Search

Background Alcohol increases cancer risk, but less is known about public awareness of this link. This scoping review summarizes recent findings on the public awareness of alcohol as a cancer risk factor in European Union and UK. Methods Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched for papers containing data on awareness of alcohol as cancer risk factor in EU or UK published between January 2017 and December 2022, and complemented with grey literature searches. Results In total, 45 studies were included covering 18 EU countries (Austria, Belgium, Cyprus, Czechia, Denmark, Finland, France, Germany, Hungary, Ireland, Italy, Netherlands, Poland, Romania, Slovakia, Slovenia, Spain, Sweden) and UK, presenting data collected between 2009 and 2022. Studies covered general population (17 studied a nationally representative sample), women, health professionals, patients and young people. Awareness of alcohol causing cancer in general was higher and studied more often than awareness of alcohol's impact on specific cancers. Among the EU general population, awareness of the link between alcohol and breast cancer ranged between 10% and 20%, head and neck cancer 15–25%, colorectal and oesophagus cancer 15–45% and liver cancer 40%. Awareness was higher among young people and specialized health professions and lower among women (the latter specifically for the breast cancer). Conclusions While awareness rates varied depending on the exact question wording, many studies showed low awareness of the alcohol-cancer link, especially for specific types such as breast and colon cancer. Public should be better informed about alcohol consumption-related cancer risk. [ABSTRACT FROM AUTHOR]

This article reports and reflects on an element of a recent survey of UK public health professionals, specifically in relation to the Public Health Knowledge and Skills Framework (PHSKF) and the ethical requirements that underpin public health practice. Only 38.4% of respondents reported accessing the PHKSF and a mere 13.7% reported accessing the accompanying background paper on ethical public health practice. Given that ethical practice underpins the PHSKF, it is concerning that so few respondents are familiar with the PHSKF and one of the source documents. While issuing frameworks and guidance is one way to support public health practice, there is a further need for greater integration of skills and knowledge around ethical public health practice within education and training initiatives. [ABSTRACT FROM AUTHOR]

Background Lowering the strength of alcohol products could lead to less alcohol being bought and drunk. In its prevention White Paper, the UK Government aims to promote a significant increase in the availability of alcohol-free and low-alcohol products by 2025. Methods Through descriptive analysis and ARIMA modelling of >4 million alcohol purchases from 69 803 British households, we study the potential impact of lower strength alcohol products in reducing household purchases of grams of alcohol over 2015–2019. Households are divided into predominantly beer, wine or spirits purchasers. Results Over 5 years, there were decreases in purchases of grams of alcohol within beer amongst beer-purchasing households and increases in purchases of grams of alcohol within wine and spirits amongst, respectively, wine- and spirits-purchasing households. Almost all the changes were due to beer-purchasing households buying less regular strength beer, and wine and spirits-purchasing households buying, respectively, more regular strength wine and spirits, rather than increases in purchases of no- and low-alcohol products. Conclusions In general, lower strength alcohol products have not contributed to British households buying fewer grams of alcohol over the 5-year follow-up period during 2015–2019. [ABSTRACT FROM AUTHOR]

Generating negative news coverage of state welfare provision has been identified as a strategy designed to create public support for radical policies aimed to reduce such provision. To date, research of this kind has focused on scandals and crises. However, little is known about the complex relationship between media representations of specific events, and those of media representations in the lead up to these events, what we refer to as periphery representations. Employing a content and frame analysis, this paper analyses the frequency and intensity of peripheral representations of the National Health Service (NHS) in the British print media for 1 week a month before and for 1 week during three key events in recent NHS history: the official consultation period for the Health and Social Care Act; the publication of Five-Year Forward View, and the first Junior Doctor Strike. This article finds that negative NHS representations in articles that are peripheral to particular topical issues of controversy evidence fluctuations, amplifications and intensities across time periods, depending on the particular context. The paper concludes by arguing that repetition of negative themes in news helps to build a sensibility of 'inadequacy' of vital services. We hope that this focus on the ways in which amplifications and de-amplifications in negative intensity of peripheral NHS representations across time and content, helps to contribute to debate about the complex interplay between public health services, media representation and policy consent. [ABSTRACT FROM AUTHOR]

The current COVID-19 pandemic confines people to their homes, disrupting the fragile social fabric of deprived neighbourhoods and citizen's participation options. In deprived neighbourhoods, community engagement is central in building community resilience, an important resource for health and a prerequisite for effective health promotion programmes. It provides access to vulnerable groups and helps understand experiences, assets, needs and problems of citizens. Most importantly, community activities, including social support, primary care or improving urban space, enhance health through empowerment, strengthened social networks, mutual respect and providing a sense of purpose and meaning. In the context of inequalities associated with COVID-19, these aspects are crucial for citizens of deprived neighbourhoods who often feel their needs and priorities are ignored. In this perspectives paper, illustrated by a varied overview of community actions in the UK and The Netherlands, we demonstrate how citizens, communities and organizations may build resilience and community power. Based on in-depth discussion among the authors we distilled six features of community actions: increase in mutual aid and neighbourhood ties, the central role of community-based organizations (CBOs), changing patterns of volunteering, use of digital media and health promotion opportunities. We argue that in order to enable and sustain resilient and confident, 'disaster-proof', communities, areas which merit investment include supporting active citizens, new (digital) ways of community engagement, transforming formal organizations, alignment with the (local) context and applying knowledge in the field of health promotion in new ways, focussing on learning and co-creation with citizen initiatives. [ABSTRACT FROM AUTHOR]

