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While the sentinel nature of freshwater systems is now well-recognized, widespread integration of freshwater processes and patterns into our understanding of broader climate-driven Arctic terrestrial ecosystem change has been slow. We review the current understanding across Arctic freshwater systems of key sentinel responses to climate, which are attributes of these systems with demonstrated and sensitive responses to climate forcing. These include ice regimes, temperature and thermal structure, river baseflow, lake area and water level, permafrost-derived dissolved ions and nutrients, carbon mobilization (dissolved organic carbon, greenhouse gases, and radiocarbon), dissolved oxygen concentrations, lake trophic state, various aquatic organisms and their traits, and invasive species. For each sentinel, our objectives are to clarify linkages to climate, describe key insights already gained, and provide suggestions for future research based on current knowledge gaps. We suggest that tracking key responses in Arctic freshwater systems will expand understanding of the breadth and depth of climate-driven Arctic ecosystem changes, provide early indicators of looming, broader changes across the landscape, and improve protection of freshwater biodiversity and resources., Arctic Science, 9 (2), ISSN:2368-7460

Climate change and other anthropogenic stressors have led to long-term changes in the thermal structure, including surface temperatures, deepwater temperatures, and vertical thermal gradients, in many lakes around the world. Though many studies highlight warming of surface water temperatures in lakes worldwide, less is known about long-term trends in full vertical thermal structure and deepwater temperatures, which have been changing less consistently in both direction and magnitude. Here, we present a globally-expansive data set of summertime in-situ vertical temperature profiles from 153 lakes, with one time series beginning as early as 1894. We also compiled lake geographic, morphometric, and water quality variables that can influence vertical thermal structure through a variety of potential mechanisms in these lakes. These long-term time series of vertical temperature profiles and corresponding lake characteristics serve as valuable data to help understand changes and drivers of lake thermal structure in a time of rapid global and ecological change., Measurement(s) temperature of water • temperature profile Technology Type(s) digital curation Factor Type(s) lake location • temporal interval Sample Characteristic - Environment lake • reservoir Sample Characteristic - Location global Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.14619009

Inland waters, such as lakes, reservoirs and rivers, are important sources of climate forcing trace gases. A key parameter that regulates the gas exchange between water and the atmosphere is the gas transfer velocity, which itself is controlled by near-surface turbulence in the water. While in lakes and reservoirs, near-surface turbulence is mainly driven by atmospheric forcing, in shallow rivers and streams it is generated by bottom friction of gravity-forced flow. Large rivers represent a transition between these two cases. Near-surface turbulence has rarely been measured in rivers and the drivers of turbulence have not been quantified. We analyzed continuous measurements of flow velocity and quantified turbulence as the rate of dissipation of turbulent kinetic energy over the ice-free season in a large regulated river in Northern Finland. Measured dissipation rates agreed with predictions from bulk parameters, including mean flow velocity, wind speed, surface heat flux, and with a one-dimensional numerical turbulence model. Values ranged from to . Atmospheric forcing or gravity was the dominant driver of near-surface turbulence for similar fraction of the time. Large variability in near-surface dissipation rate occurred at diel time scales, when the flow velocity was strongly affected by downstream dam operation. By combining scaling relations for boundary-layer turbulence at the river bed and at the air-water interface, we derived a simple model for estimating the relative contributions of wind speed and bottom friction of river flow as a function of depth. Plain Language Summary Inland water bodies such as lakes, reservoirs and rivers are an important source of climate forcing trace gases to the atmosphere. Gas exchange between water and the atmosphere is regulated by the gas transfer velocity and the concentration difference between the water surface and the atmosphere. The gas transfer velocity depends on near-surface turbulence, but robust formulations have not been developed for river systems. Their surface area is sufficiently large for meteorological forcing to cause turbulence, as in lakes and reservoirs, but turbulence generated from bed and internal friction of gravity-driven flows is also expected to contribute. Here we quantify near-surface turbulence using data from continuous air and water side measurements conducted over the ice-free season in a large subarctic regulated river in Finland. We find that turbulence, quantified as the dissipation rate of turbulent kinetic energy, is well described using equations for predicting turbulence from meteorological data for sufficiently high wind speeds whereas the contribution from bottom shear dominated at higher flow velocities. A one-dimensional river model successfully captured these processes. We provide a fundamental model for estimating the relative contributions of atmospheric forcing and bottom friction as a function of depth.

