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Ling T. Transferability of Lessons From Program Evaluations: Iron Laws, Hiding Hands and the Evidence Ecosystem. EVALUATION REVIEW 2024; 48:410-426. [PMID: 38235700 DOI: 10.1177/0193841x241228332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Assessing the transferability of lessons from social research or evaluation continues to raise challenges. Efforts to identify transferable lessons can be based on two different forms of argumentation. The first draws upon statistics and causal inferences. The second involves constructing a reasoned case based on weighing up different data collected along the causal chain from designing to delivery. Both approaches benefit from designing research based upon existing evidence and ensuring that the descriptions of the programme, context, and intended beneficiaries are sufficiently rich. Identifying transferable lessons should not be thought of as a one-off event but involves contributing to the iterative and learning of a scientific community. To understand the circumstances under which findings can be confidently transferred, we need to understand: (1) How far and why outcomes of interest have multiple, interacting and fluctuating causes. (2) The program design and implementation capacity. (3) Prior knowledge and causal landscapes (and how far these are included in the theory of change). (4) New and relevant knowledge; what can we learn in our 'disputatious community of truth seekers'.
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Affiliation(s)
- Tom Ling
- Health and Wellbeing, RAND Europe, Cambridge, UK
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Ramírez AS, Houston K, Bateman C, Campos-Melendez Z, Estrada E, Grassi K, Greenberg E, Johnson K, Nathan S, Perez-Zuniga R. Communicating about the social determinants of health: development of a local brand. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:231-238. [PMID: 36946864 PMCID: PMC10514231 DOI: 10.1080/17538068.2023.2192579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Successful comprehensive population-based approaches to chronic disease prevention leverage mass media to amplify messages and support a culture of health. We report on a community-engaged formative evaluation to segment audiences and identify major themes to guide campaign message development for a transformative health communication campaign. METHODS Four key phases of campaign development: (I) Formative evaluation to identify priorities, guiding themes, and audience segments (interviews/focus groups with residents, N = 85; representatives of community-based partner organizations, N = 10); (II) Brand development (focus groups and closed-ended surveys; N = 56); (III) Message testing approaches to verbal and visual appeals (N = 50 resident intercept interviews); (IV) Workshop (N = 26 participants representing 15 organizations). RESULTS Residents were engaged throughout campaign development and the resulting campaign materials, including the campaign name and visual aesthetic (logo, color schemes, overall look and feel) reflect the diversity of the community and were accepted and valued by diverse groups in the community. Campaign materials featuring photos of county residents were created in English, Spanish, and Hmong. Plain language messages on social determinants of health resonate with residents. The county was described as a sort of idyllic environment burdened by inequality and structural challenges. Residents demonstrated enthusiasm for the campaign and provided specific suggestions for content (education about disease risks, prevention, management; information about accessing resources; testimonials from similar people) and tone. CONCLUSIONS Communication to support a policy, systems, and environmental change approach to chronic disease prevention must carefully match messages with appropriate audiences. We discuss challenges in such messaging and effectiveness across multiple, diverse audiences.
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Dhuria P, Muir S, Lawrence W, Roe E, Crozier S, Cooper C, Baird J, Vogel C. Women Consumers' Views on Legislation to Restrict Prominent Placement and Multibuy Promotions of High Fat, Sugar, and Salt Products in England: A Qualitative Perspective. Int J Health Policy Manag 2023; 12:7597. [PMID: 38618804 PMCID: PMC10590244 DOI: 10.34172/ijhpm.2023.7597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/15/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND As part of the childhood obesity strategy, the UK Government has introduced regulations to restrict the ways high fat salt and sugar (HFSS) products can be promoted in retail settings from October 2022. This study explored (i) consumers' views on the likely impact of the UK legislation restricting the placement and promotion of HFSS products on their shopping behaviours and (ii) consumers' beliefs about who is responsible for healthy eating. METHODS Using a cross-sectional study design, qualitative semi-structured telephone interviews were conducted with a purposive sample of women who shopped at a discount supermarket. Thematic analysis was employed to identify key themes. RESULTS Participants' (n = 34) had a median age of 35 years and over half were in paid employment. Five themes were identified: (1) The legislation is acceptable, but people can still (and should be able to) buy HFSS items; (2) The legislation is likely to have more impact on shoppers who do not plan their shopping; (3) Affordability of healthy food is just as, or more, important than the legislation; (4) It's up to the individual to eat healthily; and (5) Government and retailers can better support consumers to make healthy choices. CONCLUSION Most participants were optimistic about the incoming regulations and believed that it would support consumers to make healthier food choices. Many raised concerns, however, that the high price of healthy foods and continued availability of unhealthy foods within the stores could undermine the legislation's benefits. Coupling the legislation with interventions to promote and reduce the costs of healthier products would go some way to ensure its success. Raising awareness about marketing strategies that play into consumer concerns for cost and autonomy could further increase acceptance of the policy.
