Economic opportunity: A determinant of health?

The economic circumstances into which an individual is born have been repeatedly shown to fundamentally shape health throughout their life. By contrast, surprisingly little research has been done into the inequality in an individual's opportunity to move out of those circumstances— particularly since these factors might be potentially modifiable. In The Lancet Public Health, Atheendar Venkataramani and colleagues1 provide a major contribution to the field. The traditional focus taken within much of the social mobility and health literature has been the comparison of health outcomes between those who move upwards, downwards, or remain unchanged along some dimension of social stratification—often social class or education in the UK, or income within the USA

Relative poverty still matters

No abstract available

How do systematic reviews incorporate risk of bias assessments into the synthesis of evidence? A methodological study

Background: Systematic reviews (SRs) are expected to critically appraise included studies and privilege those at lowest risk of bias (RoB) in the synthesis. This study examines if and how critical appraisals inform the synthesis and interpretation of evidence in SRs.<p></p> Methods: All SRs published in March–May 2012 in 14 high-ranked medical journals and a sample from the Cochrane library were systematically assessed by two reviewers to determine if and how: critical appraisal was conducted; RoB was summarised at study, domain and review levels; and RoB appraisals informed the synthesis process.<p></p> Results: Of the 59 SRs studied, all except six (90%) conducted a critical appraisal of the included studies, with most using or adapting existing tools. Almost half of the SRs reported critical appraisal in a manner that did not allow readers to determine which studies included in a review were most robust. RoB assessments were not incorporated into synthesis in one-third (20) of the SRs, with their consideration more likely when reviews focused on randomised controlled trials. Common methods for incorporating critical appraisals into the synthesis process were sensitivity analysis, narrative discussion and exclusion of studies at high RoB. Nearly half of the reviews which investigated multiple outcomes and carried out study-level RoB summaries did not consider the potential for RoB to vary across outcomes.<p></p> Conclusions: The conclusions of the SRs, published in major journals, are frequently uninformed by the critical appraisal process, even when conducted. This may be particularly problematic for SRs of public health topics that often draw on diverse study designs

Improving the health of trans people: the need for good data

No abstract available

Employment status and income as potential mediators of educational inequalities in population mental health

We assessed whether educational inequalities in mental health may be mediated by employment status and household income. Poor mental health was assessed using General Health Questionnaire ‘caseness’ in working age adult participants (N = 48 654) of the Health Survey for England (2001–10). Relative indices of inequality by education level were calculated. Substantial inequalities were apparent, with adjustment for employment status and household income markedly reducing their magnitude. Educational inequalities in mental health were attenuated by employment status. Policy responses to economic recession (such as active labour market interventions) might reduce mental health inequalities but longitudinal research is needed to exclude reverse causation

Early impacts of Universal Credit: the tip of the iceberg?

No abstract available

The relationship between evidence and public health policy: case studies of the English public health white paper and minimum unit pricing of alcohol in Scotland

Background: Public health researchers and practitioners have repeatedly called for policy to be informed by academic evidence. The rise of the evidence-based medicine movement has demonstrated the potential benefits of using evidence for clinical decision-making. Recently, politicians and policy documents have echoed these calls for increased use of evidence in policymaking by drawing upon the discourse of evidence-based policy. However, efforts to understand the relationship between evidence and public health policy are underdeveloped and often make limited use of knowledge from other fields, including political science and sociology. This thesis aims to explore the relationship between evidence and public health policy in the UK using two contemporary case studies: the English public health White Paper, ‘Healthy Lives, Healthy People’; and the development of minimum unit pricing of alcohol in Scotland. Methods: The first case study: ‘Healthy Lives, Healthy People’ case study investigates the extent that three prominent discourses that draw upon academic work are reflected by the policy statements contained within the White Paper. The three areas examined include evidence on ‘what works’, the Nuffield framework on public health ethics and insights from behavioural science (‘nudge’). These discourses were chosen as they are not only rhetorically prominent in the White Paper, but also because they reflect the range of direct use of specific research findings and more conceptual use of research-derived ideas. To examine the extent that evidence on ‘what works’ has been incorporated into ‘Healthy Lives, Healthy People’, the research evidence for each of 51 specific policy actions described in the White Paper was reviewed. A critical analysis of ‘nudge’ and the Nuffield framework was conducted by contrasting their application with the authors’ original articulation. The second case study explores the development of the high-profile public health policy of minimum unit pricing of alcohol by drawing upon three different sources of data. First, a review of policy documents was conducted. Second, a systematic document analysis of evidence submissions that were received by the Scottish Parliament’s Health and Sport Committee in response to its consultation on minimum unit pricing was performed. This analysis drew specifically on a framework for analysing political argumentation. Third, 36 semi-structured interviews were carried out with a broad range of policy stakeholders. Interviewees were purposively chosen to obtain diversity in supportiveness for minimum unit pricing, as well as by professional position (academic, advocate, civil servant, politician, industry representative). The evidence submissions and interview data were thematically coded and organised using NVivo 9. Results: By systematically assessing the evidence underpinning the English public health White Paper, the study empirically established that public health policy does not meet conventional public health standards for being evidence-based. Similarly, the prominence of ‘nudge’ and the Nuffield framework in the text of ‘Healthy Lives, Healthy People’ do not appear to be matched by the actions suggested. However, this first case study finds that while evidence does have an influence, it does not determine policy. This relationship appears complex, partial and contingent rather than direct and instrumental, therefore necessitating a more detailed and focused case study. The second case study begins by providing a detailed description of the process by which minimum unit pricing developed in Scotland. It then draws on the analysis of evidence submission documents combined with interview data to identify a crucial role of public health advocates, who reframed the alcohol policy debate to bring about policy change. Epidemiological concepts were important in helping to achieve this shift in policy framing. Having investigated more conceptual influences of evidence, econometric modelling carried out by a team at the University of Sheffield is focused on as an example of a specific piece of research evidence that was perceived by interviewees to be influential in the policy debate. The different types of influence that the modelling study had on the policy process are determined and reasons for its influence investigated. The study also finds that interviewees believed econometric modelling could be more widely used to inform future public health policymaking. Lastly, a ‘multiple lenses’ approach builds upon these findings and political science theory to produce a comprehensive explanation of the policy process and describe the roles of evidence on the minimum unit pricing policy process. Discussion: Analysis of the ‘Healthy Lives, Healthy People’ White Paper shows that despite the prominent rhetoric for evidence-based policy, this is not reflected by the reality of current public health policy in the UK. The investigation of the development of minimum unit pricing of alcohol in Scotland demonstrates that evidence influences the policy process in a number of ways but these influences are heavily context-dependent. The role of evidence in changing the framing of the policy debate has been identified as of particular importance for this case study. The devolution process and evolving nature of political institutions also raises particular opportunities, but also challenges, for public health professionals. The strengths of the thesis include its use of two case studies to investigate the relationship between evidence and public health policy, the analysis of multiple sources of data in relation to minimum unit pricing policy and the application of political science theories that are typically underused in public health research. Limitations include the caution required when making generalisations from these data, particularly since these case studies have been purposively chosen. Drawing upon the two case studies, a conceptual model for the relationship between evidence and public health policy is articulated. The model suggests that evidence is likely to be used in different ways depending on the extent that the political values underpinning an issue are contested, with the importance of evidence for rhetorical purposes being a legitimate and helpful means of highlighting the health aspects of public policy issues. Lessons for public health researchers and practitioners, as well as directions for future research and theoretical implications, are considered and discussed

