Use of evidence to support healthy public policy: a policy effectiveness-feasibility loop

Public policy plays a key role in improving population health and in the control of diseases, including non-communicable diseases. However, an evidence-based approach to formulating healthy public policy has been difficult to implement, partly on account of barriers that hinder integrated work between researchers and policy-makers. This paper describes a “policy effectiveness–feasibility loop” (PEFL) that brings together epidemiological modelling, local situation analysis and option appraisal to foster collaboration between researchers and policy-makers. Epidemiological modelling explores the determinants of trends in disease and the potential health benefits of modifying them. Situation analysis investigates the current conceptualization of policy, the level of policy awareness and commitment among key stakeholders, and what actually happens in practice, thereby helping to identify policy gaps. Option appraisal integrates epidemiological modelling and situation analysis to investigate the feasibility, costs and likely health benefits of various policy options. The authors illustrate how PEFL was used in a project to inform public policy for the prevention of cardiovascular diseases and diabetes in four parts of the eastern Mediterranean. They conclude that PEFL may offer a useful framework for researchers and policy-makers to successfully work together to generate evidence-based policy, and they encourage further evaluation of this approach

Moving beyond the ‘language problem': developing an understanding of the intersections of health, language and immigration status in interpreter-mediated health encounters

Health systems internationally are dealing with greater diversity in patient populations. However the focus on ‘the language problem’ has meant little attention is paid to diversity within and between migrant populations; and how interpreted consultations are influenced by intersecting migratory, ethnicity and sociodemographic variables. Our analysis of the experiences of patients, health care providers and interpreters in Scotland evidences the need to move beyond language, addressing multiple hidden inequalities in health care access and provision that operate in both clinic and, especially, home-based settings. We call for a practice-evidenced research agenda promoting cultural communication across health care and home settings, acknowledging immigration status as a social determinant of health. Sur le plan international, des systèmes de santé font face à une diversité croissante dans ses populations de patients. Cependant, l’accent sur ‘le problème de langue’ se traduit dans une manque d’attention à la diversité a l’intérieur même et entre des populations des migrants; et la façon par laquelle des variables migratoire, ethnique et sociodémographique influencent elles-mêmes des consultations interprétées. Notre analyse des expériences des patients, des professionnels fournissant de soins de santé et des interprètes offre des preuves du besoin de dépasser le problème de langue. Et en faisant cela, nous adressons des multiples inégalités, souvent cachées dans des contextes de soins de santé, dans les milieux clinique et domicile. Nous proposons un programme de recherche basé sur la pratique, qui favorise la communication culturelle dans des milieux clinique et domicile, et qui reconnait le statut d’immigration comme un déterminant social de la santé

‘It's a lonely old world’: Developing a multidimensional understanding of loneliness in farming

This is the final version. Available on open access from Wiley via the DOI in this recordData availability statement: Due to ethical concerns, the interview data supporting this publication are not available. A metadata record for the project, along with workshop notes and interview topic guides, are available from the UK Data Service in line with UKRI funding requirements.This article develops a multidimensional understanding of loneliness in farming communities, based on qualitative research with the UK farming community. It presents a conceptual model of loneliness in farming and uses evidence from workshops and interviews with farmers, farm family members and farm support practitioners to explore the various ways in which loneliness is manifested and experienced within the specific context of farming environments, cultures and identities. A range of farming-specific factors commonly contribute to experiences of loneliness within this community, and we argue that these can be conceptualised as relating to three varying, but interlinking, dimensions of loneliness: social, emotional and cultural. We also discuss the role that certain elements of farming culture and identity play in shaping the ways in which loneliness is experienced and managed. Finally, we consider some of the implications of our findings and suggest priorities for action from a range of stakeholders including the government, the public, farm support organisations and the farming community themselves. Understanding the complexities and nuances of loneliness within farming is important in order to mitigate the issue and help address wider mental health problems within this population.Loneliness and Social Isolation in Mental Health Research NetworkJohn Oldacre Foundatio

Swimming against the tide: a study of a neighbourhood trying to rediscover its ‘reason for being’– the case of South Bank, Redcar and Cleveland.

Many of the programmes and initiatives to regenerate deprived neighbourhoods appear to have had limited lasting impact. It has been argued that one reason for this is that we still have little real understanding of the nature and scale of the problems some communities face (Bernt, 2009). This article attempts to add to our knowledge through close study of an area with multiple problems and a history of failed regeneration attempts. An in-depth case study, undertaken to explore the current situation and future prospects of South Bank, a small neighbourhood in the North East of England, highlights transferable knowledge which may be applied to other regeneration areas. The analysis considers the nature and consequences of industrial decline; entrenched deprivation; the stigmatization of communities; the value of community consultation and the potential impact of retail-led regeneration. We question whether negative stigma attached to places can be changed and we ask what the future may hold for deprived communities now that public sector funding has largely dried up, and we consider an alternative approach: the potential impacts of private sector retail-led regeneration in the absence of public sector funding

Phylogenetic and non-phylogenetic structure in trophic links between gall-forming herbivores and their parasitoid natural enemies.