The hydrodynamics within small boreal lakes have rarely been studied, yet knowing whether turbulence at the air-water interface and in the water column scales with metrics developed elsewhere is essential for computing metabolism and fluxes of climate-forcing trace gases. We instrumented a humic, 4.7 ha, boreal lake with two meteorological stations, three thermistor arrays, an infrared (IR) camera to quantify surface divergence, obtained turbulence as dissipation rate of turbulent kinetic energy (epsilon) using an acoustic Doppler velocimeter and a temperature-gradient microstructure profiler, and conducted chamber measurements for short periods to obtain fluxes and gas transfer velocities (k). Near-surface epsilon varied from 10(-8) to 10(-6) m(2) s(-3) for the 0-4 m s(-1) winds and followed predictions from Monin-Obukhov similarity theory. The coefficient of eddy diffusivity in the mixed layer was up to 10(-3) m(2) s(-1) on the windiest afternoons, an order of magnitude less other afternoons, and near molecular at deeper depths. The upper thermocline upwelled when Lake numbers (L-N) dropped below four facilitating vertical and horizontal exchange. k computed from a surface renewal model using epsilon agreed with values from chambers and surface divergence and increased linearly with wind speed. Diurnal thermoclines formed on sunny days when winds were < 3 m s(-1), a condition that can lead to elevated near-surface epsilon and k. Results extend scaling approaches developed in the laboratory and for larger water bodies, illustrate turbulence and k are greater than expected in small wind-sheltered lakes, and provide new equations to quantify fluxes. Funding Agencies|Swedish Research CouncilSwedish Research Council [210-2012-1461, 2009-1692, 2011-3575, 2012-00048, 2016-04829]; European Research Council (ERC)European Research Council (ERC) [725546]; FormasSwedish Research Council Formas [2018-2022]; U.S. National Science Foundation through DEB grant [1753856, DEB 0919603, ANS 01204267, ANS 1737411]

The goals of our study were to (1) quantify production of CO2 during winter ice‐cover in arctic lakes, (2) develop methodologies which would enable prediction of CO2 production from readily measured variables, and (3) improve understanding of under‐ice circulation as it influences the distribution of dissolved gases under the ice. To that end, we combined in situ measurements with profile data. CO2 production averaged 20 mg C m−2 d−1 in a 3 m deep lake and ∼ 45 mg C m−2 d−1 in four larger lakes, similar to experimental observations at temperatures below 4°C. CO2 production was predicted by the initial rate of loss of oxygen near the sediments at ice‐on and by the full water column loss of oxygen throughout the winter. The time series data also showed the lake‐size and time dependent contribution of sediment respiration to under‐ice circulation and the decreased near‐bottom flows enabling anoxia and CH4 accumulation.

A two-dimensional hydrodynamic CE-QUAL-W2 model was configured for a deep subtropical river-run reservoir, the Xiluodu Reservoir (XLDR), in China to simulate water temperature in the first two years of impoundment (2013–2014) using measured data as model input. It was calibrated using observed temperature profiles near the dam and the outflow temperatures. Observed daily temperatures at four gauging stations upstream or downstream of XLDR before (2000–2012) and after the impoundment (4 May 2013) were analyzed and fitted with a sine function representing seasonal temperature variation. The fitted annual temperature phase shifts showed no phase delay in XLDR area before the impoundment but revealed a phase delay about 17 days between outflow and inflow after the impoundment, which was not caused by the air temperature variation. The simulated temperatures verified a similar phase delay after the impoundment. The simulated temperatures, water ages, and vertical temperature gradients demonstrated an average metalimnetic deepening rate of 0.49 m/day (average inflow ~4500 m3/s) while the largest rate due to massive inflow (~15,000 m3/s) was 1.67 m/day. The W2 model was run under hypothetic scenarios of different inflow/outflow rates and outflow withdrawn elevations. The results revealed that greater inflow/outflow rate could lead to higher metalimnetic deepening rate and smaller outflow phase delay, while deeper outflow withdrawn could lead to deeper metalimnion and larger epilimnetic depth.