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Affiliation(s)
- Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Sarah Muir
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Emma Roe
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Southampton, UK
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Southampton, UK
| | - Christina Vogel
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Southampton, UK
- Centre for Food Policy, City, University of London, London, UK
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Currie J, Schilling HT, Evans L, Boyce T, Lester N, Greene G, Little K, Humphreys C, Huws D, Yeoman A, Lewis S, Paranjothy S. Contribution of avoidable mortality to life expectancy inequalities in Wales: a decomposition by age and by cause between 2002 and 2020. J Public Health (Oxf) 2023; 45:762-770. [PMID: 36423922 DOI: 10.1093/pubmed/fdac133] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 08/17/2022] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To explore the contribution of avoidable mortality to life expectancy inequalities in Wales during 2002-2020. DESIGN Observational study. SETTING Wales, 2002-20, including early data from the COVID-19 pandemic. METHODS We used routine statistics for 2002-2020 on population and deaths in Wales stratified by age, sex, deprivation quintile and cause of death. We estimated the contribution of avoidable causes of death and specific age-categories using the Arriaga decomposition method to highlight priorities for action. RESULTS Life expectancy inequalities rose 2002-20 amongst both sexes, driven by serial decreases in life expectancy amongst the most deprived quintiles. The contributions of amenable and preventable mortality to life expectancy inequalities changed relatively little between 2002 and 2020, with larger rises in non-avoidable causes. Key avoidable mortality conditions driving the life expectancy gap in the most recent period of 2018-2020 for females were circulatory disease, cancers, respiratory disease and alcohol- and drug-related deaths, and also injuries for males. CONCLUSIONS Life expectancy inequalities widened during 2002-20, driven by deteriorating life expectancy in the most deprived quintiles. Sustained investment in prevention post-COVID-19 is needed to address growing health inequity in Wales; there remains a role for the National Health Service in ensuring equitable healthcare access to alongside wider policies that promote equity.
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Affiliation(s)
- Jonny Currie
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF10 3QN, UK
| | - Hayden T Schilling
- Centre for Marine Science & Innovation, University of New South Wales, Sydney, NSW 2052, Australia
- Sydney Institute of Marine Science, Mosman, NSW 2088, Australia
| | - Lloyd Evans
- NHS Wales Health Collaborative, Cardiff CF10 4BZ, UK
| | - Tammy Boyce
- Institute of Health Equity, Department for Epidemiology & Public Health, University College London, London WC1E 6BT, UK
| | - Nathan Lester
- Public Health Data, Knowledge and Research Directorate, Public Health Wales, Cardiff CF10 4BZ, UK
| | - Giles Greene
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK & Swansea University Medical School, Swansea SA2 8PP, UK
| | - Kirsty Little
- Public Health Data, Knowledge and Research Directorate, Public Health Wales, Cardiff CF10 4BZ, UK
| | - Ciarán Humphreys
- Wider Determinants of Health Unit, Public Health Wales, Cardiff CF10 4BZ, UK
| | - Dyfed Huws
- Public Health Data, Knowledge and Research Directorate, Public Health Wales, Cardiff CF10 4BZ, UK
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK & Swansea University Medical School, Swansea SA2 8PP, UK
| | - Andrew Yeoman
- Gwent Liver Unit, Royal Gwent Hospital, Newport NP20 2UB, UK
| | - Sally Lewis
- Value in Health, NHS Wales, Pencoed, Wales CF10 3NQ, UK
| | - Shantini Paranjothy
- Aberdeen Health Data Science Centre, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
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Capper B, Ford J, Kelly M. Has the pandemic resulted in a renewed and improved focus on heath inequalities in England? A discourse analysis of the framing of health inequalities in national policy. PUBLIC HEALTH IN PRACTICE 2023; 5:100382. [PMID: 37131506 PMCID: PMC10077814 DOI: 10.1016/j.puhip.2023.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Objectives The COVID-19 pandemic rapidly exacerbated health inequalities in England. Policy makers sought to ameliorate its impact. This paper aims to identify how health inequalities were framed in national policy documents published in England during the pandemic and how this impacts the framing of policy solutions. Study design Discourse analysis of selected national policy documents. Methods First, we identified relevant national policy documents through a broad search and eligibility criteria to identify illustrative policy documents. Second, we undertook a discourse analysis to understand the framing and constitution of health inequalities and consequent solutions within them. Third, we used existing health inequalities literature to critique the findings. Results Based on analysis of six documents, we found evidence of the idea of lifestyle drift with a marked disjunction between the acknowledgement of the wider determinants of heath and the policy solutions advocated. The target population for interventions is predominantly the worst off, rather than the whole social gradient. Repeated appeals to behaviour change indicate an inherent individualist epistemology. Responsibility and accountability for health inequalities appears delegated locally without the power and resource required to deliver. Conclusion Policy solutions are unlikely to address health inequalities. This could be done though through (i) shifting interventions towards structural factors and wider determinants of health, (ii) a positive vision of a health equitable society, (iii) a proportional universalism in approach and (iv) a delegation of power and resource alongside responsibility for delivering on health inequalities. These possibilities currently remain outside of the policy language of health inequalities.
