Geographical differences in the financial impacts of different forms of tobacco licence fees on small retailers in Scotland

Objective Retailer licencing fees are a promising avenue to regulate tobacco availability. However, they face strong opposition from retailers and the tobacco industry, who argue significant financial impacts. This study compares the impacts of different forms of tobacco licence schemes on retailers’ profits in Scotland. Methods We calculated gross profits from tobacco sales in 179 convenience stores across Scotland using 1 099 697 electronic point-of-sale records from 16 weeks between 2019 and 2022. We estimated different fees using universal, volumetric and separate urban/rural schemes. We identified the point at which 50% of retailers would no longer make a gross profit on tobacco sales for each scheme and modelled the financial impact of 10 incremental fee levels. The financial impact was assessed based on changes in retailers’ tobacco gross profits. Differences by neighbourhood deprivation and urban/rural status were examined. Results The gross profit from tobacco per convenience store averaged £15 859/year. Profits were 2.29 times higher in urban (vs rural) areas and 1.59 times higher in high-deprivation (vs low-deprivation) areas, attributable to higher sales volumes. Tobacco gross profit decreased proportionally with increasing fee levels. Universal and urban/rural fees had greater gross profit reductions in rural and/or less deprived areas, where profits were lower, compared with volumetric fees. Conclusion The introduction of tobacco licence fees offers a potential opportunity for reducing the availability of tobacco retailers. The likely impact of a tobacco licence fee is sensitive to the type of licence scheme implemented, the level at which fees are set and the retailers’ location in relation to neighbourhood deprivation and rurality

Is local alcohol outlet density related to alcohol-related morbidity and mortality in Scottish cities?

Alcohol consumption may be influenced by the local alcohol retailing environment. This study is the first to examine neighbourhood alcohol outlet availability (on- and off-sales outlets) and alcohol-related health outcomes in Scotland. Alcohol-related hospitalisations and deaths were significantly higher in neighbourhoods with higher outlet densities, and off-sales outlets were more important than on-sales outlets. The relationships held for most age groups, including those under the legal minimum drinking age, although were not significant for the youngest legal drinkers (18–25 years). Alcohol-related deaths and hospitalisations were higher in more income-deprived neighbourhoods, and the gradient in deaths (but not hospitalisations) was marginally larger in neighbourhoods with higher off-sales outlet densities. Efforts to reduce alcohol-related harm should consider the potentially important role of the alcohol retail environment

"The walls were so damp and cold" fuel poverty and ill health in Northern Ireland: results from a housing intervention

This article reports the findings from an evaluation of a fuel poverty programme in the Armagh and Dungannon Health Action Zone in Northern Ireland. Focusing on a rural community, it adds to the debate surrounding the hidden nature of rural fuel poverty. As part of the programme, energy efficiency measures, including some central heating systems, were installed in 54 homes. Surveys were conducted both pre and post intervention and analysed to assess any changes. The programme demonstrated that energy efficiency intervention can lead to improvements in health and well being, increased comfort levels in the home and a reduction in the use of health services, therefore having potential cost savings for the NHS. Some households, however, remain in fuel poverty after having full central heating installed, reflecting the significant contribution of low income on the production of fuel poverty. The article concludes by suggesting that interventions in this area require commitment from multiple sectors of society, including health professionals and local communities

A regional measure of neighborhood multiple environmental deprivation: relationships with health and health inequalities

The health impacts of simultaneous exposure to multiple adverse environmental factors are of concern in the United Kingdom. UK-wide indicators exist, but context-specific finer resolution measures are lacking. An environmental deprivation index was developed for 398 neighborhoods (average population = 760) in a Scottish council area, including measures of air pollution, noise pollution, traffic environment, undesirable land uses, and crime. Adverse environmental conditions were related to ill health in the region and implicated in wider socioeconomic health inequalities. The results suggest an independent role for environmental deprivation in explaining poor health and health inequalities