Revealing processes that structure species interactions is central to understanding community assembly and dynamics. Species interact via their phenotypes, but identifying and quantifying the traits that structure species-specific interactions (links) can be challenging. Where these traits show phylogenetic signal, however, link properties are predictable using models that incorporate phylogenies in place of trait data. We analysed variation in link richness, frequency, and identity in a multi-site dataset of interactions between host oak cynipid galls and parasitoid natural enemies, using a Bayesian mixed modelling framework allowing concurrent fitting of terms for phylogenies of both trophic levels. In both link incidence (presence/absence) and link frequency datasets, we identified strong signatures of cophylogeny (related parasitoids attack related host galls) and patterns independent of either phylogeny. Our results are robust to simulations of substantially reduced sample completeness, and are consistent with the structuring of trophic interactions by a combination of phylogenetically conserved and convergently evolving traits at both trophic levels. We discuss our results in light of phenotypic traits thought to structure gall-parasitoid interactions and wider applications of this approach, including inference of underlying community assembly processes and prediction of economically important trophic interactions

Phylogenetic and non-phylogenetic structure in trophic links between gall-forming herbivores and their parasitoid natural enemies.

Revealing processes that structure species interactions is central to understanding community assembly and dynamics. Species interact via their phenotypes, but identifying and quantifying the traits that structure species-specific interactions (links) can be challenging. Where these traits show phylogenetic signal, however, link properties are predictable using models that incorporate phylogenies in place of trait data. We analysed variation in link richness, frequency, and identity in a multi-site dataset of interactions between host oak cynipid galls and parasitoid natural enemies, using a Bayesian mixed modelling framework allowing concurrent fitting of terms for phylogenies of both trophic levels. In both link incidence (presence/absence) and link frequency datasets, we identified strong signatures of cophylogeny (related parasitoids attack related host galls) and patterns independent of either phylogeny. Our results are robust to simulations of substantially reduced sample completeness, and are consistent with the structuring of trophic interactions by a combination of phylogenetically conserved and convergently evolving traits at both trophic levels. We discuss our results in light of phenotypic traits thought to structure gall-parasitoid interactions and wider applications of this approach, including inference of underlying community assembly processes and prediction of economically important trophic interactions

Does coevolution promote species richness in parasitic cuckoos?

Why some lineages have diversified into larger numbers of species than others is a fundamental but still relatively poorly understood aspect of the evolutionary process. Coevolution has been recognized as a potentially important engine of speciation, but has rarely been tested in a comparative framework. We use a comparative approach based on a complete phylogeny of all living cuckoos to test whether parasite–host coevolution is associated with patterns of cuckoo species richness. There are no clear differences between parental and parasitic cuckoos in the number of species per genus. However, a cladogenesis test shows that brood parasitism is associated with both significantly higher speciation and extinction rates. Furthermore, subspecies diversification rate estimates were over twice as high in parasitic cuckoos as in parental cuckoos. Among parasitic cuckoos, there is marked variation in the severity of the detrimental effects on host fitness; chicks of some cuckoo species are raised alongside the young of the host and others are more virulent, with the cuckoo chick ejecting or killing the eggs/young of the host. We show that cuckoos with a more virulent parasitic strategy have more recognized subspecies. In addition, cuckoo species with more recognized subspecies have more hosts. These results hold after controlling for confounding geographical effects such as range size and isolation in archipelagos. Although the power of our analyses is limited by the fact that brood parasitism evolved independently only three times in cuckoos, our results suggest that coevolutionary arms races with hosts have contributed to higher speciation and extinction rates in parasitic cuckoos

Darwin's Manufactory Hypothesis Is Confirmed and Predicts the Extinction Risk of Extant Birds

In the Origin of Species Darwin hypothesized that the “manufactory” of species operates at different rates in different lineages and that the richness of taxonomic units is autocorrelated across levels of the taxonomic hierarchy. We confirm the manufactory hypothesis using a database of all the world's extant avian subspecies, species and genera. The hypothesis is confirmed both in correlations across all genera and in paired comparisons controlling for phylogeny. We also find that the modern risk of extinction, as measured by “Red List” classifications, differs across the different categories of genera identified by Darwin. Specifically, species in “manufactory” genera are less likely to be threatened, endangered or recently extinct than are “weak manufactory” genera. Therefore, although Darwin used his hypothesis to investigate past evolutionary processes, we find that the hypothesis also foreshadows future changes to the evolutionary tree

‘I Feel Like a Beggar’: Asylum Seekers Living in the Australian Community Without the Right to Work

While numbers of asylum seekers received by Australia are small compared to global figures, a range of deterrence measures have been implemented in response to increasing numbers arriving by boat in recent years. One of the more recent measures was denying asylum seekers who arrived by boat after 13 August 2012 the right to work upon their release from immigration detention into the community. There are around 26,000 asylum seekers who have been subject to this policy with most still waiting for their initial interview for refugee status and none have had their refugee claims resolved. This paper examines the findings of a study that explored the implications of this policy for asylum seekers. It draws on 29 semi-structured interviews with asylum seekers and highlights the distress and fear that many are enduring, caused by the denial of the right to work and ongoing uncertainty about their refugee claims. The study’s findings provide support for the conclusions of earlier research that highlight the importance of the right to work and securing employment for the mental health of asylum seekers, as well as studies that found there were negative mental health consequences of forcing asylum seekers to live for long periods with uncertainty around their protection claims