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Affiliation(s)
- Beth Capper
- Cambridge University, Department of Public Health and Primary Care, UK
| | - John Ford
- Queen Mary University, Wolfson Institute of Population Health, UK
| | - Mike Kelly
- Cambridge University, Department of Public Health and Primary Care, UK
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Savona N, Brown A, Macauley T, Aguiar A, Hayward J, Ayuandini S, Habron J, Grewal NK, Luszczynska A, Mendes S, Klepp KI, Rutter H, Allender S, Knai C. System mapping with adolescents: Using group model building to map the complexity of obesity. Obes Rev 2023; 24 Suppl 1:e13506. [PMID: 36825369 DOI: 10.1111/obr.13506] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/18/2022] [Accepted: 09/11/2022] [Indexed: 11/23/2022]
Abstract
Public health research and practice is increasingly employing systems thinking to help grapple with complex issues, from obesity to HIV treatment. At the same time, there is growing recognition that to address a given problem it is essential collaborate with those most at risk of or affected by it. Group model building (GMB), a process grounded in system dynamics, combines systems thinking and participatory methods to structure and address complex issues. As part of the CO-CREATE project we conducted GMB sessions with young people in six countries to create causal loop diagrams showing the factors that they believe drive obesity. This paper describes the background to GMB and the process we used to construct causal loop diagrams; it discusses how GMB contributed to generating noteworthy and useful findings, and the strengths and limitations of the method. Using GMB, we identified areas of concern to adolescents in relation to obesity that have so far had little attention in obesity research and policy: mental health and online activity. In using GMB, we also helped answer calls for a more participatory approach to youth involvement in research and policy development.
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Affiliation(s)
- Natalie Savona
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Brown
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Talia Macauley
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anaely Aguiar
- Department of Geography, System Dynamics Group, University of Bergen, Bergen, Norway
| | - Josh Hayward
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Sherria Ayuandini
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Janetta Habron
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Aleksandra Luszczynska
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Sofia Mendes
- Centre for Studies and Research on Social Dynamics and Health-CEIDSS, Lisbon, Portugal
| | - Knut-Inge Klepp
- Department of Nutrition, University of Oslo, Oslo, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Steven Allender
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Cécile Knai
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Avoiding nocebo and other undesirable effects in chiropractic, osteopathy and physiotherapy: An invitation to reflect. Musculoskelet Sci Pract 2022; 62:102677. [PMID: 36368170 DOI: 10.1016/j.msksp.2022.102677] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/12/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION While the placebo effect is increasingly recognised as a contributor to treatment effects in clinical practice, the nocebo and other undesirable effects are less well explored and likely underestimated. In the chiropractic, osteopathy and physiotherapy professions, some aspects of historical models of care may arguably increase the risk of nocebo effects. PURPOSE In this masterclass article, clinicians, researchers, and educators are invited to reflect on such possibilities, in an attempt to stimulate research and raise awareness for the mitigation of such undesirable effects. IMPLICATIONS This masterclass briefly introduces the nocebo effect and its underlying mechanisms. It then traces the historical development of chiropractic, osteopathy, and physiotherapy, arguing that there was and continues to be an excessive focus on the patient's body. Next, aspects of clinical practice, including communication, the therapeutic relationship, clinical rituals, and the wider social and economic context of practice are examined for their potential to generate nocebo and other undesirable effects. To aid reflection, a model to reflect on clinical practice and individual professions through the 'prism' of nocebo and other undesirable effects is introduced and illustrated. Finally, steps are proposed for how researchers, educators, and practitioners can maximise positive and minimise negative clinical context.
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Olsen JR, Thornton L, Tregonning G, Mitchell R. Nationwide equity assessment of the 20-min neighbourhood in the scottish context: A socio-spatial proximity analysis of residential locations. Soc Sci Med 2022; 315:115502. [PMID: 36368061 DOI: 10.1016/j.socscimed.2022.115502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/07/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
The 20-min neighbourhood (20 MN) is a method of designing neighbourhoods in such a way that individuals can meet the majority of their daily needs within a 10-min walk (therefore a 20-min return trip) of their home. The Scottish Government have committed to apply the 20 MN concept nationwide, focusing on disadvantaged communities. The aims of this study were to: (1) create 20 MN catchment areas for health, transport, education, social and recreational domains; (2) describe the number of residential locations within 20 MN domain catchment areas; and (3) describe variation in access to 20 MN domains by area-level socioeconomic status and urbanicity. 20 MN catchment areas (800-m) were created for 10 domains using road and path network analysis. All Scottish residential locations (n:146,190) were plotted, assigned area-level socioeconomic status and urbanicity. A dichotomised (yes/no) variable was created to identify whether it was within a 10-min walk of individual 20 MN domains. One in five residential locations had access to all 10 20 MN domains (Urban: 28%, Rural: 5%). There was variation in proportion of residential locations that has access to at least one facility by domains; 91% had access to at least one public transport stop and 84% a public open space. There was poorer access to primary care services (42%) and healthy food retailers (50%). Across all domains, access to at least one facility was greater within the most deprived areas. Access to 20 MN domains was greatest in areas where individual health status tends to be worse. A policy focusing solely on improving access to key facilities and amenities for deprived areas may be ineffective in reducing health inequalities. Future studies should assess the quality of facilities and co-location with health damaging facilities, particularly within more deprived areas. Alternative policy approaches may be required for improving access to facilities and amenities for rural communities.