Natural experimental studies are often recommended as a way of understanding the health impact of policies and other large scale interventions. Although they have certain advantages over planned experiments, and may be the only option when it is impossible to manipulate exposure to the intervention, natural experimental studies are more susceptible to bias. This paper introduces new guidance from the Medical Research Council to help researchers and users, funders and publishers of research evidence make the best use of natural experimental approaches to evaluating population health interventions. The guidance emphasises that natural experiments can provide convincing evidence of impact even when effects are small or take time to appear. However, a good understanding is needed of the process determining exposure to the intervention, and careful choice and combination of methods, testing of assumptions and transparent reporting is vital. More could be learnt from natural experiments in future as experience of promising but lesser used methods accumulates.

Peer reviewed. ©2015. The Authors.This is an open access article under theterms of the Creative CommonsAttribution-NonCommercial-N oDerivsLicense, which permits use and distri-bution in any medium, provided theoriginal work is properly cited, the use isnon-commerc ial and no modificationsor adaptations are made., In this first worldwide synthesis of in situ and satellite-derived lake data, we find that lake summer surface water temperatures rose rapidly (global mean = 0.34°C decade 1) between 1985 and 2009. Our analyses show that surface water warming rates are dependent on combinations of climate and local characteristics, rather than just lake location, leading to the counterintuitive result that regional consistency in lake warming is the exception, rather than the rule. The most rapidly warming lakes are widely geographically distributed, and their warming is associated with interactions among different climatic factors —from seasonally ice-covered lakes in areas where temperature and solar radiation are increasing while cloud cover is diminishing (0.72°C decade 1) to ice-free lakes experiencing increases in air temperature and solar radiation (0.53°C decade 1). The pervasive and rapid warming observed here signals the urgent need to incorporate climate impacts into vulnerability assessments and adaptation efforts for lakes.

Higher rates of reported morbidity among women are sometimes attributed to lower thresholds among women for experiencing and reporting symptoms. Gender differences in the perception of signs and symptoms of minor illness were examined on data from the MRC Common Cold Unit. Volunteers assessed the presence and severity of colds at the end of their stay in the Unit, using the same two measures as a trained clinical observer (all ratings were double blind). Even after adjustment for other variables, men were significantly more likely to 'over-rate' their symptoms in comparison with the clinical observer than were women. These data, and recent analyses from elsewhere, suggest that rather than artefactually exaggerating gender differences in morbidity, differing thresholds for perceiving and reporting symptoms may produce underestimates of gender differences in morbidity.

Lakes and other inland waters contribute significantly to regional and global carbon budgets. Emissions from lakes are often computed as the product of a gas transfer coefficient, k 600 , and the difference in concentration across the diffusive boundary layer at the air–water interface. Eddy covariance (EC) techniques are increasingly being used in lacustrine gas flux studies and tend to report higher values for derived k 600 than other approaches. Using results from an EC study of a small, boreal lake, we modelled k 600 using a boundary-layer approach that included wind shear and cooling. During stratification, fluxes estimated by EC occasionally were higher than those obtained by our models. The high fluxes co-occurred with winds strong enough to induce deflections of the thermocline. We attribute the higher measured fluxes to upwelling-induced spatial variability in surface concentrations of CO 2 within the EC footprint. We modelled the increased gas concentrations due to the upwelling and corrected our k 600 values using these higher CO 2 concentrations. This approach led to greater congruence between measured and modelled k values during the stratified period. k 600 has a well-resolved and ~cubic relationship with wind speed when the water column is unstratified and the dissolved gases well mixed. During stratification and using the corrected k 600 , the same pattern is evident at higher winds, but k 600 has a median value of ~7 cm h −1 when winds are less than 6 m s −1 , similar to observations in recent oceanographic studies. Our models for k 600 provide estimates of gas evasion at least 200% higher than earlier wind-based models. Our improved k 600 estimates emphasize the need for integrating within lake physics into models of greenhouse gas evasion. Keywords: carbon dioxide, gas transfer, upwelling, eddy covariance, heat flux, thermocline tilting (Published: 19 May 2014) Citation: Tellus B 2014, 66 , 22827, http://dx.doi.org/10.3402/tellusb.v66.22827

There is believed to be a ‘beauty premium’ in key life outcomes: it is thought that people perceived to be more physically attractive have better educational outcomes, higher-status jobs, higher wages, and are more likely to marry. Evidence for these beliefs, however, is generally based on photographs in hypothetical experiments or studies of very specific population subgroups (such as college students). The extent to which physical attractiveness might have a lasting effect on such outcomes in ‘real life’ situations across the whole population is less well known. Using longitudinal data from a general population cohort of people in the West of Scotland, this paper investigated the association between physical attractiveness at age 15 and key socioeconomic outcomes approximately 20 years later. People assessed as more physically attractive at age 15 had higher socioeconomic positions at age 36– in terms of their employment status, housing tenure and income - and they were more likely to be married; even after adjusting for parental socioeconomic background, their own intelligence, health and self esteem, education and other adult socioeconomic outcomes. For education the association was significant for women but not for men. Understanding why attractiveness is strongly associated with long-term socioeconomic outcomes, after such extensive confounders have been considered, is important.