In the UK, domestic abuse has shifted from the margins to the mainstream, and is now firmly established as an important public policy issue. This paper is concerned with how domestic abuse is constructed in public policy, particularly in the realms of safeguarding children and public health. These issues are examined through a Foucaldian theoretical lens which draws attention to the discursive constructions of social problems and how they are managed under conditions of governmentality, and presents a line of analysis rarely applied to domestic abuse. The paper illustrates how health and social care professionals come to know about domestic abuse affecting women and children through techniques of surveillance; this includes routine inquiry in health care, police notifications to children's social care and risk assessment used by MARACs (Multi Agency Risk Assessment Conferences). The emphasis upon identification has increased awareness of the problem, but questions remain on whether the safety and support of women and children affected by domestic abuse has improved. Moreover, these developments have taken place amidst resource constraints which create a challenging context for delivering effective services for women and children. [ABSTRACT FROM PUBLISHER]

Background This paper presents the results of an exercise to scope the potential of a virtual network to support dissemination, collaboration and innovation among the UK research community on the topic of 'work and health and well-being'. Methods Through a search of the literature and internet searches, a database of 333 individuals and 10 organizations (stakeholders) was developed to whom an online questionnaire was sent. The questionnaire scoped the potential of a virtual network on work and health and well- being. We compared respondents' aspirations for a network with the critical management literature examining the core conditions under which networks work best. Results We identified 1435 papers, published since 2008. In the UK, 333 individuals and 10 organizations were identified as working within the broad topic of Work and Health and Well-being. Of the 110 (a 34% response) responses to our online questionnaire, the majority (80%, n = 88) stated they would be interested in joining a virtual network. Conclusions Respondents indicated a willingness to engage with the network. They had a range of ideas regarding how a network could operate, which broadly match the conditions that support network effectiveness. A virtual-enabled network would be best supplemented by opportunities for face-to-face interaction. [ABSTRACT FROM AUTHOR]

Modern slavery is crime of extreme exploitation. It includes the use of coercion, force, deception and abuse of vulnerability for such purposes as trafficking, labour, sexual exploitation, forced criminal activity and domestic servitude. It is a topic of growing interest in the UK and beyond as it has emerged as an issue of considerable scale and consequence. To date, debates have been dominated by a law enforcement perspective. Less apparent has been an articulation of the implications of modern slavery for the health sector. This is despite growing evidence of the dire physical and mental health consequences for survivors. This paper addresses this gap by examining a series of issues relevant to UK health systems. After describing what is modern slavery and the nature of the problem, we identify how the health sector has responded to date. We then articulate how health services and public health can more coherently and systematically meet the challenges of modern slavery through policy and practice. Finally, we present a call for the health sector to position itself as a central to the wellbeing of survivors and as a fundamental ally in modern slavery prevention. [ABSTRACT FROM AUTHOR]

In response to the SARS-CoV-2 coronavirus pandemic the UK government has passed the Coronavirus Act 2020 (CA). Among other things, this act extends existing statutory powers to impose restrictions of liberty for public health purposes. The extension of such powers naturally raises concerns about whether their use will be compatible with human rights law. In particular, it is unclear whether their use will fall within the public heath exception to the Article 5 right to liberty and security of the person in the European Convention of Human Rights. In this paper, I outline key features of the CA, and briefly consider how the European Court of Human Rights has interpreted the public health exception to Article 5 rights. This analysis suggests two grounds on which restrictions of liberty enforced some under the CA might be vulnerable to claims of Article 5 rights violations. First, the absence of specified time limits on certain restrictions of liberty means that they may fail the requirement of legal certainty championed by the European Court in its interpretation of the public health exception. Second, the Coronavirus Act's extension of powers to individuals lacking public health expertise may undermine the extent to which the act will ensure that deprivations of liberty are necessary and proportionate. [ABSTRACT FROM AUTHOR]

Background Physical inactivity rates have remained high worldwide since 2001. Public policies are an essential upstream lever to target individual physical activity (PA) behaviour. However, implementers have different strategies and face implementation challenges that are poorly understood. The present study analyzes the implementation processes of public policies to promote PA in terms of: (i) the policies covered and their legal quality, (ii) the actors and stakeholders involved in the implementation process and (iii) the used implementation strategies (vertical, horizontal or a mix). Methods A scoping review was systematically conducted (registered Open Science Framework: osf.io/7w84q/), searching 10 databases and grey literature until March 2022. Of the 7741 titles and abstracts identified initially, 10 studies were included. Results The current evidence includes high-income countries (USA, n  = 7; UK, New Zealand and Oman, n  = 1 each). Policy areas covered are education (school sector) and PA promotion in general (national PA plans or city-wide approaches). The legal classification ranges from laws (school sector) to coordination and budgeting to non-legally binding recommendations. The jurisdictions covered were federal (n  = 4), state (n  = 1), county (n  = 1), school district (n  = 1) and city (n  = 3). Implementation strategies for city-wide approaches are characterized by a coordinated approach with vertical and horizontal integration; federal PA policies by a mix of implementation strategies; and the school sector by a strict horizontal top-down integration without the involvement of other actors. Conclusion Implementation strategies differ by policy field. Therefore, continuous evaluation of the implementation process is necessary to align policy implementation with policy goals to promote individual PA behaviour. [ABSTRACT FROM AUTHOR]

The article discussed COVID-19 pandemic responses among select ASEAN countries. Topics discussed include actions that helped save lives in UK during Covid-19, vaccination detail of ASEAN countries with Singapore vaccinating 28.8% of its people, followed by Cambodia at 10.6%, and importance of plan-do-study-act (PDSA) cycle for countries with developing economies to strategically prepare and craft response plans for future disease outbreaks.

The article discusses excess deaths that were not correctly diagnosed and reported during Covid-19 in Philippines. Topics discussed include WHO estimates of undercount of total deaths directly and indirectly attributed to COVID-19, The Economist report on Malaysia, Thailand and the Philippines showing negative excess mortality, fewer deaths than normal days, and importance of, accurate and timely data in public health decision-making.