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Affiliation(s)
- Jonathan R Olsen
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Lukar Thornton
- Department of Marketing, Faculty of Business and Economics, Universityof Antwerp, Antwerp, Belgium
| | - Grant Tregonning
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Richard Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Griffin N, Wistow J, Fairbrother H, Holding E, Sirisena M, Powell K, Summerbell C. An analysis of English national policy approaches to health inequalities: 'transforming children and young people's mental health provision' and its consultation process. BMC Public Health 2022; 22:1084. [PMID: 35641951 PMCID: PMC9153869 DOI: 10.1186/s12889-022-13473-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 05/13/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A national policy for England, published in 2017, entitled 'Transforming Children and Young People's Mental Health Provision' aimed to address the increasing prevalence mental health problems in children and tackle inequalities. In the context of this policy's implementation as ongoing and the effects of the Covid-19 pandemic, the need for appropriate, timely and ongoing national government commitment is vital. METHODS A narrative review using a problem representation evaluation [1], we critiqued the policy and related consultation documents using a social determinants of health perspective. We also reviewed wider policy discourses through engaging with stakeholder responses, providing an innovative methodological contribution to scholarship on public health policy and health inequalities. RESULTS We found absences and oversights in relation to inequalities (most notably the lack of acknowledgement that mental health can cause inequalities), access, workforce capacity, and the impacts of cuts and austerity on service provision. We suggest these inadequacies may have been avoided if stakeholder responses to the consultation process had been more meaningfully addressed. We illustrate how 'problems' are discursively created through the process of policy development, justified using specific types of evidence, and that this process is politically motivated. Local policy makers have a critical role in translating and adapting national policy for their communities but are constrained by absences and oversights in relation to health inequalities. CONCLUSIONS This narrative review illustrates how policy discourse frames and produces 'problems', and how the evidence used is selected and justified politically. This review contributes to the existing transdisciplinary field of knowledge about how using methods from political and social science disciplines can reveal new insights when critiquing and influencing policy approaches to health inequalities.
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Affiliation(s)
- Naomi Griffin
- grid.8250.f0000 0000 8700 0572Durham University, Durham, UK
- Fuse, The UK Centre for Translational Research in Public Health, Newcastle, UK
| | - Jonathan Wistow
- grid.8250.f0000 0000 8700 0572Durham University, Durham, UK
- Fuse, The UK Centre for Translational Research in Public Health, Newcastle, UK
| | - Hannah Fairbrother
- grid.11835.3e0000 0004 1936 9262University of Sheffield, Sheffield, UK
- grid.11835.3e0000 0004 1936 9262ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Eleanor Holding
- grid.11835.3e0000 0004 1936 9262University of Sheffield, Sheffield, UK
- grid.11835.3e0000 0004 1936 9262ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mihirini Sirisena
- Fuse, The UK Centre for Translational Research in Public Health, Newcastle, UK
- grid.1006.70000 0001 0462 7212Newcastle University, Newcastle, UK
| | - Katie Powell
- grid.11835.3e0000 0004 1936 9262University of Sheffield, Sheffield, UK
- grid.11835.3e0000 0004 1936 9262ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Carolyn Summerbell
- grid.8250.f0000 0000 8700 0572Durham University, Durham, UK
- Fuse, The UK Centre for Translational Research in Public Health, Newcastle, UK
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Ortegon-Sanchez A, Vaughan L, Christie N, McEachan RRC. Shaping Pathways to Child Health: A Systematic Review of Street-Scale Interventions in City Streets. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5227. [PMID: 35564621 PMCID: PMC9105466 DOI: 10.3390/ijerph19095227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 12/01/2022]
Abstract
Street-level built environment factors, for example, walking infrastructure, building density, availability of public transport, and proliferation of fast-food outlets can impact on health by influencing our ability to engage in healthy behaviour. Unhealthy environments are often clustered in deprived areas, thus interventions to improve the built environments may improve health and reduce inequalities. The aim of this review was to identify whether street-level built environment interventions can improve children's health in high income countries. A secondary aim was to describe key built environment elements targeted in interventions and research gaps. A systematic review of published literature was conducted by a multi-disciplinary team. Ten intervention papers were included. Physical activity or play was the only health outcome assessed. Most interventions described temporary changes including closure of streets to traffic (N = 6), which were mainly located in deprived neighbourhoods, or the addition of technology to 'gamify' active travel to school (N = 2). Two studies reported permanent changes to street design. There was limited evidence that closing streets to traffic was associated with increases in activity or play and inconclusive evidence with changes to street design and using technology to gamify active travel. Our ability to draw conclusions was hampered by inadequate study designs. Description of interventions was poor. Rigorous evaluation of built environment interventions remains challenging. We recommend a multi-disciplinary approach to evaluation, explicit reporting of built environment indicators targeted in interventions and offer solutions to others working in this area.
