‘Emptying the cage, changing the birds’: state rescaling, path-dependency and the politics of economic restructuring in post-crisis Guangdong

This paper evaluates how economic restructuring in Guangdong is entwined with the politicization of state rescaling during and after the global financial crisis of 2008. It shows how a key industrial policy known as ‘double relocation’ generated tensions between the Guangdong government, then led by Party Secretary Wang Yang, and the senior echelon of the Communist Party of China in Beijing. The contestations and negotiations that ensued illustrate the dynamic entwinement between state rescaling and institutional path-dependency: the Wang administration launched this industrial policy in spite of potentially destabilizing effects on the prevailing national structure of capital accumulation. This foregrounds, in turn, the constitutive and constraining effects of established, national-level policies on local, territorially-specific restructuring policies

Regional differences in multidimensional aspects of health: findings from the MRC cognitive function and ageing study

BACKGROUND: Differences in mortality and health experience across regions are well recognised and UK government policy aims to address this inequality. Methods combining life expectancy and health have concentrated on specific areas, such as self-perceived health and dementia. Few have looked within country or across different areas of health. Self-perceived health, self-perceived functional impairment and cognitive impairment are linked closely to survival, as well as quality of life. This paper aims to describe regional differences in healthy life expectancy using a variety of states of health and wellbeing within the MRC Cognitive Function and Ageing Study (MRC CFAS). METHODS: MRC CFAS is a population based study of health in 13,009 individuals aged 65 years and above in five centres using identical study methodology. The interviews included self-perceived health and measures of functional and cognitive impairment. Sullivan's method was used to combine prevalence rates for cognitive and functional impairment and life expectancy to produce expectation of life in various health states. RESULTS: The prevalence of both cognitive and functional impairment increases with age and was higher in women than men, with marked centre variation in functional impairment (Newcastle and Gwynedd highest impairment). Newcastle had the shortest life expectancy of all the sites, Cambridgeshire and Oxford the longest. Centre differences in self-perceived health tended to mimic differences in life expectancy but this did not hold for cognitive or functional impairment. CONCLUSION: Self-perceived health does not show marked variation with age or sex, but does across centre even after adjustment for impairment burden. There is considerable centre variation in self-reported functional impairment but not cognitive impairment. Only variation in self-perceived health relates to the ranking of life expectancy. These data confirm that quite considerable differences in life experience exist across regions of the UK beyond basic life expectancy

DIET AND THE GEOGRAPHICAL DISTRIBUTION OF MULTIPLE SCLEROSIS

Data are presented to suggest that a geographical predisposing factor (G.P.F.) in multiple sclerosis (M.S.) may reflect regional dietary differences, and, further, that this factor is directly related to milk production or consumption. A number of biochemical hypotheses are proposed which would predict a resultant weakened blood-brain barrier or immunological defence, or the production of defective myelin, which would then increase susceptibility to the aetiological agent, possibly a virus. From the standpoint of brain development, two different ideas emerge--one, that differences in the composition of bovine and human milk, particularly during weaning, lead to the G.P.F.; the other, that drinking of milk beyond the normal nursing period is detrimental. More epidemiological studies are needed, with emphasis on diet, especially during periods of rapid brain development. Cow's milk may be an unfortunate substitute for human milk in infancy or a risky food source thereafter, or both. Epidemiological data raise these questions but do not provide ready answers. The milk correlation could be spurious, but at least ideas based on such a correlation pay attention to the most important epidemiological clue in M.S.--namely, the geographical distribution of the disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/22234/1/0000668.pd

Interprovincial migration, regional development and state policy in China, 1985-2010

Internal migration in China occurs as a result of both market forces and government interventions. This paper investigates how indicators of migration have changed over the past quarter of a century using data from successive censuses, with particular attention given to the roles of regional economic development and national policy and the effects of age and education on spatial patterns of migration. The results show a surge in migration throughout the period, an increasing concentration of migration destinations and an improvement of migration efficiency prior to 2000, but a decreased focusing of migration during the first decade of the twenty-first century. Widening regional disparity has been responsible for a sharp increase of migration from the interior to the coast, and different national economic growth poles emerged as major migration destinations at different stages of economic reforms. The analyses of age- and education-specific migration flows indicate that young adults were more mobile and more sensitive than older cohorts to interregional economic differentials, and that educated migrants were more concentrated than less-educated migrants since knowledge-based industries were more concentrated than labour-intensive industries. Our findings suggest that massive eastward migration induced by unbalanced economic development and relaxed migration restrictions still persisted in the 2000s, and that the State's recent efforts to alleviate regional inequalities were far from achieving equilibrium in the migration system

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trial

Background: Bowel cancer screening reduces cancer-specific mortality. There is a socioeconomic gradient in the uptake of the English NHS Bowel Cancer Screening Programme (BCSP), which may lead to inequalities in cancer outcomes. Objective: To reduce socioeconomic inequalities in uptake of the NHS BCSP’s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group. Design: Workstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘gist’ information, (2) a ‘narrative’ leaflet, (3) ‘general practice endorsement’ (GPE) and (4) an ‘enhanced reminder’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention. Methods: Interventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘usual care’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘gist’ leaflet (n = 163,525), (2) ‘narrative’ leaflet (n = 150,417), (3) GPE on the invitation letter (n = 265,434) and (4) ER (n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual’s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘definitive’ test result of either ‘normal’ (i.e. no further investigation required) or ‘abnormal’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome. Results: The gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; all p-values > 0.05). GPE showed no effect on the gradient (p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10; p < 0.0001]. ER showed a significant interaction with SECs (p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20; p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06; p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11; p = 0.001). All interventions were inexpensive to provide. Limitations: In line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect. Conclusions: Enhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results highlight the challenge of achieving equitable delivery of the screening offer when all communication is written; the format is universal and informed decision-making mandates extensive medical information. Future work: Socioculturally tailored research to promote communication about screening with family and friends should be developed and evaluated. Trial registration: Current Controlled Trials ISRCTN74121020. Funding: This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 5, No. 8. See the NIHR Journals Library website for further project information

Did London 2012 deliver a sports participation legacy?

Despite the increasing academic interest in the analysis of the Olympic legacy, there is a relative knowledge gap as far as sports participation legacy is concerned. The authors bridge this gap by analysing the short-term sports participation legacy of the London 2012 Olympic and Paralympic Games on the adult population in England. By using data from the Active People Survey and considering different sports participation variables and the effect of the economic climate, results demonstrate a positive association with participation from hosting the Games. Participation rates were adjusted to take into account seasonality and changes in the gross domestic product (GDP), accounting in this way for the effect of the recent economic recession. The biggest effect was observed in relation to frequent participation (at least three times per week for at least 30 minutes) in the year immediately after the Games. In 2014, the sports participation rates fell relative to 2013 but remained higher than pre-Olympic levels. The sport participation legacy of the Olympic Games appeared to have significant differences between socio-demographic groups