Environmental justice and health: the implications of the socio-spatial distribution of multiple environmental deprivation for health inequalities in the United Kingdom

Understanding persistent and increasing spatial inequalities in health is an important field of academic enquiry for geographers, epidemiologists and public health researchers. Delivering robust explanations for the growing spatial divide in health offers potential for improving health outcomes across the social spectrum, but particularly among disadvantaged groups. One potential driver for the increasing geographical differences in health is the disparity in exposure to key characteristics of the physical environment that are either health promoting or health damaging. While the framework of 'environmental justice' has long been used to consider whether disadvantaged groups bear a disproportionate burden of environmental disamenities, perhaps surprisingly, the research fields of environmental justice and health inequalities have remained largely separate realms. In this paper we examine the confluence of environmental characteristics that potentially function as key mechanisms to account for the socio-economic gradient in health outcomes in the UK. We developed the Multiple Environmental Deprivation Index (MEDIx), an area-based measure that represented the multiple dimensions of health-related environmental disamenities for census wards across the UK. By comparing the index to an area measure of income deprivation, we found that, at the national level, multiple environmental deprivation increased as the degree of income deprivation rose. Using mortality records we also found that MEDIx had an effect on health that remained after taking into account the age, sex and socio-economic profile of each area. Area-level health progressively worsened as the multiple environmental deprivation increased. However, this effect was most pronounced in least income-deprived areas. Our findings emphasise the importance of the physical environment in shaping health, and the need to consider the social and political processes that lead to income-deprived populations bearing a disproportionate burden of multiple environmental deprivation. Future research should simultaneously consider the 'triple jeopardy' of social, health and environmental inequalities

Environmental justice and health: A study of multiple environmental deprivation and geographical inequalities in health in New Zealand

There is an increasing interest in the unequal socio-spatial distribution of environmental ‘goods’ and ‘bads’ and the associated implications for geographical inequalities in health. Until recently, research in this area has focused on solitary environmental characteristics and has been hindered by the absence of geographically-specific measures that recognise the multifactorial nature of the physical environment. However, recent work in the United Kingdom has developed an area-level multivariate index of health-related physical environmental deprivation that captures both pathogenic and salutogenic environmental characteristics. Applications of this index have demonstrated that, at the national level, multiple environmental deprivation increased as the degree of income deprivation rose. Further, after adjusting for key confounders, there was a significant association between multiple environmental deprivation and the health outcomes of local residents. In the current study we tested the methods developed in the UK to create the New Zealand Multiple Environmental Deprivation Index (NZ-MEDIx) for small areas across the country (n = 1860). We considered whether socially disadvantaged places in New Zealand had higher levels of multiple environmental deprivation, and if environmental disadvantage exerted an influence on health after adjustment for key confounders such as socioeconomic status. We found that although neighbourhoods with higher levels of multiple environmental deprivation tended to have greater social disadvantage, this association was not linear. Further, multiple environmental deprivation tended to exert a modest effect on health that was independent of the age, sex and socioeconomic structure of the population. These findings demonstrate that it is possible to develop an index of multiple environmental deprivation in an alternative national context which has utility in epidemiological investigations

Mortality inequalities by environment type in New Zealand

In previous work a multivariate measure of health-related physical environment – the Multiple Environmental Deprivation Classification (MEDClass) – was created to investigate relationships between exposure to differing types of physical environment and health for the UK. Associations between MEDClass and all cause mortality, mortality from certain specific causes, and self-reported morbidity, independent of the level of socio-economic deprivation, were found. In this short report we determine whether the MEDClass approach has potential for international replication and whether the relationships with health prevails. We use New Zealand as a case study. Six environmental clusters were identified and similar associations between environmental classification and health outcomes were observed. Whilst this report shows that the framework used to create MEDClass can be transferred to an international context, we are reminded of the need to engage locally with place based research upon which an evidence base of cumulative impacts of the environment can be built

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical science. © The Author(s) 2019. Published by Oxford University Press