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Affiliation(s)
- Adriana Ortegon-Sanchez
- Centre for Transport Studies, Department of Civil, Environmental and Geomatic Engineering, UCL, London WC1E 6BT, UK;
| | - Laura Vaughan
- Space Syntax Laboratory, The Bartlett School of Architecture, UCL, London WC1E 6BT, UK;
| | - Nicola Christie
- Centre for Transport Studies, Department of Civil, Environmental and Geomatic Engineering, UCL, London WC1E 6BT, UK;
| | - Rosemary R. C. McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6RJ, UK
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Griffin N, Phillips SM, Hillier-Brown F, Wistow J, Fairbrother H, Holding E, Powell K, Summerbell C. A critique of the English national policy from a social determinants of health perspective using a realist and problem representation approach: the 'Childhood Obesity: a plan for action' (2016, 2018, 2019). BMC Public Health 2021; 21:2284. [PMID: 34906093 PMCID: PMC8669235 DOI: 10.1186/s12889-021-12364-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The UK government released Chapter 1 of the 'Childhood Obesity: a plan for action' (2016), followed by Chapter 2 (2018) and preliminary Chapter 3 was published for consultation in 2019 (hereon collectively 'The Policy'). The stated policy aims were to reduce the prevalence of childhood obesity in England, addressing disparities in health by reducing the gap (approximately two-fold) in childhood obesity between those from the most and least deprived areas. METHODS Combining a realist approach with an analysis of policy discourses, we analysed the policies using a social determinants of health (SDH) perspective (focusing on socio-economic inequalities). This novel approach reveals how the framing of policy 'problems' leads to particular approaches and interventions. RESULTS While recognising a social gradient in relation to obesity measures, we critique obesity problem narratives. The Policy included some upstream, structural approaches (e.g. restrictions in food advertising and the soft-drinks industry levy). However, the focus on downstream individual-level behavioural approaches to reduce calorie intake and increase physical activity does not account for the SDH and the complexity and contestedness of 'obesity' and pays insufficient attention to how proposals will help to reduce inequalities. Our findings illustrate that individualising of responsibility to respond to what wider evidence shows is structural inequalities, can perpetuate damaging narratives and lead to ineffective interventions, providing caution to academics, practitioners and policy makers (local and national), of the power of problem representation. Our findings also show that the problem framing in The Policy risks reducing important public health aims to encourage healthy diets and increase opportunities for physical activity (and the physical and mental health benefits of both) for children to weight management with a focus on particular children. CONCLUSIONS We propose an alternative conceptualisation of the policy 'problem', that obesity rates are illustrative of inequality, arguing there needs to be policy focus on the structural and factors that maintain health inequalities, including poverty and food insecurity. We hope that our findings can be used to challenge and strengthen future policy development, leading to more effective action against health inequalities and intervention-generated inequalities in health.
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Affiliation(s)
- Naomi Griffin
- Fuse, the NIHR (UK) Centre for Translational Research in Public Health (website), Newcastle, UK
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Sophie M. Phillips
- Fuse, the NIHR (UK) Centre for Translational Research in Public Health (website), Newcastle, UK
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Frances Hillier-Brown
- Fuse, the NIHR (UK) Centre for Translational Research in Public Health (website), Newcastle, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Jonathan Wistow
- Fuse, the NIHR (UK) Centre for Translational Research in Public Health (website), Newcastle, UK
- Department of Sociology, Durham University, Durham, UK
| | | | - Eleanor Holding
- ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katie Powell
- ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Carolyn Summerbell
- Fuse, the NIHR (UK) Centre for Translational Research in Public Health (website), Newcastle, UK
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
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12
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Di Ciaula A, Krawczyk M, Filipiak KJ, Geier A, Bonfrate L, Portincasa P. Noncommunicable diseases, climate change and iniquities: What COVID-19 has taught us about syndemic. Eur J Clin Invest 2021; 51:e13682. [PMID: 34551123 PMCID: PMC8646618 DOI: 10.1111/eci.13682] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/18/2021] [Accepted: 09/19/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND COVID-19 is generating clinical challenges, lifestyle changes, economic consequences. The pandemic imposes to familiarize with concepts as prevention, vulnerability and resilience. METHODS We analysed and reviewed the most relevant papers in the MEDLINE database on syndemic, noncommunicable diseases, pandemic, climate changes, pollution, resilience, vulnerability, health costs, COVID-19. RESULTS We discuss that comprehensive strategies must face multifactorial consequences since the pandemic becomes syndemic due to interactions with noncommunicable diseases, climate changes and iniquities. The lockdown experience, on the other hand, demonstrates that it is rapidly possible to reverse epidemiologic trends and to reduce pollution. The worst outcome is evident in eight highly industrialized nations, where 12% of the world population experienced about one-third of all COVID-19-deaths worldwide. Thus, a great economic power has not been fully protective, and a change of policy is obviously needed to avoid irreversible consequences. CONCLUSIONS We are accumulating unhealthy populations living in unhealthy environments and generating unhealthy offspring. The winning policy should tackle structural inequities through a syndemic approach, to protect vulnerable populations from present and future harms.