BackgroundThe relationship between childhood residential mobility and health in the UK is not well established; however, research elsewhere suggests that frequent childhood moves may be associated with poorer health outcomes and behaviours. The aim of this paper was to compare people in the West of Scotland who were residentially stable in childhood with those who had moved in terms of a range of health measures.MethodsA total of 850 respondents, followed-up for a period of 20 years, were included in this analysis. Childhood residential mobility was derived from the number of addresses lived at between birth and age 18. Multilevel regression was used to investigate the relationship between childhood residential mobility and health in late adolescence (age 18) and adulthood (age 36), accounting for socio-demographic characteristics and frequency of school moves. The authors examined physical health measures, overall health, psychological distress and health behaviours.ResultsTwenty per cent of respondents remained stable during childhood, 59% moved one to two times and 21% moved at least three times. For most health measures (except physical health), there was an increased risk of poor health that remained elevated for frequent movers after adjustment for socio-demographic characteristics and school moves (but was only significant for illegal drug use).ConclusionsRisk of poor health was elevated in adolescence and adulthood with increased residential mobility in childhood, after adjusting for socio-demographic characteristics and school moves. This was true for overall health, psychological distress and health behaviours, but physical health measures were not associated with childhood mobility.

Srinivasa Vittal Katikireddi and colleagues ’ analysis of the government’s white paper Healthy Lives, Healthy People finds many of the interventions proposed lack evidence of effectiveness and some have even been shown not to work

Evaluating complex interventions is complicated. The Medical Research Council's evaluation framework (2000) brought welcome clarity to the task. Now the council has updated its guidance\ud \ud Complex interventions are widely used in the health service, in public health practice, and in areas of social policy that have important health consequences, such as education, transport, and housing. They present various problems for evaluators, in addition to the practical and methodological difficulties that any successful evaluation must overcome. In 2000, the Medical Research Council (MRC) published a framework1 to help researchers and research funders to recognise and adopt appropriate methods. The framework has been highly influential, and the accompanying BMJ paper is widely cited.2 However, much valuable experience has since accumulated of both conventional and more innovative methods. This has now been incorporated in comprehensively revised and updated guidance recently released by the MRC (www.mrc.ac.uk/complexinterventionsguidance). In this article we summarise the issues that prompted the revision and the key messages of the new guidance.

Background:\ud Reviews have reported mixed findings for associations between physical activity and proximity to a range of environmental resources. Initially most studies used self reported proximity, but more are now using GIS techniques to measure proximity objectively. We know little about the extent of agreement between self reported and directly measured proximity of the same resource.\ud \ud Methods:\ud We used previously collected data in a community survey in Glasgow in which 658 respondents aged around 40 and 60 were asked whether they lived within half a mile of a public park. We compared their answers with GIS measures of whether there was a park within a half mile service area of their home (and whether their home was within a half mile crow fly buffer of a park).\ud \ud Results:\ud Agreement was poor; percentage agreement between measured network distance and reported residence within 0.5 miles of a park was 62.0%, and the kappa value was 0.095. Agreement was no higher than poor in any socio-demographic subgroup, or when using crow fly buffers instead of service areas.\ud \ud Conclusion:\ud One should be cautious about assuming that respondents' self reports of proximity to a resource are a valid proxy for actual distance, or vice versa. Further research is needed to establish whether actual or self-reported proximity predict physical activity or other behaviours, and if so which is the strongest predictor. Further, qualitative study, also needs to examine the basis of people's judgements about the location of resources, and the possibility that these are shaped by their social and personal significance.