The article offers a few comments on the interesting paper ‘Responsibility, Prudence and Health Promotion' by Brown, Maslen and Savulescu. Topics include the development of NCDs is powerfully influenced by social and environmental forces beyond an individual's direct control, and the undue emphasis on individuals ‘taking responsibility' for making healthy choices is unethical, sometimes stigmatizing and always unscientific.

Background Public health leadership has been criticized as being ineffective. The public health profession is relatively small. Critics have argued that there is over-emphasis on technical aspects and insufficient use of the ‘community as a source of public health actions’. Methods The paper analyses the resources, motivations and skills utilized by high-profile individuals who have made contributions to the public health agenda. The phenomenon of celebrity diplomacy is critiqued. Two exemplars are discussed: Jamie Oliver and Michael Bloomberg. The risks of involving celebrities are also considered. Results Leaders for public health demonstrate ‘a paradoxical blend of personal humility and professional will’ to make the ‘right decisions happen’. While they may have ego or self-interest, in this context, at least, they channel their ambition for the public health cause, not themselves. Conclusions Leaders from outside public health may have no understanding of what public health is nor consider their work as part of a wider public health agenda. It is important to understand why they become leaders for public health. This will inform a strategy for how others may be encouraged to collaborate for public health causes. Some key points for working with high-profile leaders for public health are identified. [ABSTRACT FROM AUTHOR]

This paper presents and analyses the poem 'Tea and Bread'. It is about content and process, about a struggle for survival as an asylum seeker in a UK city and about exploring poetic transcription, as pioneered by sociologist Laurel Richardson, as representational practice in public health. The asylum seeker, known by the pseudonym of Peter, was interviewed as part of a project to compare the destitution of the past with that of today. [ABSTRACT FROM AUTHOR]

The article discusses tackling inequalities and the challenges associated with achieving health equity globally. Topics include historical perspectives on inequality; the persistence of inequalities over time and the British government's approach to addressing inequality; and the importance of social determinants of health.

Background Community pharmacies are an important setting for the provision of preventative health services in the UK. There has been debate over the value of delivering routine immunizations in a pharmacy setting, though government policy supports this initiative and in 2015 the first nationally commissioned community pharmacy vaccination service was launched for seasonal influenza vaccination. The impact of these vaccination services needs to be evaluated to inform future policy. Methods We conducted a comprehensive review of peer-reviewed studies and unpublished evaluations of community pharmacy-based vaccination services implemented in the UK between 2000 and 2015. We assessed evidence of their impact on acceptability, uptake, cost-effectiveness and addressing inequalities. Results We identified 28 evaluations of pharmacy immunization programmes in the UK, only three of which were published in peer-reviewed journals. These showed no evidence of increased vaccination uptake, and weak evidence of widening access to individuals who had not previously been vaccinated. There was good evidence that pharmacies were acceptable and convenient venues for vaccination. Cost-effectiveness was not assessed in any of the included studies. Conclusions Our review challenges an assumption that pharmacy provision of immunizations will simultaneously improve patient choice, increase uptake and widen access. These are important findings for policy makers. [ABSTRACT FROM AUTHOR]

Aim To examine trends in public awareness and knowledge of drinking guidelines in the UK since their revision in 2016, which had moved from a daily to a weekly guideline, made the guideline the same for men and women, and reduced the guideline for men by around one-third. Method Data were from a representative, repeat cross-sectional survey. We analysed changes in awareness and knowledge of drinking guidelines among 8168 adult drinkers between 2016 and 2022 and associations with sociodemographic characteristics, smoking status and level of alcohol consumption. Results The proportion of drinkers aware of guidelines declined from 86.0% (95%CI 84.0–88.0%) in 2016 to 81.7% (79.5–84.0%) in 2019, then increased during the COVID-19 pandemic, peaking at 91.6% (90.1–93.1%) in 2020. The proportion who correctly identified the guideline as a maximum of exactly 14 units/week remained at around a quarter from 2016 (25.0%, 22.4–27.5%) to 2018 (25.8%, 23.2–28.3%), whereas the proportion who gave a figure of 14 units or fewer rose from 52.1 (49.2–55.0%) to 57.4% (54.6–60.3%). However, by 2022, guideline knowledge had worsened significantly, with these figures falling to 19.7 (17.4–21.9%) and 46.5% (43.6–49.4%), respectively. Changes over time were similar across subgroups. Odds of guideline awareness and knowledge were higher among drinkers who were aged ≥35, female, more educated and from more advantaged social grades. Conclusions The majority of adult drinkers in the UK are aware of low-risk drinking guidelines. However, 6 years since their announcement, knowledge of the revised drinking guidelines remains poor. Less than a quarter know the recommended weekly limit and only around half think it is 14 units or less. Inequalities have persisted over time, such that disadvantaged groups remain less likely to know the guidelines. [ABSTRACT FROM AUTHOR]

In an editorial, the editors note how crucial the role is of public health activism in enforcing efficient and effective public health management. The government is the lead institution in any national response to the pandemic and to ensure transparency on its end, it is important for any network of health organizations and associations not to shy away from embracing an activist role. In this correspondence, the author explores the case of the Alliance of Health Workers, a union of government and private health workers, and its advocacy towards an empowered status of healthcare professionals in the Philippines. [ABSTRACT FROM AUTHOR]

In 2021, during a drug-related death crisis in the UK, the Government published its ten-year drugs strategy. This article, written in collaboration with the Faculty of Public Health and the Association of Directors of Public Health, assesses whether this Strategy is evidence-based and consistent with international calls to promote public health approaches to drugs, which put 'people, health and human rights at the centre'. Elements of the Strategy are welcome, including the promise of significant funding for drug treatment services, the effects of which will depend on how it is utilized by services and local commissioners and whether it is sustained. However, unevidenced and harmful measures to deter drug use by means of punishment continue to be promoted, which will have deleterious impacts on people who use drugs. An effective public health approach to drugs should tackle population-level risk factors, which may predispose to harmful patterns of drug use, including adverse childhood experiences and socioeconomic deprivation, and institute evidence-based measures to mitigate drug-related harm. This would likely be more effective, and just, than the continuation of policies rooted in enforcement. A more dramatic re-orientation of UK drug policy than that offered by the Strategy is overdue. [ABSTRACT FROM AUTHOR]