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Affiliation(s)
- Agostino Di Ciaula
- Department of Biomedical Sciences and Human OncologyClinica Medica ‘A. Murri’University of Bari ‘Aldo Moro’ Medical SchoolBariItaly
| | - Marcin Krawczyk
- Department of Medicine IISaarland University Medical CenterSaarland UniversityHomburgGermany
- Laboratory of Metabolic Liver DiseasesDepartment of General, Transplant and Liver SurgeryCentre for Preclinical ResearchMedical University of WarsawWarsawPoland
| | | | - Andreas Geier
- Division of HepatologyDepartment of Internal Medicine IIUniversity Hospital WürzburgWürzburgGermany
| | - Leonilde Bonfrate
- Department of Biomedical Sciences and Human OncologyClinica Medica ‘A. Murri’University of Bari ‘Aldo Moro’ Medical SchoolBariItaly
| | - Piero Portincasa
- Department of Biomedical Sciences and Human OncologyClinica Medica ‘A. Murri’University of Bari ‘Aldo Moro’ Medical SchoolBariItaly
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13
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Patient and practitioner views on cancer risk discussions in primary care: a qualitative study. BJGP Open 2021; 6:BJGPO.2021.0108. [PMID: 34645652 PMCID: PMC8958738 DOI: 10.3399/bjgpo.2021.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/07/2021] [Indexed: 12/04/2022] Open
Abstract
Background It is estimated that nearly 600 000 cancer cases in the UK could have been avoided in the past 5 years if people had healthier lifestyles, with the principle modifiable risk factors being smoking, obesity, alcohol consumption, and inactivity. There is growing interest in the use of cancer risk information in general practice to encourage lifestyle modification. Aim To explore the views and experiences of patients and practitioners in relation to cancer prevention and cancer risk discussions in general practice. Design & setting Qualitative study among patients and practitioners in general practices in Glasgow, UK. Method Semi-structured interviews were conducted with nine practitioners (five GPs and four practice nurses, recruited purposively from practices based on list size and deprivation status), and 13 patients (aged 30–60 years, with two or more specified comorbidities). Results Currently, cancer risk discussions focus on smoking and cancer, with links between alcohol and/or obesity and cancer rarely made. There was support for the use of the personalised cancer risk tool as an additional resource in primary care. Practitioners felt practice nurses were best placed to use it. Use in planned appointments (for example, chronic disease reviews) was preferred over opportunistic use. Concerns were expressed, however, about generating anxiety, time constraints, and widening inequalities. Conclusion Health behaviour change is complex and the provision of information alone is unlikely to have significant effects. Personalised risk tools may have a role, but important concerns about their use remain, particularly in areas of socioeconomic disadvantage.
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14
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Dhuria P, Lawrence W, Crozier S, Cooper C, Baird J, Vogel C. Women's perceptions of factors influencing their food shopping choices and how supermarkets can support them to make healthier choices. BMC Public Health 2021; 21:1070. [PMID: 34090410 PMCID: PMC8178895 DOI: 10.1186/s12889-021-11112-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/13/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To examine women's perceptions of factors that influence their food shopping choices, particularly in relation to store layout, and their views on ways that supermarkets could support healthier choices. DESIGN This qualitative cross-sectional study used semi-structured telephone interviews to ask participants the reasons for their choice of supermarket and factors in-store that prompted their food selections. The actions supermarkets, governments and customers could take to encourage healthier food choices were explored with women. Thematic analysis was conducted to identify key themes. SETTING Six supermarkets across England. PARTICIPANTS Twenty women customers aged 18-45 years. RESULTS Participants had a median age of 39.5 years (IQR: 35.1, 42.3), a median weekly grocery spend of £70 (IQR: 50, 88), and 44% had left school aged 16 years. Women reported that achieving value for money, feeling hungry, tired, or stressed, and meeting family members' food preferences influenced their food shopping choices. The physical environment was important, including product quality and variety, plus ease of accessing the store or products in-store. Many participants described how they made unintended food selections as a result of prominent placement of unhealthy products in supermarkets, even if they adopted more conscious approaches to food shopping (i.e. written or mental lists). Participants described healthy eating as a personal responsibility, but some stated that governments and supermarkets could be more supportive. CONCLUSIONS This study highlighted that in-store environments can undermine intentions to purchase and consume healthy foods. Creating healthier supermarket environments could reduce the burden of personal responsibility for healthy eating, by making healthier choices easier. Future research could explore the interplay of personal, societal and commercial responsibility for food choices and health status.
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Affiliation(s)
- Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
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15
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Blue S, Shove E, Kelly MP. Obese societies: Reconceptualising the challenge for public health. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1051-1067. [PMID: 33963575 DOI: 10.1111/1467-9566.13275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 06/12/2023]
Abstract
The prevalence of obesity and related health problems has increased sharply in recent decades. Dominant medical, economic, psychological, and especially epidemiological accounts conceptualise these trends as outcomes of individuals' lifestyles - whether freely chosen or determined by an array of obesogenic factors. As such, they rest on forms of methodological individualism, causal narratives, and a logic of substitution in which people are encouraged to set currently unhealthy ways of life aside. This article takes a different approach, viewing trends in obesity as consequences of the dynamic organisation of social practices across space and time. By combining theories of practice with emerging accounts of epigenetics, we explain how changing constellations of practices leave their marks on the body. We extend the concept of biohabitus to show how differences in health, well-being, and body shape are passed on as relations between practices are reproduced and transformed over time. In the final section, we take stock of the practical implications of these ideas and conclude by making the case for extended forms of enquiry and policy intervention that put the organisation of practices front and centre.
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Affiliation(s)
| | | | - Michael P Kelly
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
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16
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Exemplary medical care or Trojan horse? An analysis of the 'lifestyle medicine' movement. Br J Gen Pract 2021; 71:229-232. [PMID: 33926883 DOI: 10.3399/bjgp21x715721] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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17
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Affiliation(s)
- Theresa M Marteau
- Department of Public Health and Primary Care, Behaviour and Health Research Unit, University of Cambridge, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Michael Marmot
- Institute of Health Equity, University College London, UK
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18
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Stansfield J, South J, Mapplethorpe T. What are the elements of a whole system approach to community-centred public health? A qualitative study with public health leaders in England's local authority areas. BMJ Open 2020; 10:e036044. [PMID: 32847905 PMCID: PMC7451485 DOI: 10.1136/bmjopen-2019-036044] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of the study was to identify key elements of whole system approaches to building healthy communities and putting communities at the heart of public health with a focus on public health practice to reduce health inequalities. DESIGN A mixed-method qualitative study was undertaken. The primary method was semi-structured interviews with 17 public health leaders from 12 local areas. This was supplemented by a rapid review of literature, a survey of 342 members of the public via Public Health England's (PHE) People's Panel and a round-table discussion with 23 stakeholders. SETTING Local government in England. RESULTS Eleven elements of community-centred public health practice that constitute taking a whole system approach were identified. These were grouped into the headings of involving, strengthening, scaling and sustaining. The elements were underpinned by a set of values and principles. CONCLUSION Local public health leaders are in a strong position to develop a whole system approach to reducing health inequalities that puts communities at its heart. The elements, values and principles summarise what a supportive infrastructure looks like and this could be further tested with other localities and communities as a framework for scaling community-centred public health.
