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Background: Traditional approaches to monitoring health inequalities predominantly rely on headcount methods. However, these methods fail to reflect the non-linear health economic implications of changes in disease severity. Alternative, distribution-sensitive metrics are available which could more adequately inform financial planning and policy decision making. Methods: We describe the design of the Foster-Greer-Thorbecke (FGT) index, and discuss its relative merits as a summary monitoring metric of health inequalities in the population, compared to the Erreygers concentration index. We illustrate the FGT index by conducting a comparative longitudinal analysis of adult excess inequalities in England using Health Survey for England data from 2009 to 2019. Findings: Excess weight inequalities have steadily increased in the English adult population, especially over the last five years. Going beyond headcount, the FGT index analyses revealed that, unlike the rest of the population, the average overweight adult from the most socio-economically deprived group is either obese (30.3 BMI for females) or at the brink of obesity (29.1 BMI for males). These results underscore a deepening divide in obesity severity between communities, with the most socioeconomically deprived groups being increasingly and disproportionally affected. Conclusions: The FGT index can address some shortcomings of traditional approaches to inequality measurement and local governments should consider adopting it as an alternative population health metric. Future research should apply and develop more refined distribution-sensitive measures of health inequality.

Background: Many high-income countries (HICs) have now vaccinated a substantial proportion of their population against COVID-19. Many low-income countries (LICs) may need to wait until at least 2022 before even the most vulnerable 20% of their populations are vaccinated. Beyond ethical considerations, some redistribution of doses would reduce the risk of the emergence and spread of new variants and benefit the economy, both globally and in donor countries. However, the willingness of HIC governments to donate vaccine doses is likely to depend on public support. While previous work has indicated strong average levels of public support in HIC for donation, little is known about how broad-based this support is. Objective: To investigate the extent to which support for donation holds across both pre-specified and exploratory subgroups. Methods: From 24 November–28 December 2020 we conducted an online survey of 8209 members of the general public in seven HIC (Australia, Canada, France, Italy, Spain, UK and USA). We conducted tests of proportions and used Bayesian ordinal logistic regression models to assess the extent of support for donation across population subgroups. Results: We found broad-based support for donations in terms of age, gender, socio-economic status and political ideology. We found no strong evidence that support for donations was higher among those with greater income or a university education. Support for donation among those on the political right and centre was lower than on the left, but 51% (95% confidence interval 48–53%) of respondents who identified with the right supported some level of donation. Those in the more altruistic half of the sample (as captured by willingness to donate money to a good cause) were more likely to support donation than those who were not, but around half of the less altruistic group supported some level of donation. Conclusion: There is broad-based support for policym

Introduction: In 2025, more than 400 million people will have asthma, and chronic obstructive pulmonary disease (COPD) will be the third leading cause of death by 2030. This trial, called better outcomes for everybody (BOFE), will evaluate the effectiveness and cost-effectiveness of a pharmacist-led intervention delivered by community pharmacists in collaboration with physicians to asthma and COPD patients to improve disease control compared with usual care. Methods: A pragmatic parallel 2-arm randomized controlled trial will be conducted in one Italian region (Sicily). A 2:1 randomization and sample size of 900 adult patients (450 with asthma, 450 with COPD) will be sufficient to detect a difference of 15% between the intervention and control groups using a dichotomized score (controlled versus non-controlled) of the Asthma Control Test (ACT) and the Clinical Chronic Obstructive Pulmonary Disease Questionnaire (CCQ) with a two tails, 99% power and 5% significance level. A hundred pharmacists will recruit 9 consecutive patients each and administer either ACT or CCQ according to the patients’ disease. Patients will be followed up for 12 months, and the pharmacists will meet their patients every three months. The control group will receive usual care, the intervention a bespoke, structured, and systematic consultation immediately after baseline and 6 months later. The primary outcomes are asthma and COPD control at baseline and 12 months. Secondary outcomes: risk of uncontrolled asthma and COPD, number of active ingredients, pharmaceutical care issues, adherence to medications, minimal clinically important differences in asthma and COPD, and a full health economic evaluation. The analysis will follow an intention-to-treat principle. Generalized estimating equations will be used to test the primary outcomes. Ethics approval was obtained. Discussion: This is the first study conducted in Italy to assess the effectiveness and cost�effectiveness of a pharmacist-led interve