Background Public Health registrars (SpRs) were an important component of the workforce that contributed to the COVID-19 response. This study explores their contribution and the impact the early stages of the pandemic had on their learning and training. Methods Data were collected from SpRs in the London and Kent, Surrey, Sussex training programme between July and September 2020 through a mixture of questionnaires and semi-structured interviews. A thematic analysis of interview transcripts was undertaken to identify themes. Results 35/128 SpRs responded to the survey and 11 were interviewed. SpRs were placed across a range of organizations and made a significant contribution to the COVID-19 response. Overall, SpRs learned important skills but working on the response may for some have impacted negatively on training. A number of facilitators and barriers to learning were identified. Conclusion The study findings highlight the opportunities for learning created by the pandemic. However, changing projects and the desire of SpRs to contribute to the response meant the impacts on training were mixed. Future deployment of SpRs should consider the balance of responsibility and pace when delegating work, as well as the need to supervise effectively and support remote working to maintain good mental wellbeing. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has created immense challenges for governments in their management of the public health response and tested the limits of public law. This article undertakes a comparative analysis of the common law jurisdictions of the United Kingdom, New Zealand, and Australia. It discusses the imposition of 'stay at home' restrictions pursuant to public health legislative frameworks, focusing on judicial scrutiny in the context of statutory interpretation. It examines the appellate cases of R (Dolan) v Secretary of State for Health and Social Care [2021] 1 WLR 2326, Borrowdale v Director-General of Health [2022] 2 NZLR 356, and Kassam v Hazzard (2021) 106 NSWLR 520. Using these case studies, this article seeks to reveal key themes and implications for public law. What approaches have the courts adopted to construe public health emergency powers? How have the courts treated 'rights-based' principles of statutory interpretation? Have the courts approached interpretation in the usual manner or displayed an unorthodox level of deference to other branches of government? The article concludes on what implications the judicial approaches have for the interpretation of emergency powers in the future. [ABSTRACT FROM AUTHOR]

Background Public Health England developed and led a new UK-wide pledge campaign aiming to improve behaviours around the prudent use and prescription of antibiotics. This paper presents a process evaluation for the first season of the campaign to determine the impact of the campaign and inform future campaigns. Methods Data were collected from AntibioticGuardian.com and Google analytics between August 2014 and January 2015. The primary outcome was the decision to pledge and was assessed according to target audience, location, source and route of referral to the website. Results There were 47 158 unique visits to the website and 12 509 visitors made a pledge (26.5%) to become Antibiotic Guardians (AGs); 69% were healthcare professionals. Social media directed the most traffic to the website (24% of the public that signed up cited social media as how they discovered the campaign), other acquisition routes such as self-directed, email or website referral, were more effective at encouraging visitors to pledge. Conclusions The campaign completed its goal of 10 000 AGs in the first year. Further work is required to improve engagement with target audiences and determine whether this campaign has an impact on antibiotic consumption and prescribing behaviour among the public and healthcare professionals. [ABSTRACT FROM AUTHOR]

Clinical knowledge and experience, and demographic changes, indicated the need to ensure provision of adequate ‘psychogeriatric’ services to provide treatment for mentally ill older people (generally over 65 years). Various factors influenced the provision of these services, including politics, economics and stereotypical negative attitudes towards older people. Clinicians successfully led service developments, often unsupported by central government and local health authorities, despite benefits being noted in the localities where services were established. In 1989, services were available to most of the population of England and the Department of Health officially recognised psychogeriatrics as a medical specialty. [ABSTRACT FROM AUTHOR]

Introduction or background Life expectancy is an important summary measure of population health. In the absence of a significant event like war or disease outbreak, trends should, and historically have, increase over time, albeit with some fluctuations. Sources of data Data were extracted from the human mortality database for life expectancy at birth and age 65 years from 1980 to the latest available year for England & Wales, Scotland (Great Britain), France, Spain, Italy, the Netherlands and Germany. Areas of agreement It is well established that life expectancy improvements in Great Britain have stalled in recent years, and that a similar stalling was seen in other high-income countries during the mid-2010s. Areas of controversy The significance and causes of the slowdown in improvement in life expectancy in Britain are disputed. First, was Britain's slowdown in progress in life expectancy in the 2010s a deviation 'from' earlier sustained improvements or simply returning to normal (slower) improvement rates following faster gains in the 2000s? Second, did other European countries have slowdowns comparable to that in Britain? Growing points Life expectancy, as a summary measure, conceals inequalities. Other measures, such as lifespan disparity, complement it in understanding changing trends. While annual fluctuations in life expectancy are expected, continued stalls should raise concern. The three British nations examined were the only ones among these European countries to experience stalling of life expectancy gains in both sexes. Areas timely for developing research While it is clear that Britain is making less progress in health than similar countries, more research is needed to explain why. [ABSTRACT FROM AUTHOR]

Introduction Economic evaluation has an important role to play in the demonstration of value for money of early childhood public health interventions; however, concerns have been raised regarding their consistent application and relevance to commissioners. This systematic review of the literature therefore aims to collate the breadth of the existing economic evaluation evidence of these interventions and to identify the approaches adopted in the assessment of value. Source of data Recently published literature in Medline, EMBASE, EconLit, Health Management Information Consortium, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Health Technology Assessment, NHS EED and Web of Science. Areas of agreement The importance of the early childhood period on future health and well-being as well as the potential to impact health inequalities making for a strong narrative case for expenditure in early childhood public health. Areas of controversy The most appropriate approaches to evaluating value for money of such preventative interventions relevant for UK decision-makers given the evident challenges. Growing points The presented review considered inconsistencies across methodological approaches used to demonstrate value for money. The results showed a mixed picture in terms of demonstrating value for money. Areas timely for developing research Future resource allocations decisions regarding early childhood public health interventions may benefit from consistency in the evaluative frameworks and health outcomes captured, as well as consistency in approaches to incorporating non-health costs and outcomes, incorporating equity concerns and the use of appropriate time horizons. [ABSTRACT FROM AUTHOR]