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Affiliation(s)
- Jude Stansfield
- Health Improvement Division, Public Health England, London, UK
- School of Health and Community Studies, Leeds Beckett University, Leeds, West Yorkshire, UK
| | - Jane South
- Health Improvement Division, Public Health England, London, UK
- School of Health and Community Studies, Leeds Beckett University, Leeds, West Yorkshire, UK
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19
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Rutter H, Horton R, Marteau TM. The Lancet-Chatham House Commission on improving population health post COVID-19. Lancet 2020; 396:152-153. [PMID: 32682466 PMCID: PMC7365625 DOI: 10.1016/s0140-6736(20)31184-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | | | - Theresa M Marteau
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK.
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20
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Preconception nutrition: building advocacy and social movements to stimulate action. J Dev Orig Health Dis 2020; 12:141-146. [PMID: 32419689 DOI: 10.1017/s2040174420000197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Action to improve preconception nutrition is a collective, societal responsibility. We believe that the Developmental Origins of Health and Disease (DOHaD) society is ideally placed to facilitate the development of a global agenda for preconception nutrition which recognises the societal importance of nutrition for young women and men, and supports them in optimising their nutritional status for the benefit of the next generation. In this paper, we outline four key actions that can be taken by the members of DOHaD's international society located across 67 countries, and nine regional societies, to demonstrate this leadership role. The recommended actions to place preconception nutrition at the top of national and regional agendas include (i) continuing to build the scientific evidence, (ii) monitoring of progress made by governments and commercial companies, (iii) developing advocacy coalitions that unite individuals and organisations around common policy options and (iv) working with partners to develop an emotive and empowering preconception nutrition awareness campaign. Collectively, these actions hold the potential to develop into a preconception nutrition social movement to invoke high-level government support and across-sector policy action, while raising public demand for action and engaging corporate actors.
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21
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The effect of income-based policies on mortality inequalities in Scotland: a modelling study. THE LANCET PUBLIC HEALTH 2020; 5:e150-e156. [PMID: 32113518 DOI: 10.1016/s2468-2667(20)30011-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/20/2019] [Accepted: 01/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The unequal distribution of income is a fundamental determinant of health inequalities. Decision making around economic policies could be enhanced by showing their potential health effects. We used scenario modelling to assess the effects of 12 income-based policies on years of life lost (YLL) and inequalities in YLL in Scotland for the 2017-21 period. METHODS In this modelling study, we used EUROMOD version H1.0+, a tax-benefit microsimulation model, to estimate the effects of hypothetical fiscal policies on household income for Scottish households in the 2014/15 Family Resources Survey (n=2871). The effects were modelled excluding housing costs. Income change from baseline was estimated for each quintile of the 2016 Scottish Index of Multiple Deprivation (SIMD) after weighting to account for differential non-response to the Family Resources Survey, and incomes were equivalised according to the Organisation for Economic Co-operation and Development's modified equivalence scale. A regression analysis of cross-sectional data was used to estimate the relationship between income change and all-cause mortality, followed up by a sensitivity analysis to account for uncertainties around the assumptions on effect size. Informing Interventions to reduce health Inequalities (Triple I), a health inequalities scenario modelling tool, was used to estimate policy effects on YLL and government spending after five years of theoretical implementation. The Triple I model used population estimates for 2016 stratified by sex, 5-year age group, and SIMD quintile, which were obtained from the National Records of Scotland. Preliminary estimates of relative policy costs were calculated from the EUROMOD-derived combined effects of each policy on tax bills, National Insurance contributions, and benefits receipts for Scottish households. FINDINGS Taxation-based policies did not substantially affect household incomes, whereas benefits-based policies had large effects across the quintiles. The best policy for improving health and narrowing health inequalities was a 50% increase to means-tested benefits (approximately 105 177 [4·7%] YLL fewer than the baseline of 2·2 million, and a 7·9% reduction in relative index of inequality). Effects on YLL and health inequalities were inversely correlated in response to changes in taxation policy. Citizen's Basic Income (CBI) schemes also substantially narrowed inequalities (3·7% relative index of inequality for basic scheme, 5·9% for CBI with additional payments for individuals with disability), and modestly reduced YLL (0·7% for the basic scheme and 1·4% with additional payments). The estimated government spending associated with a policy was proportional to its effect on YLL, but less closely related to its effect on inequalities in YLL. INTERPRETATION Policies that affect incomes could potentially have marked effects on health and health inequalities in Scotland. Our projections suggest that the most effective policies for reducing health inequalities appeared to be those that disproportionately increased incomes in the most deprived areas. Although modelling was subject to various assumptions, the approach can be useful to inform decisions around addressing the upstream determinants of health inequalities. FUNDING None.