Trends in population mental health before and after the 2008 recession: a repeat cross-sectional analysis of the 1991-2010 health surveys of England

<p>Objective: To assess short-term differences in population mental health before and after the 2008 recession and explore how and why these changes differ by gender, age and socio-economic position.</p> <p>Design: Repeat cross-sectional analysis of survey data.</p> <p>Setting: England.</p> <p>Participants: Representative samples of the working age (25–64 years) general population participating in the Health Survey for England between 1991 and 2010 inclusive.</p> <p>Main outcome measures: Prevalence of poor mental health (caseness) as measured by the general health questionnaire-12 (GHQ).</p> <p>Results: Age–sex standardised prevalence of GHQ caseness increased from 13.7% (95% CI 12.9% to 14.5%) in 2008 to 16.4% (95% CI 14.9% to 17.9%) in 2009 and 15.5% (95% CI 14.4% to 16.7%) in 2010. Women had a consistently greater prevalence since 1991 until the current recession. However, compared to 2008, men experienced an increase in age-adjusted caseness of 5.1% (95% CI 2.6% to 7.6%, p<0.001) in 2009 and 3% (95% CI 1.2% to 4.9%, p=0.001) in 2010, while no statistically significant changes were seen in women. Adjustment for differences in employment status and education level did not account for the observed increase in men nor did they explain the differential gender patterning. Over the last decade, socio-economic inequalities showed a tendency to increase but no clear evidence for an increase in inequalities associated with the recession was found. Similarly, no evidence was found for a differential effect between age groups.</p> <p>Conclusions: Population mental health in men has deteriorated within 2 years of the onset of the current recession. These changes, and their patterning by gender, could not be accounted for by differences in employment status. Further work is needed to monitor recessionary impacts on health inequalities in response to ongoing labour market and social policy changes.</p&gt

Assessing reporting of narrative synthesis of quantitative data in public health systematic reviews

No abstract available

Implications for alcohol minimum unit pricing advocacy: what can we learn for public health from UK newsprint coverage of key claim-makers in the policy debate?

On May 24th 2012, Scotland passed the Alcohol (Minimum Pricing) Bill. Minimum unit pricing (MUP) is an intervention that raises the price of the cheapest alcohol to reduce alcohol consumption and related harms. There is a growing literature on industry’s influence in policymaking and media representations of policies, but relatively little about frames used by key claim-makers in the public MUP policy debate. This study elucidates the dynamic interplay between key claim-makers to identify lessons for policy advocacy in the media in the UK and internationally. Content analysis was conducted on 262 articles from seven UK and three Scottish national newspapers between 1st May 2011 and 31st May 2012, retrieved from electronic databases. Advocates’ and critics’ constructions of the alcohol problem and MUP were examined. Advocates depicted the problem as primarily driven by cheap alcohol and marketing, while critics’ constructions focused on youth binge drinkers and dependent drinkers. Advocates justified support by citing the intervention’s targeted design, but critics denounced the policy as illegal, likely to encourage illicit trade, unsupported by evidence and likely to be ineffective, while harming the responsible majority, low-income consumers and businesses. Critics’ arguments were consistent over time, and single statements often encompassed multiple rationales. This study presents advocates with several important lessons for promoting policies in the media. Firstly, it may be useful to shift focus away from young binge drinkers and heavy drinkers, towards population-level over-consumption. Secondly, advocates might focus on presenting the policy as part of a wider package of alcohol policies. Thirdly, emphasis on the success of recent public health policies could help portray the UK and Scotland as world leaders in tackling culturally embedded health and social problems through policy; highlighting past successes when presenting future policies may be a valuable tactic both within the UK and internationally