The speciality, Public Health Medicine (PHM), was developed in response to political and health realities in pre-apartheid South Africa (SA), following the lead of the discipline in Britain, SA's previous coloniser. This article describes a 47-year journey from its origins as Community Health through to current practice, based on reviews of archival material, databases of institutional stakeholders involved in trainee education and our own experiences. Embedded throughout PHM's history are tensions between colonial forms of public health education and practice and resistance to these. As found in complementary SA research, and globally, this review shows that concerns about unclear roles, inadequate career paths and professional boundaries have preoccupied and are innate to the speciality. To be institutionalised more definitively in SA, PHM needs to demonstrate its value as a key resource for the functioning of SA's health system and thus improve the health status of her population. [ABSTRACT FROM AUTHOR]

The article offers information on a study regarding association between alcohol use and long-term cognitive decline in middle and late life. Topics discussed include determination of alcohol as a neurotoxin; impact of alcohol over cerebral health; and use of restricted cubic spline models in epidemiological studies of critical public health importance.

Improvements in life expectancy at birth in the UK had stalled prior to 2020 and have fallen during the COVID-19 pandemic. The stagnation took place at a time of relatively high net migration, yet we know that migrants to Australia, the USA and some Nordic countries have positively impacted national life expectancy trends, outperforming native-born populations in terms of life expectancy. It is important to ascertain whether migrants have contributed positively to life expectancy in the UK, concealing worsening trends in the UK-born population, or whether relying on national life expectancy calculations alone may have masked excess mortality in migrant populations. We need a better understanding of the role and contribution of migrant populations to national life expectancy trends in the UK. [ABSTRACT FROM AUTHOR]

Background: This study explores the implications of the UK Department of Health's intention to introduce charging for undocumented migrants for primary health care. Methods: Following a background review of relevant recent literature, 12 in-depth qualitative interviews were conducted with experts on vulnerable populations in England and/or the English health care system, in collaboration with Doctors of the World UK. Data were analysed qualitatively using thematic coding and framework analysis. Results: Stakeholders were concerned that implementing charging for migrants in England could deter medically necessary treatment, leading to threats to public health and increased health care costs. Interviewees identified potential challenges and opportunities provided by the Health and Social Care Act 2012 to improve health care for migrants. Conclusions: There are considerable concerns about adverse consequences of implementing charges for undocumented migrants. It will be essential to evaluate the effects of this policy once it is implemented. [ABSTRACT FROM AUTHOR]

Background The proportion of media sports coverage devoted to women is reported at between 1 and 6%. Our survey examines and compares reporting patterns before and after the 2012 Olympics and Paralympics. Methods We collected data on sports coverage in six national newspapers on 3 weekend days in February and March 2012, and in February 2013; ∼5 months before the opening of the 2012 Olympic Games and 5 months after the closing of the Paralympic Games. Results In 2012, 39 of 876 articles in national newspapers (4.5%) related to women's sports, compared with 22 of 755 (2.9%) in 2013; a non-significant reduction in coverage [difference 1.54%, 95% confidence interval (CI) −0.28 to 3.36). In 2012, 24 of 647 pictures (3.7%) related to women's activities, compared with 10 of 738 (1.4%) in 2013; a significant reduction in coverage (difference 2.35%; 95% CI 0.68–4.03). The median area per article was significantly greater for men in both years. Conclusions We found a continuing bias towards men's sport in the media analysed and no evidence of improvement either before or after the 2012 Olympics and Paralympics. Increased support of women's sport in the print media could benefit individuals and influence the health of the population. [ABSTRACT FROM PUBLISHER]

Background Medical tourism is a growing phenomenon. This review of the literature maps current knowledge and discusses findings with reference to the UK National Health Service (NHS). Methods Databases were systematically searched between September 2011 and March 2012 and 100 papers were selected for review. Results The literature shows specific types of tourism depending on treatment, eg, dentistry, cosmetic, or fertility. Patient motivation is complex and while further research is needed, factors beyond cost, including availability and distance, are clearly important. The provision of medical tourism varies. Volume of patient travel, economic cost and benefit were established for 13 countries. It highlights contributions not only to recipient countries' economies but also to a possible growth in health systems' inequities. Evidence suggests that UK patients travel abroad to receive treatment, complications arise and are treated by the NHS, indicating costs from medical travel for originating health systems. Conclusion It demonstrates the importance of quality standards and holds lessons as the UK and other EU countries implement the EU Directive on cross-border care. Lifting the private-patient-cap for NHS hospitals increases potential for growth in inbound medical tourism; yet no research exists on this. Research is required on volume, cost, patient motivation, industry, and on long-term health outcomes in medical tourists. [ABSTRACT FROM AUTHOR]

Background Increasing the price of alcohol reduces alcohol consumption and harm. The role of food complementarity, transaction costs and inflation on alcohol demand are determined and discussed in relation to alcohol price policies. Methods UK Biobank (N  = 502,628) was linked by region to retail price quotes for the years 2007 to 2010. The log residual food and alcohol prices, and alcohol availability were regressed onto log daily alcohol consumption. Model standard errors were adjusted for clustering by region. Results Associations with alcohol consumption were found for alcohol price (β  = −0.56, 95% CI, −0.92 to −0.20) and availability (β  = 0.06, 95% CI, 0.04 to 0.07). Introducing, food price reduced the alcohol price consumption association (β  = −0.26, 95% CI, −0.50 to −0.03). Alcohol (B  = 0.001, 95% CI, 0.0004 to 0.001) and food (B  = 0.001, 95% CI, 0.0005 to 0.0006) price increased with time and were associated (ρ  = 0.57, P  < 0.001). Conclusion Alcohol and food are complements, and the price elasticity of alcohol reduces when the effect of food price is accounted for. Transaction costs did not affect the alcohol price consumption relationship. Fixed alcohol price policies are susceptible to inflation. [ABSTRACT FROM AUTHOR]