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22
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Howick J, Kelly P, Kelly M. Establishing a causal link between social relationships and health using the Bradford Hill Guidelines. SSM Popul Health 2019; 8:100402. [PMID: 31193417 PMCID: PMC6527915 DOI: 10.1016/j.ssmph.2019.100402] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/25/2019] [Accepted: 04/19/2019] [Indexed: 11/27/2022] Open
Abstract
An abundance of evidence suggests that the size and quality of our social relationships improves humans' physical and mental health while increasing lifespan. However most of this evidence comes from observational rather than experimental (randomised trial) evidence, leaving open the possibility that the connection between social relationships and health could be associational rather than causal. However there are examples, including the link between smoking and lung cancer, where a cause was established without experimental evidence. This was sometimes achieved by looking at the totality of evidence, using the 'Bradford Hill Guidelines', which considers factors including the strength of association, reversibility, and evidence of a plausible mechanism. In this paper we apply the Bradford Hill Guidelines to the link between social relationships and health. We conclude that having strong and supportive social relationships causes better health and longer life. Beyond establishing that social relationships are a causal factor for health, the method we used here can be applied to other areas where randomised trials are unethical or not feasible.
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Affiliation(s)
- Jeremy Howick
- University of Oxford, Nuffield Department of Primary Care Health Science, Faculty of Philosophy, 32 Woodstock Road, Oxford, OX2 6GG, United Kingdom
| | - Paul Kelly
- University of Edinburgh, Sport, Physical Education and Health Sciences (SPEHS), Moray House School of Education, United Kingdom
| | - Mike Kelly
- University of Cambridge, Department of Public Health and Primary Care, United Kingdom
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23
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Kelly MP, Kriznik NM, Kinmonth AL, Fletcher PC. The brain, self and society: a social-neuroscience model of predictive processing. Soc Neurosci 2019; 14:266-276. [PMID: 29718764 PMCID: PMC6467179 DOI: 10.1080/17470919.2018.1471003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/25/2018] [Indexed: 11/22/2022]
Abstract
This paper presents a hypothesis about how social interactions shape and influence predictive processing in the brain. The paper integrates concepts from neuroscience and sociology where a gulf presently exists between the ways that each describe the same phenomenon - how the social world is engaged with by thinking humans. We combine the concepts of predictive processing models (also called predictive coding models in the neuroscience literature) with ideal types, typifications and social practice - concepts from the sociological literature. This generates a unified hypothetical framework integrating the social world and hypothesised brain processes. The hypothesis combines aspects of neuroscience and psychology with social theory to show how social behaviors may be "mapped" onto brain processes. It outlines a conceptual framework that connects the two disciplines and that may enable creative dialogue and potential future research.
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Affiliation(s)
- Michael P Kelly
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Natasha M. Kriznik
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Ann Louise Kinmonth
- Department of Public Health and Primary Care Institute of Public Health, Fellow St Johns College University of Cambridge, Cambridge, UK
| | - Paul C. Fletcher
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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24
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Towards a preventative approach to improving health and reducing health inequalities: a view from Scotland. Public Health 2019; 169:195-200. [DOI: 10.1016/j.puhe.2019.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 10/23/2018] [Accepted: 02/04/2019] [Indexed: 11/20/2022]
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25
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Cognitive biases in public health and how economics and sociology can help overcome them. Public Health 2019; 169:163-172. [PMID: 30879646 DOI: 10.1016/j.puhe.2019.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/16/2018] [Accepted: 02/04/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The objective of this study was to identify important gaps in the public health evidence base and consider the implications of these for public health and public health economics. STUDY DESIGN This was a review and critique of public health policy in the UK. METHODS Using two key psychological concepts relating to cognitive biases, viz. cognitive dissonance and heuristics, the shortcomings in public health approaches to confronting the prevalence of non-communicable diseases are described. The implications are drawn out. RESULTS Two cognitive biases in public health thinking are identified. (i) A dissonance between what is known and what is done, resulting in the repetition of solutions that have previously been shown to have had little or no effect. (ii) The habitual use of set of heuristics which mean that simple solutions to complex problems are preferred to undertaking the detailed assessment of how to bring about change. These biases mean that the evidence about the dynamics of populations and the ways that the mechanisms of prevention actually operate seldom feature in the way interventions, policy and practice are undertaken. The evidence base is consequently highly skewed. CONCLUSIONS Health economics combined with sociological reasoning has potentially an important role to play in developing the ideas that will overcome the problems attaching to the cognitive biases.
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26
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Anjum RL, Copeland S, Kerry R, Rocca E. The guidelines challenge-Philosophy, practice, policy. J Eval Clin Pract 2018; 24:1120-1126. [PMID: 30027569 DOI: 10.1111/jep.13004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/11/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Rani Lill Anjum
- Principal Investigator CauseHealth Project, Director Centre for Applied Philosophy of Science, Norwegian University of Life Sciences, Ås, Norway
| | - Samantha Copeland
- CauseHealth Project, Centre for Applied Philosophy of Science, Norwegian University of Life Sciences, Ås, Norway
| | - Roger Kerry
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Elena Rocca
- CauseHealth Project, Centre for Applied Philosophy of Science, Norwegian University of Life Sciences, Ås, Norway
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