Objective: To test the hypothesis that IQ is a fundamental cause of socioeconomic inequalities in health.\ud \ud Design: Cross sectional and prospective cohort study, in which indicators of IQ were assessed by written test and socioeconomic position by self report.\ud \ud Setting: West of Scotland.\ud \ud Participants: 1347 people (739 women) aged 56 in 1987.\ud \ud Main outcome measures: Total mortality and coronary heart disease mortality (ascertained between 1987 and 2004); respiratory function, self reported minor psychiatric morbidity, long term illness, and self perceived health (all assessed in 1988).\ud \ud Results: In sex adjusted analyses, indices of socioeconomic position (childhood and current social class, education, income, and area deprivation) were significantly associated with each health outcome. Thus the greatest risk of ill health and mortality was evident in the most socioeconomically disadvantaged groups, as expected. After adjustment for IQ, a marked attenuation in risk occurred for poor mental health (range of attenuation in risk ratio across the five socioeconomic indicators: 15-58%), long term illness (25-53%), poor self perceived health (41-56%), respiratory function (44-66%), coronary heart disease mortality (31-111%), and total mortality (45-131%). Despite the clear reduction in the magnitude of these effects after controlling for IQ, in half of the associations examined the risk of ill health in socioeconomically disadvantaged people was still at least twice that of advantaged people. Statistical significance was lost for only 5/25 separate socioeconomic health gradients that showed significant relations in sex adjusted analyses.\ud \ud Conclusions: Scores from the IQ test used here did not completely explain the socioeconomic gradients in health. However, controlling for IQ did lead to a marked reduction in the magnitude of these gradients. Further exploration of the currently scant information about IQ, socioeconomic position, and health is needed.

Obesity levels are high and increasing worldwide. Being overweight is linked with increased death rates and contributes to a wide range of conditions, including ischaemic heart disease, hypertension, stroke, diabetes, certain cancers, and diseases of the gall bladder.1 The principal cause of obesity is an imbalance between energy intake and energy expenditure. And there is growing recognition that, independently of individual characteristics, place of residence may be associated with health outcomes, including body size2 and health related behaviours, such as level of physical exercise.3 \ud Few studies have explored which features of the local neighbourhood might be related to these outcomes or behaviours, although perceived attractiveness has been found to be related to levels of physical activity.4 Levels of incivilities, such as litter and graffiti, are associated with poorer health outcomes such as general wellbeing but not, to our knowledge, with levels of physical activity. Few studies use objectively measured indicators of the residential environment or similar research instruments across different settings. Based on our previous work, we hypothesised that areas which are pleasant with lots of greenery and few incivilities might encourage people to take exercise and thereby influence levels of obesity.

Background There is a popular belief that out-of-home eating outlets, which typically serve energy dense food, may be more commonly found in more deprived areas and that this may contribute to higher rates of obesity and related diseases in such areas. Methods We obtained a list of all 1301 out-of-home eating outlets in Glasgow, UK, in 2003 and mapped these at unit postcode level. We categorised them into quintiles of area deprivation using the 2004 Scottish Index of Multiple Deprivation and computed mean density of types of outlet (restaurants, fast food restaurants, cafes and takeaways), and all types combined, per 1000 population. We also estimated odds ratios for the presence of any outlets in small areas within the quintiles. Results The density of outlets, and the likelihood of having any outlets, was highest in the second most affluent quintile (Q2) and lowest in the second most deprived quintile (Q4). Mean outlets per 1,000 were 4.02 in Q2, 1.20 in Q4 and 2.03 in Q5. With Q2 as the reference, Odds Ratios for having any outlets were 0.52 (CI 0.32–0.84) in Q1, 0.50 (CI 0.31 – 0.80) in Q4 and 0.61 (CI 0.38 – 0.98) in Q5. Outlets were located in the City Centre, West End, and along arterial roads. Conclusion In Glasgow those living in poorer areas are not more likely to be exposed to out-of-home eating outlets in their neighbourhoods. Health improvement policies need to be based on empirical evidence about the location of fast food outlets in specific national and local contexts, rather than on popular 'factoids'.