To explore how Experts by Experience (EbyE) conceptualize key priorities for preventing and reducing gambling-related harm in the United Kingdom (UK). To identify barriers and facilitators to EbyE engagement in decisions for gambling research, education, treatment (RET) and policy development. Qualitative study utilizing semi-structured interviews with 20 participants from the UK between March and July 2020. Gamblers aged 29–60 years who self-reported that they had experienced gambling-related harm, and who actively used their experiences to inform strategies to prevent and reduce gambling-related harm in the UK. Participants were motivated to: advocate for gambling reform, and raise awareness of their experiences of gambling addiction or disorder. Gambling regulation was described as not adequately keeping pace with gambling industry practices, with initiatives needed to prevent the harms associated with product design, how individuals engaged with products and marketing practices. The reliance on voluntary contributions by the gambling industry for RET was perceived as a potential barrier to reform. Participants recommended new independent structures which engaged EbyE in meaningful ways in contributing to decision-making. An independent body run by and for EbyE was one mechanism that participants perceived could represent the voices of those impacted by gambling-related harm. Individuals with a lived experience of gambling-related harm, including affected social network members, bring a range of unique experiences and perspectives, and should be seen as valuable stakeholders in co-producing strategies to prevent and reduce gambling-related harm. [ABSTRACT FROM AUTHOR]

Background Knife-related violence is of growing concern in the UK. This study aims to investigate the impact of the COVID-19 pandemic on the frequency of penetrating injuries at a UK major trauma centre. Methods This was a retrospective study comparing the number of patients attending the emergency department of King's College Hospital (KCH) with a penetrating injury (gunshot or stab wound) during the 'pandemic year' (1 March 2020–28 February 2021) compared with the equivalent time period in the previous year. Penetrating injuries as a result of self-harm were excluded. The primary outcome was to assess whether there were any changes to the frequency of presentations during three periods of national lockdowns. Results Lockdown 1 showed a 48.45% reduction in presentations in the 'pandemic year' compared to the previous year, lockdown 2 showed a 31.25% reduction; however, lockdown 3 showed an 8.89% increase in the number of presentations. Conclusion Our findings suggest that despite the initial reduction in the number of presentations of penetrating injury during lockdown 1, this returned to normal levels by lockdown 3. Further research is required to understand the effects of government-imposed restrictions on interpersonal violence and identify appropriate methods of outreach prevention during a pandemic. [ABSTRACT FROM AUTHOR]

An editorial is presented on the most important public health issue for decades that public health can actually affect and have not yet seen the full impact across the world. Topics inlcude the media in the Great Britain during May 2020 has seemed to have adopted the attitude regarding everything that was being done, the childcare arrangements of a government advisor, and showing Remdesivir has shortened serious illness has unreported despite to become seriously ill with COVID-19 infection.

Background Exposure to tobacco and alcohol content in media is a risk factor for smoking and alcohol use in young people. Our previous research suggested that tobacco and alcohol imagery is common in soap operas. We now report an analysis of tobacco and alcohol content in a sample of soap operas broadcast in the UK. Methods We used 1-minute interval coding to quantify tobacco and alcohol content in all episodes (including advertisement breaks) of six soap operas broadcast on UK television during three separate weeks in November and December 2018 and January 2019. Results We coded 2222 intervals from 87 episodes and 360 intervals from 77 advertisement breaks. Tobacco content was rare, occurring in 4% of all intervals across 30% of episodes, the only tobacco appearances in adverts appeared in anti-smoking advertising. Alcohol occurred in 24% of intervals across 95% of episodes and in 13% of advertisement intervals. The programmes delivered ~381.28 million tobacco and 2.1 billion alcohol gross impressions to the UK population, including 18.91 million tobacco and 113 million alcohol gross impressions to children. Conclusion Whilst tobacco was rare, alcohol content was common, resulting in billions of viewer impressions. Soap operas represent a potential driver of alcohol consumption in young people. [ABSTRACT FROM AUTHOR]

This work proposes a novel framework for planning the capacity of diagnostic tests in cancer pathways that considers the aggregate demand of referrals from multiple cancer specialties (sites). The framework includes an analytic tool that recursively assesses the overall daily demand for each diagnostic test and considers general distributions for both the incoming cancer referrals and the number of required specific tests for any given patient. By disaggregating the problem with respect to each diagnostic test, we are able to model the system as a perishable inventory problem that can be solved by means of generalized G/D/C queuing models, where the capacity |$C$| is allowed to vary and can be seen as a random variable that is adjusted according to prescribed performance measures. The approach aims to provide public health and cancer services with recommendations to align capacity and demand for cancer diagnostic tests effectively and efficiently. Our case study illustrates the applicability of our methods on lung cancer referrals from UK's National Health Service. [ABSTRACT FROM AUTHOR]

Background Illegal high interest lending or 'loan sharking' exploits the vulnerable and has profound negative impacts on individuals and communities. The 2008 UK financial crash and subsequent austerity programme coupled with changes in the consumer credit market have fuelled an increase in predatory lending. Methods The study is a descriptive analysis of demographic, financial, health and behavioural data on 753 victims (2011–2017). A review of the causative factors and potential political, economic and public health responses is analysed. Results Most victims were female but males were considerably more indebted. Illegal loans are largely taken out for routine living expenses and over 70% of victims reported other serious debts. Victims are disproportionately poor, unemployed and on benefits but fewer than half have had financial or benefits advice. Despite 90% reporting they would not borrow illegally again, 30% had previously done so from the same shark and over half considered them a friend. Conclusions The increase in loan sharking has coincided with the withdrawal of traditional sub-prime lenders and local welfare assistance schemes, and the low penetration of Credit Unions in many areas. Conventional perceptions of loan sharks and their relationships with victims are largely incorrect. A range of coordinated financial, political and social interventions is required. [ABSTRACT FROM AUTHOR]

