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

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

Integrating ecology into macroevolutionary research

On 9 March, over 150 biologists gathered in London for the Centre for Ecology and Evolution spring symposium, ‘Integrating Ecology into Macroevolutionary Research’. The event brought together researchers from London-based institutions alongside others from across the UK, Europe and North America for a day of talks. The meeting highlighted methodological advances and recent analyses of exemplar datasets focusing on the exploration of the role of ecological processes in shaping macroevolutionary patterns

Population mixing and incidence of cancers in adolescents and young adults between 1990 and 2013 in Yorkshire, UK

Purpose: Epidemiological evidence suggests a role for an infectious etiology for cancers in teenagers and young adults (TYAs). We investigated this by describing associations between infection transmission using the population mixing (PM) proxy and incidence of cancers in TYAs in Yorkshire, UK. Methods: We extracted cancer cases from the Yorkshire Specialist Register of Cancer in Children and Young People from 1990 to 2013 (n = 1929). Using multivariable Poisson regression models (adjusting for effects of deprivation and population density), we investigated whether PM was associated with cancer incidence. We included population mixing–population density interaction terms to examine for differences in effects of PM in urban and rural populations. Results: Nonsignificant IRRs were observed for leukemias (IRR 1.20, 95% CI 0.91–1.59), lymphomas (IRR 1.09, 95% CI 0.90–1.32), central nervous system tumors (IRR 1.06, 95% CI 0.80–1.40) and germ cell tumors (IRR 1.14, 95% CI 0.92–1.41). The association between PM and cancer incidence did not vary in urban and rural areas. Conclusions: Study results suggest PM is not associated with incidence of cancers among TYAs. This effect does not differ between rural and urban settings

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

‘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

A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries.

BACKGROUND: Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. METHODS AND FINDINGS: Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia;$39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and$1,3000,000,000 and 378439 LYG in Turkey. CONCLUSION: Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives

Experiences Marketing: A Cultural Philosophy for Contemporary Hospitality Marketing Studies

This article explores the landscape of contemporary hospitality marketing. It is argued that the teaching and academic discussions that surround the subject area adopt a predominantly positivistic approach; although important, that does not adequately reflect the nature of the industry or the products offered. Such a metrics-oriented position, although significant in the formulation of marketing strategy, does not reflect the complex experiential, nontangible nature of the hospitality product. This article presents a culturally located philosophy that reflects the multifaceted nature of the industry. The philosophy is underpinned by three precepts that draw from a multidisciplinary theoretical framework to create a more subject-specific approach to marketing, that when woven with traditional approaches can create a more effective and informed contemporary approach

Rural factors and survival from cancer: analysis of Scottish cancer registrations

In this survival study 63 976 patients diagnosed with one of six common cancers in Scotland were followed up. Increasing distance from a cancer centre was associated with less chance of diagnosis before death for stomach, breast and colorectal cancers and poorer survival after diagnosis for prostate and lung cancers. © 2000 Cancer Research Campaig