life is a potentially important mechanism through which health may generate, and possibly sustain, economic inequality. If material advantage can be excercised within the domain of health, then economic inequality will generate health inequality. In high income countries, the evidence that income (wealth) does have a causal impact on health in adulthood is weak. But this may simply reflect the difficulty of identifying a relationship that, should it exist, is likely to emerge over the lifetime as poor material living conditions slowly take their toll on health. There is little credible evidence to support the claim that the economic inequality in society threatens the health of all its members, or that relative income is a determinant of health

Socioeconomic Differences in Health over the Life Cycle in an Egalitarian Country

A strong relationship between health and socioeconomic status is firmly established. Yet, partly due to the multidimensional and dynamic nature of the variables, the causal mechanisms connecting them are poorly understood. This paper argues that adoption of a life-cycle perspective is essential to uncover these causal pathways. A life-cycle perspective also allows investigation of whether the socioeconomically disadvantaged, on top of a lower health level, experience a sharper deterioration of their health over the life cycle. We show that in the Netherlands, as in the US, the socioeconomic gradient in health widens until late-middle age and narrows thereafter. The analysis and the available evidence suggests that the widening gradient is attributable both to health-related withdrawal from the labor force, resulting in lower incomes, and the cumulative protective effect of education on health outcomes. The less educated suffer a double health penalty in that they begin adult life with a slightly lower health level, which subsequently declines at a faster rate. The observed narrowing of the gradient in old age is partly an artefact stemming from the fact that only the most healthy of the disadvantaged survive into old age. It also reflects that after middle age, withdrawal from the labor force increasingly occurs for non health-related reasons

Finding the 'right' GP : a qualitative study of the experiences of people with long-COVID

Background: An unknown proportion of people who had an apparently mild COVID-19 infection continue to suffer with persistent symptoms, including chest pain, shortness of breath, muscle and joint pains, headaches, cognitive impairment (‘brain fog’), and fatigue. Post-acute COVID-19 (‘long-COVID’) seems to be a multisystem disease, sometimes occurring after a mild acute illness; people struggling with these persistent symptoms refer to themselves as ‘long haulers’. Aim: To explore experiences of people with persisting symptoms following COVID-19 infection, and their views on primary care support received. Design & setting: Qualitative methodology, with semi-structured interviews to explore perspectives of people with persisting symptoms following suspected or confirmed COVID-19 infection. Participants were recruited via social media between July–August 2020. Method: Interviews were conducted by telephone or video call, digitally recorded, and transcribed with consent. Thematic analysis was conducted applying constant comparison techniques. People with experience of persisting symptoms contributed to study design and data analysis. Results: This article reports analysis of 24 interviews. The main themes include: the ‘hard and heavy work’ of enduring and managing symptoms and accessing care; living with uncertainty, helplessness and fear, particularly over whether recovery is possible; the importance of finding the 'right' GP (understanding, empathy, and support needed); and recovery and rehabilitation: what would help? Conclusion: This study will raise awareness among primary care professionals, and commissioners, of long-COVID and the range of symptoms people are experiencing. Patients require their GP to believe their symptoms and to demonstrate empathy and understanding. Ongoing support by primary care professionals during recovery and rehabilitation is crucial