An inter-war analysis of the British and Australian departments charged with compensating disabled First World War veterans and the British ex-service migrant in inter-war Australia illustrates how nation-states have failed to unify welfare and disability rehabilitation. Contemporary welfare states continue to codify and establish categories of prioritisation regarding communities with disabilities for public finance administered by national government departments. This binational case study identifies reoccurring type one and type two error problems: policy can deny legitimate claims for state assistance while also validating and financing potentially illegitimate claims. This underlines the factors that dictate which error type is ruled to be the least significant and the impact the resulting model has on individual claimants. This study reinforces the thesis of David Gerber who stresses the ahistorical centrality of 'biopolitics' or the relationship between societal and political perceptions of a conflict on state policy, in the treatment of veteran communities. [ABSTRACT FROM AUTHOR]

Background: COVID-19 pandemic has had a major impact globally, with older people living in aged care homes suffering high death rates.Objectives: We aimed to compare the impact of initial government policies on this vulnerable older population between the UK and Australia during the first wave of attack.Methods: We searched websites of governments in the UK and Australia and media outlets. We examined the key policies including the national lockdown dates and the distribution of some important resources (personal protective equipment and testing) and the effects of these initial policies on the mortality rates in the aged care homes during the first wave of attack of COVID-19.Results: We found that both countries had prioritized resources to hospitals over aged care homes during the first wave of attack. Both countries had lower priority for aged care residents in hospitals (e.g. discharging without testing for COVID-19 or discouraging admissions). However, deaths in aged care homes were 270 times higher in the UK than in Australia as on 7 May 2020 (despite UK having a population only 2.5 times larger than Australia). The lower fatality rate in Australia may have been due to the earlier lockdown strategy when the total daily cases were low in Australia (118) compared to the UK (over 1000), as well as the better community viral testing regime in Australia.Conclusion: In conclusion, the public health policy in Australia aimed towards earlier intervention with earlier national lockdown and more viral testing to prevent new cases. This primary prevention could have resulted in more lives being saved. In contrast, the initial policy in the UK focussed mainly on protecting resources for hospitals, and there was a delay in national lockdown intervention and lower viral testing rate, resulting in more lives lost in the aged care sector. [ABSTRACT FROM AUTHOR]

It's official: The UK is in a recession. The economy has suffered its biggest slump on record with a drop in gross domestic product (GDP) of 20.4%. 1 This is going to have a significant impact on our health and well-being. It risks creating a spiralling decay as we know good health is not only a consequence, but also a condition for sustained and sustainable economic development. 2 In this way, the health of a nation creates a virtuous circle of improved health and improved economic prosperity. How we measure prosperity is therefore important and needs to be considered. [ABSTRACT FROM AUTHOR]

Brexit has direct and indirect negative health consequences, whether from economic damage or from the political paralysis and distraction from public health that it has created. Brexit is a public health problem in its own right, as other literature has shown—but, we argue, it is also a symptom of deeper problems in the governance of the United Kingdom. In particular, the combination of executive dominance, partisanship and opacity that give rise to the constitutional casualism of the Brexit decisions has already affected public health policy and will continue to do so unless addressed. [ABSTRACT FROM AUTHOR]

The 1920s witnessed a radical approach to sexual health in Britain, and women doctors quickly capitalized on the opportunities offered by the new VD Service. Because venereology was considered low status, it was among the few interwar specialties that offered footholds to women. In view of the long-standing aversion to female engagement with subjects like venereal disease, the large numbers of women doctors entering the VD Service seems puzzling. But as this article reveals, their clinical work was facilitated by rapid shifts in social and medical attitudes toward the treatment of venereal disease as well as the role of women in public life. By exploring how these women navigated the shifting terrain of interwar public health, it deconstructs the notion that venereology was principally a male sphere of clinical practice and research. Moreover, it presents an important counterpoint to the narrative of women's bodies subordinated to male medical authority. Although the individual lives of these women remain frustratingly elusive, a prosopographical study of their careers allows us to chart their professional networks and clinical activities. We can see how they appropriated prevailing moral codes and styled themselves as guardians of the nation's health. At its heart, this article demonstrates how women established identities within a profession that remained inherently masculine. Moreover, it opens up new perspectives on the provision of care and the gendered politics of sexual health in a period of profound economic and social change. [ABSTRACT FROM AUTHOR]

The regulation of professional activity in the Health and Social Care sector in the UK is carried out by a number of statutory bodies that hold legal mandates to manage the risks of professional malpractice. The prime method used to perform this duty, and thereby protect the public, is the construction of a register of the suitability qualified—and creation of appropriate professional standards to establish a benchmark for practice. When registrant's performance or conduct is felt not to meet these standards, they are placed within a fitness to practice process administered by the regulatory body. This article examines the publicly available data on fitness to practice cases from UK regulatory bodies relating to the professions of social workers, nurses, midwives and doctors. Examining nearly 1,000 cases, the authors run a statistical analysis of the data to establish whether any differences are found amongst and between these professional groupings. We find there are several areas where significant differences arise, namely gender, attendance and representation. Most of these regulatory bodies are, in turn, regulated in the UK by the Professional Standards Authority (PSA), and the article concludes by suggesting ways forward for the PSA in addressing or further examining apparent inequalities. The analysis is placed within a wide range of literature, with an emphasis on the international transferability of the approach to professional regulation. [ABSTRACT FROM AUTHOR]