In this paper we introduce and describe in detail an addition to the UK's population-based resources for the investigation of biological and social influences on health across the life course and between generations: the Aberdeen Children of the 1950s study. We also provide an account of postwar Aberdeen when study members were growing up, report on findings of analyses of data from the original survey on which this study is based and its follow-up, assess the strengths and limitations of the study, and outline current and future research directions.\ud \ud This cohort comprises individuals born in Aberdeen, Scotland (UK) between 1950 and 1956, and is derived from 15 thousand subjects who took part in the Aberdeen Child Development Survey, a cross-sectional study of 'mental subnormality' (learning disability) in a population of all children who were attending Aberdeen primary schools in December 1962. Data collection included information on birthweight, gestational age, childhood height and weight, tests of cognition and behavioural disorder, and a range of multilevel socio-economic indicators. In 1998 we began the process of revitalising this cohort (now termed the Aberdeen Children of the 1950s study). We have been successful in ascertaining the current vital status and whereabouts of 98.5% of a target population of 12 150 subjects (6276 males, 5874 females) with full baseline data. The large majority (81%) of study participants still reside in Scotland and many (73%) have remained in the Grampian region which incorporates Aberdeen. At the present time, a total of almost 500 subjects are known to have died. Linkages to hospital admissions and other health endpoints captured through the Scottish Morbidity Records system have been completed. This includes an intergenerational linkage to approximately eight thousand deliveries in Scotland occurring to female members of the study population. A postal questionnaire to all traced surviving cohort members has also been distributed.

Assertions can be reported so often that they are considered true (“factoids”). They may sometimes even be used to determine health policy when empirical information is lacking. Steven Cummins and Sally Macintyre use the claimed existence of “food deserts”—poor urban areas where residents cannot buy affordable, healthy food—to illustrate why policy makers need to look more critically at the facts In December 2001 a cross party motion on food poverty signed by 198 UK MPs gained its first reading in parliament. The Food Poverty (Eradication) Bill is now waiting to be read for a second time.1 Though this bill is a laudable attempt to introduce a policy designed to improve the nutrition of those with the lowest incomes and in the poorest places, it is an example of how some ideas become accepted as fact though they may not be true. They become “factoids”: assumptions or speculations reported and repeated so often that they are popularly considered true; they are simulated or imagined facts.2 This paper illustrates how, if the social climate is right, facts about the social world can be assumed and hence used as the basis for health policy in the absence of much empirical information. ### Summary points Factoids are assumptions or speculations reported and repeated until they are considered true They are sometimes used to determine health policy when empirical information is lacking The assumption that in the United Kingdom there are poor urban areas where residents cannot buy affordable, healthy food (“food deserts”) is a factoid Policy strategies to combat the existence of food deserts exemplify how factoids can influence health and social policy The burden of proof, or demand for evidence, may vary according to a policy's perceived fit within current collective world views Policy makers need to move away from unquestioning acceptance and should …

Housing tenure and car access predict longevity and health in many European countries. It is usually assumed that they do so only because they are markers of other material determinants of health. However, in a previous paper we showed that both variables were still significantly associated with several health outcomes after controls for age, sex, and income.1 Here we replicate and extend that analysis in another sample, examining whether observed relations between tenure or car access and health remain after controlling for alternative measures of material assets (social class and income), and, following suggestions that socioeconomic gradients in health may differ between men and women,2 whether there are interactions with gender. A postal questionnaire, with three follow ups, achieved a response rate of 50% (42% male, 58% female), from a random sample of 6500 adults from the electoral roll in eight local authority areas in the west of Scotland in 1997. We examined four domains of self assessed health: chronic, recent and mental …

Editorial by George Davey Smith Doctors are exhorted to practice evidence based medicine, and the British government says that it wants public policy to be based on evidence.1 We share the government's enthusiasm, but can it become a reality rather than an aspiration? How much do we know about what works, and are researchers, government ministers, and civil servants truly committed to developing and using the best evidence? We had an opportunity to learn about the realities of evidence based policy making when we were invited in late 1997 to become an “evaluation group” to assist the independent inquiry into inequalities in health.2 Our reflections concern the material submitted and the evaluation process, not the final report. #### Summary points The UK government is trying to create a culture of “evidence based policy” that will apply to public health and social policy as well as to health care Submissions to a government inquiry about possible interventions to reduce health inequalities lacked evidence of effectiveness and information on costs and possible harms There is a need to improve the evidence base used for making public policy In 1997 the minister for public health for England and Wales, Tessa Jowell, commissioned Donald Acheson, the former chief medical officer for England, to “moderate a Department of Health review of the latest available information on inequalities in health … and in the light of evidence, to conduct—within the broad framework of the Government's overall financial strategy—an independent review to identify priority areas in future policy development, which scientific and expert evidence indicates are likely to offer opportunities for Government to develop beneficial, cost effective, and affordable interventions to reduce health inequalities.”2 The report was to be submitted by the end of June 1998. Three key limitations were placed on the inquiry: recommendations had to …

