Terrapene ornata

Number of Pages: 4Integrative BiologyGeological Science

Britain’s centralising state makes it vulnerable to clientelism and cronyism

Bradley Ward and Joseph Ward argue that processes of centralisation under the Johnson government constitute an acceleration of, rather than a divergence from, extant British governance patterns, providing fertile ground for the clientelism and cronyism that has pervaded the current government

Understanding excess child and adolescent mortality in the United Kingdom compared with the EU15+ countries

Background Understanding why mortality in children and young people (CYP) in the UK is higher than similar high-income countries can inform efforts to improve outcomes. Methods I used data from the World Mortality Database, Office for National Statistics, and Global Burden of Disease Study to describe current patterns and long-term trends in UK CYP mortality, and compare this to a group of similar countries (the EU5+). I then used Hospital Episode Statistics data to understand how health service factors may contribute to the UK’s poor outcomes, and identify patterns of healthcare activity associated with mortality hazard. I finally place concerns regarding UK adolescent mortality in an international context, and examine global trends in deaths in 10-24 year olds. Results I found large differences in rates of mortality decline in the UK by age group and cause, with adolescents lagging behind other age groups. Improvements in UK mortality since 1970 have also been slower than the EU15+. I found the UK to currently have significantly higher CYP mortality for respiratory conditions, neurological conditions, common infections, and diabetes and endocrine conditions, but good outcomes for injuries. I found some areas of England to have mortality rates comparable with the best performing EU15+ countries, and that levels of deprivation explain much of the geographic variation in UK CYP mortality. Amongst CYP admitted with epilepsy, asthma and diabetes, (conditions where the UK has high mortality), recurrent attendances to hospital, missed appointments, mental health contacts, and difficulties transitioning to adult services, were all associated with increased mortality hazard. Global trends in adolescent mortality mirrored concerns in the UK, with poor progress compared with younger groups, despite most causes of death being preventable. Conclusions Interventions to improve UK CYP mortality require action across multiple health determinants. This should include addressing high levels of CYP poverty, but also further examination of the contribution of health service factors

The British state and the recentralisation of power: from Brexit to COVID-19

Joseph Ward demonstrates how through Brexit implementation, Theresa May’s government initiated a process of centralisation of both policy-making influence and administrative resources within Whitehall. These centralising tendencies have only been accelerated by the COVID-19 crisis under Johnson