Background We examined whether the greater severity of coronavirus disease 2019 (COVID-19) amongst men and Black, Asian and Minority Ethnic (BAME) individuals is explained by cardiometabolic, socio-economic or behavioural factors. Methods We studied 4510 UK Biobank participants tested for COVID-19 (positive, n  = 1326). Multivariate logistic regression models including age, sex and ethnicity were used to test whether addition of (1) cardiometabolic factors [diabetes, hypertension, high cholesterol, prior myocardial infarction, smoking and body mass index (BMI)]; (2) 25(OH)-vitamin D; (3) poor diet; (4) Townsend deprivation score; (5) housing (home type, overcrowding) or (6) behavioural factors (sociability, risk taking) attenuated sex/ethnicity associations with COVID-19 status. Results There was over-representation of men and BAME ethnicities in the COVID-19 positive group. BAME individuals had, on average, poorer cardiometabolic profile, lower 25(OH)-vitamin D, greater material deprivation, and were more likely to live in larger households and in flats/apartments. Male sex, BAME ethnicity, higher BMI, higher Townsend deprivation score and household overcrowding were independently associated with significantly greater odds of COVID-19. The pattern of association was consistent for men and women; cardiometabolic, socio-demographic and behavioural factors did not attenuate sex/ethnicity associations. Conclusions In this study, sex and ethnicity differential pattern of COVID-19 was not adequately explained by variations in cardiometabolic factors, 25(OH)-vitamin D levels or socio-economic factors. Factors which underlie ethnic differences in COVID-19 may not be easily captured, and so investigation of alternative biological and genetic susceptibilities as well as more comprehensive assessment of the complex economic, social and behavioural differences should be prioritised. [ABSTRACT FROM AUTHOR]

Background Giving children the best start in life is critical for their future health and wellbeing. Political devolution in the UK provides a natural experiment to explore how public health systems contribute to children's early developmental outcomes across four countries. Method A systematic literature review and input from a stakeholder group was used to develop a public health systems framework. This framework then informed analysis of public health policy approaches to early child development. Results A total of 118 studies met the inclusion criteria. All national policies championed a 'prevention approach' to early child development. Political factors shaped divergence, with variation in national conceptualizations of child development ('preparing for life' versus 'preparing for school') and pre-school provision ('universal entitlement' or 'earned benefit'). Poverty and resourcing were identified as key system factors that influenced outcomes. Scotland and Wales have enacted distinctive legislation focusing on wider determinants. However, this is limited by the extent of devolved powers. Conclusion The systems framework clarifies policy complexity relating to early child development. The divergence of child development policies in the four countries and, particularly, the explicit recognition in Scottish and Welsh policy of wider determinants, creates scope for this topic to be a tracer area to compare UK public health systems longer term. [ABSTRACT FROM AUTHOR]

Amid wider efforts to improve maternal and infant health in Britain around the First World War, public health officials debated making pregnancy a notifiable condition. Although the policy never entered national legislation, a number of local authorities introduced 'notification of pregnancy' schemes in various guises, with at least one surviving until the 1950s. Resistance from private practitioners to infectious diseases notification in the later nineteenth century has been well documented. We know less about opposition to the extension of this measure to maternal and infant welfare, especially from newly professionalising female health occupations. Conflict over notification of pregnancy drew midwives, in particular, into longstanding arguments over the powers of municipal authorities, family privacy and professional ethics. The controversy was the key battleground in negotiations over the organisation of 'antenatal care' as occupational groups of varying degrees of authority sought to define their roles and responsibilities within the emerging health services. [ABSTRACT FROM AUTHOR]

This study uses the search terms 'opiate*', 'opioid*' and 'fentanyl' to analyse social work peer-reviewed literature (n  = 573) between 1978 and 2017. There is an increasing focus on opioid use within literature during the forty-year period—a knowledge base predominantly outside discipline-specific social work journals—and a high prevalence of research from the USA and the UK. The thematic analysis finds a focus on identifying behaviours and risks associated with opioid use, assessment of opioid use and needs of service users in treatment, and intervention and relapse-prevention practices. There are many sound practice-relevant insights. However, the literature is limited in its ability to assess the needs of individuals not in treatment along with documenting preventative methods for opioid-related overdose. This is a significant omission, warranting further research, given the unknowing nature of opioid use associated with increasing rates of overdose throughout the world. [ABSTRACT FROM AUTHOR]

Background The United Kingdom documented a decline of >30% in imported cases of malaria annually between 1996 and 2003; however, there are still approximately 1700 cases and 5–10 deaths each year. Prophylaxis health messages focus on families returning to their country of origin. Methods We reviewed 225 records of patients seen in Cambridge University Hospital Foundation Trust [CUHFT], a tertiary referral center in Cambridge, England. All records of patients seen in CUHFT between 2002–2016 were analyzed in the context of national figures from Public Health England. Results Between 2004–2016, there was no decrease in imported cases of malaria locally or nationally. Plasmodium falciparum remains responsible for most imported infections (66.7%); Plasmodium vivax contributed 15.1%, Plasmodium malariae 4%, and Plasmodium ovale 6.7%; 7.5% (17/225) of patients had an incomplete record. Most cases were reported in people coming from West Africa. Sierra Leone and the Ivory Coast had the highest proportions of travelers being infected at 8 and 7 per 1000, respectively. Visiting family in the country of origin (27.8%) was the commonest reason for travel. However, this was exceeded by the combined numbers traveling for business and holidays (22.5% and 20.1%, respectively). Sixty percent of patients took no prophylaxis. Of those who did, none of the patients finished their chemoprophylaxis regimen. Conclusions Significant numbers of travelers to malarious countries still take no chemoprophylaxis. Health advice about prophylaxis before travel should be targeted not only at those visiting family in their country of origin but also to those traveling for holiday and work. [ABSTRACT FROM AUTHOR]