This is the second of seven articles The secretary of state for health recently announced the establishment of six “modernisation action teams” to help develop a national plan for a national health service.1 The government has committed itself to improving public health and reducing inequalities in health. The decision to set up a “modernisation action team” on prevention and inequality is consistent with these goals. It is not clear, however, what this team is expected to do that is different from the analysis and recommendations contained in various recent government reports.2–7 Saving Lives: Our Healthier Nation said its aim was “to improve the health of everyone, and the health of the worst off in particular.” 3 It acknowledged the role of social, economic, and environmental factors in influencing population health and inequalities in health but did not confine itself to non-NHS initiatives to improve population health. The Acheson inquiry gave careful consideration to recent trends in, possible causal models for, and policies to reduce inequalities in health and made 39 policy recommendations, three of them relating to the NHS.6 So attention has recently been given to the role of the NHS in promoting public health and reducing inequalities in health.8 9 What will this action team do that has not already been done fairly recently? Does the government think that all these reports were a waste of time or have failed, or that the situation has changed radically since they were published? #### Summary points The major drivers of health and the distribution of health lie outside the health service, so this plan should not confine itself to actions that could be taken by the NHS The government should review progress in implementing the Acheson …

STUDY OBJECTIVE: To examine gender differences in minor morbidity among men and women working in similar circumstances, and to test whether the relation between reported working conditions and health is similar for men and women. DESIGN: Multivariate analysis of data collected from a postal questionnaire distributed to full time employees in white collar jobs within a single organisation. SETTING: A British university. PARTICIPANTS: 1641 employees (1009 men and 632 women) working full time in white collar occupations in the university. MAIN RESULTS: Overall, female university employees reported more "physical" symptoms (2.0 v 1.7, p < 0.001) and more "malaise" symptoms (1.4 v 1.1, p < 0.001) than male employees, but mean scores on a measure of minor psychiatric morbidity did not differ by gender. Poor perceived working conditions (and particularly lack of job stimulation, job drain and poor physical conditions) were consistently related to all three measures of minor morbidity, and these variables accounted for most of the variance in these health measures in this sample. When the analysis controlled for occupational grade, perceived working conditions and orientation to gender roles, there was no difference between men and women for any of the health measures. The relations for the predictor variables were generally the same for men and women (and there were no interactions with gender for any of the work related variables). CONCLUSIONS: Although small gender differences in recent experience of malaise and physical symptoms remain when examining men and women in as similar working circumstances as possible, these differences are cumulatively eroded by taking account of occupational grade, reported working conditions and orientation to gender. These results lend support to a differential exposure, rather than a differential vulnerability, model of gender differences in health.

This paper discusses two prevailing views— optimistic and pessimistic— about the potential benefits and risks arising from developments in human genetics, and argues that we do not yet have enough evidence to assess which elements (if any) of either view are likely to be correct.

It has previously been suggested that deprived neighbourhoods within modern cities have poor access to general amenities, for example, fewer food retail outlets. Here we examine the distribution of food retailers by deprivation in the City of Glasgow, UK. We obtained a list of 934 food retailers in Glasgow, UK, in 2007, and mapped these at address level. We categorised small areas (data zones) into quintiles of area deprivation using the 2006 Scottish Index of Multiple Deprivation Income sub-domain score. We computed mean number of retailers per 1000 residents per data zone, and mean network distance to nearest outlet from data zone centroid, for all retailers combined and for each of seven categories of retailer separately (i.e. bakers, butchers, fruit and vegetable sellers, fishmongers, convenience stores, supermarkets and delicatessens). The most deprived quintile (of areas) had the greatest mean number of total food retailers per 1000 residents while quintile 1 (least deprived) had the least, and this difference was statistically significant (Chi-square p < 0.01). The closest mean distance to the nearest food retailer was within quintile 3 while the furthest distance was within quintile 1, and this was also statistically significant (Chi-square p < 0.01). There was variation in the distribution of the seven different types of food retailers, and access to amenities depended upon the type of food retailer studied and whether proximity or density was measured. Overall the findings suggested that deprived neighbourhoods within the City of Glasgow did not necessarily have fewer food retail outlets.